Age: 1.3
Sex: F
Vaccine: DTP, HIBV, MMR, OPV
Symptoms: Otitis media, Speech disorder
Clinical narrative: Information has been received from an attorney regarding a 9 1/2 year old female with a history of chronic otitis media who was noted to have developmental delay on 9/24/94 at the age of 25 months. On 11/10/95, a pediatric neurologist dx'd the child as being autistic from the age of 2. Medical history revealed the child was a full term infant, delivered by Caesarian section. Birth weight was reported as 6 lbs 6 ozs, 18.5" in length. Her APGAR scores in the delivery room were 9/9 (maximum 10). She had newborn jaundice. Obstetrical records noted that the child's mother took Synthroid (levothyroxine) and prenatal vitamins during her pregnancy. Immunization records indicated that the child received her 4th doses of DPT (lot 2841006, OPV (lot 357919), ProHibit (lot 21141007 and her 1st dose of MMR (lot 1145W) vaccines on 12/30/93. Additionally, on this date, a dx of resolved otitis media was made. Otolaryngology evaluation performed on 3/18/94 revealed that the child had been experiencing ear infections since 11/93 and had been receiving antibiotic therapy Augmentin (amoxicillin/clavulanate) most of that time. A tympanogram showed a flat response curve bilaterally. A plan for ventilation tube insertion was made. Five days later, on 3/23/94, during an audiologist visit, the child's mother expressed concern about the child's hearing ability, as she did not respond to simple commands. Testing summary suggested a moderate hearing loss for the right ear with abnormal middle ear function for both ears. An operative report from 4/12/94 noted a preoperative dx of chronic otitis media. Bilateral myringotomies with ventilation tube insertion was done. A pediatric assessment on 9/24/94, noted developmental delay not totally explainable from illegible hearing. A TB skin test was administered. Verbal delay was considered "severe". An evaluation by a psychologist who concluded that the child meets the criteria for a dx of autism. Cognitive development was consistent up to 11 months, limited by language tasks. Motor skills tested as high as 19 months. At 2 years 4 months, she began behavior modifications which continues. In February 1995, a psychologist reportedly "agreed with a diagnosis of autism." The child was treated with "super Mithera vitamins" and DMG (dimethylglycine). Subsequently, her poor eye contact "improved significantly," her vocalizations "improved," and "dramatic improvement in attention, awareness, nonverbal imitation and vocalizations" was observed. Additionally, behavior modifications was noted to have had a "noticeable impact" on the child's predominant self-stimulatory behavior." The psychologist reported that the child "seems to have times of 'clarity,' then returns to her 'fog' and noted that neither an EEG nor a fully BAEP had been performed on the child. On 11/10/95, the child was seen by a pediatric neurologist "regarding her diagnosis of autism made at age 2." The neurologist "agreed with previous conclusions that (the child) met criteria for diagnosis of autism" but indicated that she suspected the child's behavior had a "paroxyamal quality" and that it was very important to rule out the possibility of a seizure disorder which in interfering with her language processing and producing some of the symptoms." A full BAEP was ordered; however, results were not reported. On 10/1/95, the child's blood lead concentration was within CDC class I. The same month, the child began receiving "individual discreet training" with a pyschologist; the child's pediatrician noted the programs' "benefits" regarding the child's progress. AS of April 1996, treatment included ferrous sulfate. DMG, vitamin B6 and "diet restrictions." A pediatrician's note date 5/13/96 indicated that the child was experiencing tantrums and was treated with Prozac(fluoxentine). It was noted that the tantrums were "worse since, " and Prozac was discontinued. In a note dated 9/26/96, her pediatrician indicated that her behavior was "quite good," speech was "slow," and attention and receptive language was "great." At her 5-year physical examination on 9/26/97, treatment included DMG and vitamins. It was noted that she recognized the alphabet, dressed herself, had begun to print her first and last names, and was adjusting to school "well". In October 1998, her peditrician indicated that she was receiving speical education. The child's faterh alleges that she "has been diagnosed with mercury poisoning and with neurological injuries, including 'disintegrative (or regressiv, late-onset, or degenerative') autism. Hearing loss, autism, mercury poisoning, and neurological injuries were considered medically important.