Foetal exposure during pregnancy; Low birth weight; Pre-term birth; This is a serious spontaneous case, initially received from other health professional on 20-Nov-2019, concerning a female neonate patient.  The patient's mother was a 25-year-old, adult, female of body weight: 259.2 lbs, height: 66 inches and body mass index (BMI):41.8, whose obstetrical history included one previous pregnancy with one full term live birth. The mother had no history of offspring with major congenital malformation (MCM) and did not have a prior history of use of tobacco, alcohol or illicit drugs during pregnancy. Also, the mother had no maternal or paternal history with MCM.   The mother's current conditions included pregnancy induced hypertension and high BMI.  The mother's concomitant medication included labetalol for pregnancy induced hypertension and Prenatal vitamins (unspecified minerals and vitamins) as neonatal care.  The patient's mother last menstrual period date (LMP) was 18-Jan-2019. The estimated delivery date (EDD) was 25-Oct-2019 and corrected estimated delivery date (CEDD) was 29-Oct-2018. The type of pregnancy was multiple (twins). The pregnancy was complicated with high BMI and pregnancy induced hypertension.  On 14-Mar-2019, the patient's mother underwent ultrasound scan and no MCM was noted.  On 02-Apr-2019, the patient's mother underwent first trimester screen and no MCM was noted.  On 17-Jun-2019, the patient's mother underwent ultrasound scan and no MCM was noted.  On 23-Sep-2019, at approximately 35 weeks of gestation, the mother was administered Flucelvax QIVc [influenza vaccine, subunit influenza virus vaccine polyvalent, cell-subunit, batch number: 261207; dose, route of administration, expiry date and anatomical location: not reported] (explicitly coded as Foetal exposure during pregnancy') for an unknown indication.   On 02-Oct-2019, at 36.1 weeks of gestational age, the mother vaginally delivered live female neonate. Neonate's birth weight was 2345 grams, body length was 45.7 cm, head circumference was not reported and the appearance, pulse, grimace, activity and respiration (APGAR) score one minute: 8, five minutes: 9 and ten minutes: not reported. There was no MCM identified at birth.  At the time of initial reporting, the outcome of the event of premature birth and low birth weight was not reported.   This case was assessed as serious (medically significant).  The reporter did not provide causality assessment.  This case is linked to cases 201906222 (mother case) and 201906225 (same reporter).  Company Comment: The female neonate was delivered as low birth weight baby and premature baby after foetal exposure during pregnancy with the suspect product, Flucelvax QIV. Chronology is plausible. Mother's medical history of hypertension, obesity (body mass index 41.8) and twin pregnancy may provide more plausible alternative aetiology for the events. Causality was also confounded with concomitant medication, labetalol. Foetal exposure during pregnancy is assessed as not related per company's conventions. For the events low birth weight baby and premature baby, causal role of the suspect product cannot be totally excluded and is assessed as unlikely related.; Sender's Comments: The female neonate was delivered as low birth weight baby and premature baby after foetal exposure during pregnancy with the suspect product, Flucelvax QIV. Chronology is plausible. Mother's medical history of hypertension, obesity (body mass index 41.8) and twin pregnancy may provide more plausible alternative aetiology for the events. Causality was also confounded with concomitant medication, labetalol. Foetal exposure during pregnancy is assessed as not related per company's conventions. For the events low birth weight baby and premature baby, causal role of the suspect product cannot be totally excluded and is assessed as unlikely related.