Age: 4.0
Sex: M
Vaccine: HEP
Symptoms: Pyrexia, Screaming, Speech disorder, Staring
Clinical narrative: This case was reported by a lawyer and described the occurrence of neurological damage in a male subject who was vaccinated with Hep B vaccine (Engerix B) and or unidentified Hep B vaccine for prophylaxis. On an unspecified date the subject received unspecified dose of hepatitis B vaccine. According to the legal complaint, at an unspecified time after vaccination with hepatitis B vaccine, the subject experienced neurological damage which were attributed to cumulative mercury toxicity. The following information was received via medical records: the subject received Hep B vaccination on 5/30/1995, 6/29/1995 and 7/23/1995. All vaccinations were identified in the vaccine record as manufactured by the manufacturer, however, the 7/23/1996 Hep B reflected a different manufacturer lot number and was therefore identified as Engerix B. At approx one year of age, the subject was crawling, and taking a few steps, and was speaking some identifiable words. Between birth and approx four years of age, the subject experienced recurrent fevers and chronic coughing. In Dec 1994, at 30 months of age and prior to Engerix B vaccination, the subject underwent speech and language testing and was determined to have expressive and receptive language skills at the 18 to 23 month level. A progress note dated 10/12/1998 noted that over past 3 to 4 months at night screams with severe leg pain. Between 12/98 and 1/99 the subject continued to experience fevers and coughing, and in Sept 1999 was diagnosed with probable asthma. He underwent re evaluation between 2/10/99 and 5/11/99. Evaluation revealed that the subject was communication at a higher lever overall, and was noted to maintain eye contact and to show improved memory. Between 9/99 and 12/99, the subject continued to exhibit marked phonological awareness skills. Between 6/00 and 7/00 the subject continued to show improvement without meeting all language objectives. During this third grade year, he experienced academic difficulties that were not considered to be fully explained by his handicapping condition speech and language impaired. The subject exhibited clumsiness and poor coordination, difficulty shifting subjects or trying new things, and a mildly abnormal response to pain. An evaluation performed an on unk date did not indicate that the subject was truly autistic, however he was diagnosed with pervasive developmental disorder. On 8/3/00 the subject was enrolled in a speech program through school. He was described at the time as an average student. The subject was re evaluated In Sept 2001 by a psychologist following a recommendation that the subject be provided special education services under the categorical disability of autism. Findings were consistent with previous recommendations including continued speech therapy, with the subject exhibiting overall variability in performance, without consistency with a particular intellectual or cognitive disorder. Signs of possible neurological involvement included slow processing speed, occasional staring into space and motor clumsiness. The subject manifested some features of autism without meeting all criteria for the disorder.