Sex: M
Vaccine: HEP
Symptoms: Acoustic stimulation tests normal, Aggression, Agitation, Alanine aminotransferase increased, Aphasia
Clinical narrative: Information has been received from a legal firm regarding a case in litigation concerning an approximately 18-month-old male, who was injected with vaccines reportedly containing Thimerosal. It is alleged that between 12 and 25 micrograms of toxic ethylmercury were injected into the patient's body with each individual dose of Thimerosal and that the schedule of injections introduced a cumulative dose of 238 micrograms. In approximately December 1998, at approximately 18 months of age, the patient suddenly regressed developmentally. He became withdrawn, unable to speak and unresponsive to his environment. His injuries included a loss of language skills, motor skills and effect. It is further alleged that beginning in approximately January 1999, at approximately 18 months of age, the patient began to display symptoms of neurological damage consistent with mercury poisoning, not limited to losing his language skills engaging in repetitive and stereotypical behaviors, suffering from diminished cognitive ability and becoming socially disintegrative (or late onset, degenerative or regressive) autism. Follow up information was received from a legal firm that indicated that the patient was exposed to airborne vapors and mercury through the food chain, other mercury-laden products and power plant emissions. The patient was exposed to mercury from continually inhaling and ingesting industrial mercury emissions from fossil fuel driven power plants. The mercury included in the thimerosal-laden products and power plant emissions together caused him to suffer serious and permanent injuries, including mental, intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments. The patient had heightened vulnerability to suffer neurological injuries from industrial mercury as a direct result of thimerosal exposure. Upon internal review, autism mercury poisoning, neurological injuries, permanent injuries (included mental, intellectual, developmental), learning disability, learning disorder and neurological disorder were considered to be other important medical events. Additional information has been received through medical records concerning a male with no known allergies who on 22-JUN-1997 was vaccinated with the first dose of Recombivax HB (Lot # 621107/1436D). The patient was born via spontaneous vaginal delivery at 27 weeks gestation. The prenatal course was complicated by severe right lower back pain which was thought to be from renal calculus since she passed sandy material, but this was never confirmed. The patient's mother also had thrombosed hemorrhoids necessitating incision and evacuation of thrombosed hemorrhoids one week before delivery. The patient's mother did have a variable deceleration but this improved with oxygen and turning the patient to her left side. She went into full dilatation after artificial rupture of membranes was performed and delivered a health male infant weighing 8 lb and 2 oz. There was a cord around the right leg. The patient's immunization history included Dtap, on 22-AUG-1997, 22-OCT-1997, 05-JAN-1998 and 06-JAN-1999 respectively, Hib conj vaccine (unspecified carrier) on 22-AUG-1997, OCT-22-1997, 05-JAN-1998 and 06-JAN-1999, Poliovirus vaccine inactivated (unspecified) on 22-AUG-1997, 22-OCT-1997 and 25-JUN-1998, MMR II, on 25-JUN-1998 and 09-OCT-2001, Varivax, on 06-JAN-1999 and subsequent Engerix B 05-JAN-1998, 22-AUG-1997. The patient was diagnosed in December 2001, with Pervasive developmental disorder (PDD). On 28JAN-2002, the patient was re-evaluated after a previous evaluation showed severe expressive and receptive language delays. At the present time the patient was using about 25-30 words spontaneously and appropriately, including occasional two and three word combinations. The patient's parents reported that the patient was 24 months old when he underwent a "regression" in speech skills. However, from that time, he has gradually making progress. His motor milestones were met within normal limits, as with sitting and walking independently. It was noted that the patient appeared to have fairly limited means of communication in general including weakness in nonverbal communication. His means of communication often included "grabbing" and pulling parents by the shirt to the desired object or place. He could be rather "self-occupying" in nature, and had a very strong visual processing and visual interest in general. He was said to "study" everything with respect to minute details, including the movement of wheels on toy cars. His play also tended to be somewhat repetitive in nature, as in lining up his toy trains. Repetitiveness was also evident in general, as with becoming upset if there are changes in routine. At the same time, though, the parents reported that the patient has "good days" and "bad days" in this regard. Perhaps the most significant challenges are with temper tantrums owing his frustration in communication. He was described as an extremely active and impulsive child who "touched everything". When the patient was observed during uninstructed times, he was observed to be very active, impulsive, and fitting from one activity to another. However, he could be structured quite readily as a small testing table for sustained periods of conginitive testing. He exhibited a significant weakness in social communication, both verbally and non verbally. His eye contact was reduced, as were indications of "shared enjoyment" in interaction (where he might have been expected to reference back more frequently to parents when having a particularly good time). At the same time with considerable external structure, a judicious degree