Sex: F
Vaccine: HPV4
Symptoms: Apgar score normal, Congenital naevus, Constipation, Diarrhoea, Drug exposure during pregnancy
Clinical narrative: Information has been received from a physician via medical records concerning an 8 day old female patient with no known drug allergies, who was born to a 22 year old female patient with left ovarian cyst history and no drug reactions or allergies who in September 2008, was vaccinated with a first dose GARDASIL (lot # not reported). On 02-MAR-2009 she received the third dose of GARDASIL (lot # not reported). After she received three doses of vaccine she was found out that she was pregnant. Patient had last menstrual period on 13-FEB-2009. It was reported that the mother had a normal pregnancy. On, with no complication during labor/delivery at 38 weeks from last menstrual period she had a normal female baby which was born via vaginal delivery. The baby was slightly yellow in the hospital, but all values were within normal limits. The baby weight was 6 lb and 0 ounce, length 19 inches and apgar score 9/9. On 19-NOV-2009, the 8 day old patient presented to the physician's office for an outpatient's visit with congestion and a yellow drainage from her nose that began 3 days ago, on 16-NOV-2009. Review of systems were normal except that the patient was positive for jaundice in her face to her chest, that it seems to was improving by her mother. During the nasal septum/mucosa test was found that was partially obscured by purulent drainage. The patient had normal respiratory rate and pattern with no distress, normal breath sounds with no rales, rhonchi, wheezes or rubs. On the same day a Flu test and a RSV were performed and the results were negative. The physician's assessment was nasal congestion. The physician's order's included: Radiology/test: Non invasive ear or pulse oximetry for oxygen saturation; single determination; A RSV antigen EIA and influenza A or B: antigen detection by enzyme immunoassay (X2). No prescriptions were generated, provider does have access to a qualified e-prescribing system. The physician's recommendations included: humidifier/vaporizer, bulb suction and nasal saline, and monitor fever. Schedule follow up appointments on a p.r.n. basis. Follow up if patient's fever is higher than 100, irritable, not eating well, increasing respiratory effort or new concerns E-prescribing available but not used. On 28-JAN-2010, the 11-week old female baby patient presented to an office/outpatient's visit. Reviewing of the system was normal, except for: positive for loose stool 5 times/day. The stool's color was yellow or green. The integumentary review, showed positive for a right dorsal hand with Mongolian spot since birth. The patient also experienced hemangioma to left buttocks, and a 0.25 hyperpigmented macule in the left hip. No jaundice had been noted. The physician reported that the mother tried Similac advanced but the patient got constipated. The physician's orders were: Immunization administration under 8 years of age; DTAP, HIB, and ROTATEQ (MSD), 3 dose schedule, live, for oral use; pneumococcal vaccine (unspecified), polyvalent, and HEP B (manufacturer unknown). The physician's plans were: The patient was vaccinated on the same day, 28-Jan-2010 with a dose of HEP B (manufacturer unknown), ROTATEQ (MSD), pneumococcal vaccine (unspecified) and DTAP-IPV. The physician's recommendation was: gave samples of Isomil formula, if works he would will give "wic" form, anticipatory guidance and scheduled a follow up visit in 2 months. E-prescribing available but was not used. Upon internal review Mongolian spot was considered to be an other important medical event. The mother's experienced has been captured in WAES No 0905USA03368. Additional information has been requested.