Age: 3.0
Sex: M
Vaccine: HEP, DTAP, IPV, MMR, HIBV, MMR
Symptoms: Metal poisoning, Nervous system disorder, Neurodevelopmental disorder, Odynophagia, Pharyngolaryngeal pain
Clinical narrative: Information has been received regarding a case in litigation concerning a 45 month old male pt, who at 20 months old found with nifedipine (Procardia) pills in his mouth, for which he was hospitalized and who had a history of anoxia at the time of birth, four ear infections, vomiting, and asthma, who was exposed to high levels of mercury from thimerosal though exposure to unspecified products. In additional, the pt was exposed to mercury from continually inhaling and ingesting industry mercury emissions from fossil fuel driven power plants. The mercury included in thimerosal laden products and power plant emissions together caused the pt to suffer from serious and permanent neurological injuries. The pt was exposed to airborne mercury vapor and mercury through food chain. The exposure to airborne mercury in the environment through inhalation, the food chain, and other sources contributed to the cumulative mercury toxicity and was a substantial factor in causing his neurological damage. It was noted that the pt had a heightened vulnerability to suffer neurological injuries from industrial mercury as a direct result of thimerosal exposure. As a direct and proximate cause of the toxic mercury exposure to  the pt, minor male was caused to suffer serious and permanent neurological damage which included past and future mental, intellectual, development and neurological incapacity and associated learning disabilities, disorders and impairments. Follow up information from a health professionals and physicians via medical records indicated that the pt was vaccinated with a first and second dose in the right arm of hepatitis B virus vaccine rHBsAg yeast (lot 610586/0363A) on 5/30/1995 and 6/29/1995m respectively. On 7/23/1996, the pt was vaccinated with a third dose of hepatitis B virus vaccine rHBsAg (yeast) (lot 2072A2). Concomitant vaccine administered on 7/23/1996 included a dose in the right arm of varicella virus vaccine live (Varivax) (lot 616867/0243D). It was reported that at 30 months of age the pt had receptive and expressive language skills at the 18-23 month level. Articulation was also delayed. The pt was diagnosed with language delay, and was treated with individual therapy sessions twice a week for 50 minutes from 2/10/1999 to 5/11/1999. The pt continued treatment with individual therapy sessions twice a week for 50 minutes from 9/15/1999 to 12/15/1999. It was recommended that the pt should receive speech and language treatment twice a week for 50 minutes and that the therapy should focus on the following areas, phonological awareness skill, grapheme sound relationships, articulation and word retrieval. The pt was treated for language delay individually three times per week from 6/6/2000 to 7/20/2000. it was recommended that the pt should continue to receive speech and language treatment and should focus on the following areas: assessment of his word retrieval ability, maintenance of articulation for /sh/, use of auxiliary and copula verbs, use of possessive pronouns his, her, and their, and lengthening utterance and formulation of grammatically complete sentences. The pt was evaluated to determine cognitive strengths and weaknesses and to plan for his educational needs. The summary was that the pt had borderline intelligence whose speech and language delays had evolved to become deficits of social and written language as well as academic delays despite his mastery of isolated facts. It was noted that the pts educational disability existed on the autism continuum as a pervasive developmental disorder. The pt had a speech and language assessment on 5/8/01, 5/14/01, and 5/21/01. The result of the evaluation suggested that the pts receptive language skills fell within the average range of his chronological age, He was able to comprehend relatively small units of information well and made connections in terms of meaning. It was reported that as the language became more complex and the pt was required to process more lengthy information, he was less successful. Those difficulties wee compounded by subtle attentional issues, particularly evident in large group settings and weak memory skills. Expressively, the pt was demonstrating delays in pragmatic language, oral formulation, and expressive grammar. A mild articulation disorder was present, as well. it was noted that the deficits appeared to adversely affect the pts educational performance in terms of comprehension of content material, social interactions/class participation, and oral and written communication. The pt had a psychological evaluation on 9/21/01 and 9/28/01 that indicated that the pts performance showed overall variability but was not consistent with any particular intellectual cognitive disorder such as attention deficit disorder or mental retardation. There were signs of possible neurological involvement, such as his slow processing speed and occasional reports of staring into space or motor clumsiness, although an assessment of his gross motor skills identified no apparent problems which would have required the provision of remedial services in that area. It was noted that the pt manifested some of the features of autism, although he did not meet all of the criteria for the disorder. The pt did meet all the criteria for pervasive developmental disorder. Follow up information received on 9/12/06 contained the following adverse experienced fever, tongue hurts, pain with swallowing, stomach ache, diarrhea, cough, and sore throat. Upon internal review, the cumulative mercury toxicity and language delay were considered to be other important medical events (OMIC). The pts pervasive developmental disorder was considered to be disabling. No further information is available. All available medical records will be provided upon request.