of "joint attention behavior could be elicited, where he would make eye contact with the examiner during shared tasks and activities. He was heard to use single words, although most often only in direct response to testing, as in picture identification. The patient used his right hand for pencil and paper activities, exhibiting an immature grasp of the pencil. The patient was administered a series of test and it was noted that he was a "high functioning" child. He functioned well within normal ranges in nonverbal cognitive skills, including his abilities in visual analysis, visual organization, and short-term visual memory. However, his verbal skills fell to the well below average range. Utilizing the imitative norms of the Developmental Test of Visual Motor integration, the patient functioned within normal limits. Despite his awkward pencil grasp, the patient was able to imitate the drawing of a vertical line, horizontal line, circle and cross. However, daily living skills were delayed for chronological age. He obtained an age equivalent of 2 years 7 months on the Vineland utilization parent report. His weakness were primarily in fine-motor tasks, as in feeding himself with a spoon and fork. However, his inattention and high activity level seemed to be primary factors precluding more functional motor abilities. The patient recently had very well established with respect to both bowel and bladder training. The Children's Atypical Development Scale was completed by both parents as part of this evaluation. Based upon the parents' perception and observation, it seemed evident that the patient had difficulties in speech development were occurring unusual routines, strong attachment to inanimate objects (e.g. toy trains) extreme reactions to minor inconviences, as well as difficulties dealing with change in daily schedule were reported. In addition, the patient had difficulty with eye contact with others and did not typically respond to the initiations of other children. The Child Behavior Checklist was also completed by the parents. This patient certainly presented with many behavioral challenges, particularly those associated with inattention and overactivity. In conclusion and formulation the examiner felt that they had a cooperative, attractive, and bright 4 year old with a history of verbal delays. It was the examiner's impression that the patient difficulties in language development were occurring within the broad context of social communication disorder (i.e. pervasive developmental disorder). The patient had not yet received an aggressive early intervention services or had much opportunity to interact with typical children (e.g. preschool program), the examiner was reluctant to make a more formal diagnosis such of that of autism. However, he did think it is highly likely that the patient's presentation will ultimately be along the lines of an autism spectrum disorder. On the positive side, the patient is higher functioning who clearly has normal mental problem-solving skills and intelligence. The diagnosis at this time was Autism Spectrum Disorder. The plan was for the patient to attend special education services. A recommendation for a pediatric developmental evaluation was made and consultation with an educational and behavioral specialist in autism and similar disorders. On 19-AUG-2002, the patient was seen for a Behavioral/Developmental Pediatric Evaluation. The patient was 5 years and 2 months and has started for children with disabilities and parents noticed that he had regressed in terms of milestones already reached, like potty training. He also had been exhibiting increased aggressive behavior. His frequent temper tantrums, now involved pushing his mother away or going after her. He sometimes appeared to be unable to hear when his name was called. His audiologic screen done in October 2001 showed his hearing to be within normal limits in both ears. Since enrollment in school the patient's mother noted some improvement in his language skill. He can now speak in 2-3 word sentences. Since starting school, he regressed to bedwetting and soiling his underpants. His temper tantrums have also become more extreme. Once, his temper tantrum was so severe that he punched a glass window at school. Now that he is out of school for summer break, there has been no toileting issues. He had not been receiving speech or Occupational therapy while in school but would be receiving them while school was out. He easily becomes upset when routines are changed. He loves to spin around and play in the water. He chews on everything and all of his toys. He takes great interest in electronics and computer. He takes his toys apart. He displays echolalia. He is a picky eater. Although the patient already came in with the diagnosis of Autism, the diagnostic tool called the CARS (Childhood Autism Rating Scale). On the CARS, the patient had a total score of 34, where he falls at the cusp of moderately to severely autistic. The diagnosis of Autism-moderate was made. Additional information received on 28-MAR-2007 included the following adverse experiences: 1.0 cm laceration of the face (07-SEP-1998), type 2 lateral condyle fracture of the left elbow (11-SEP-2001), Cellulitis and acute allergic reaction (16-JUL-2002), Chronic adenotonsillitis (26-MAY-2004, impetigo (02-DEC-2004), popcorn kernel stuck in ear (08-DEC-2005), cold (12-DEC-2005), subconjunctival hemorrhage and upper respiratory infection (21-MAR-2005), earache and rash on (23-JUN-2006), skin avulsion (14-MAR-2002), low iron, low vitamin A, low HDL cholesterol, elevated cardio CRP, and elevated AST and ALT (10-MAR-2004). A copy of the patients medical record is attached to further document the patients experience. All available medical records available on request.