Age: 0.55
Sex: M
Vaccine: MMR
Symptoms: Strabismus, Upper respiratory tract infection, Viral infection, Visual disturbance
Clinical narrative: Information has been received from a case in litigation concerning an approximately 25 week old male born with pre sacral dimple and history of chicken pox ( Dec 08 1995), purulent nasal discharge, cough and very dry skin on his face and neck who on Jan 08 1996 was vaccinated with a dose of measles virus vaccine live  (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (lot 61628/0592B). Previous vaccination therapy included on Aug 24 1995, Sept 28 1995(lot K1148) and on Nov 02 1995 (lot K1148) a first, second and third dose of Hib conj vaccine tet toxoid (Act Hib). Other previous vaccination therapy included on Aug 24 1995, Sept 28 1995 and Nov 02 1995 a dose of diphtheria toxoid (+) pertussis vaccine unspecified (+) tetanus toxoid manufacturer unknown. On Aug 03 1995 (reported as 08/03/1996) the patient had his 6 week assessment, and a physician reported that he was functioning normally. The presence of a dimple at the base of his spine was noted. At that point, the patient had already been seen because of the possibility of pilonidal sinus. It was noted that the patient also had very dry skin on his fact and neck. On Dec 08 1995 the patient was admitted to the hospital with chicken pox with coryza. The patient had reported chicken pox contact sibling. The patient had raised fontanelle which was gone by time of arrival on ward. It was noted that there was no other evidence of encephalitis. The patient was discharged on Dec 09 2005. On Feb 08 1996 the patient was seen by a physician for his 8 month assessment. The patients mother was concerned that he was not rolling or sitting solo. It was noted that the patient had been quite ill with chicken pox in Dec 1995 and had been admitted to the hospital and then discharged the same day. The mother had reported that the patient had not been well since he had chicken pox. The physician reported that at his development assessment, the patient was clearly showing signs of delay. He was not bracing his shoulders when pulled to sit and there was still some head lag, he fell forward when attempting to sit and there no propping reflexes, he was not weight bearing, he was not transferring toys and his left thumb was held across the palm. He was babbling but not making two syllable sounds. He recognized his name and although he was socially responsive, he was fairly dozey and not very interested in the world around him. he had an upper respiratory infection which made him unresponsive for a hearing check. On Aug 29 1996 it was reported that the patient at 14 months of age was seen for developmental delay. It was noted that up to about the age of 6 months, he was fairly normal developmentally, however at that stage he had quite a severe attack of chicken pox. On Aug 29 1996 it was reported that since then he had never really got over that and was tending to be very susceptible to minor infection. These infections tended to leave him very flat, miserable, fevered and as a result his development appeared to have fallen way behind. The mother reported that he had never really been right since that time. His mother felt that he became very lethargic and was not interested and responsive to his surroundings, it was noted that after he had a measles virus vaccine live  (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) injection and for a period of a month after that he felt significantly off again. It was reported that his development was significantly impaired. He could not stand alone, he could not walk. He was reluctant to many things that a 14 month old could do with difficulty, A community medical officer had done a detailed examination and she felt that he was 4-5 months, if not 6 months behind with his development. It was noted that his delivery was unremarkable and there were no neonatal problems of note. On Dec 05 1996 it was reported that the patient appeared markedly delayed, functioning around 9 to 10 month level at a chronological age of 17 months, The patient had some dysmorphic features with broad forehead, epicanthic folds and projecting ears. On Dec 05 1996 a blood sample for chromosome analysis and fragile X was reportedly taken, On Apr 20 1999 the patient had been seen by a physician for developmental delay. The patient had had an assessment which confirmed his delayed development. In Sept/Oct 2000 the then 5 year old patient was evaluated by an occupational therapist. the patient showed year level in the gross motor area, around 4 to 4 and a half years in the fine motor perceptual low normal resting muscle tone throughout, and had lower stability, power and endurance for movement. Quality of hand grasp and manipulative skills were also affected by this. On Oct 10 2000 the patient had been evaluated by a community learning disabilities health service. The patient had presented with resistance and inability to deal with change, difficulty retaining information, mobility problems, leg weakness (low energy legs), poor coordination motor skills, poor cognition, unable to occupy or motivate himself, poor short term memory, but long term memory is good, tended to learn form modeling others behavior, actions.  The patient also had facial change which occurred lasting only a second or two but which involved his eyes flickering and moving upwards and to the right. This sometimes coincided with a flickering of his fingers. On Dec 01 2000 the patient was seen by a physician. The mother reported to the physician that her son was having recurrent episodes of extending his upper limbs, flicking his fingers followed by his eyes becoming vacant. He appeared to be conscious throughout these episodes. There was no dropping to the ground or disorientation following them. The episodes lasted up to 30 seconds and were repeated many times throughout the day although not in rapid succession. The mother felt that these had been present for some years but the frequency had increased. Th physician expressed concern about partial epilepsy or possible myoclonic epilepsy. The mother also reported that her son became tired after walking short distances and complained of pain in his calf muscles. She reported his muscle bulk to be poor and felt he was not as agile as other children of his age. the patient was known to have difficulties with motor coordination and it may be that the extra effort required to make for motor activities had resulted in him becoming more easily tired. On Apr 13 2001 it was reported that the patients EEG on an unspecified date was normal. On Jun 14 2001 a physician reported that the patient was currently having prolonged and significant tantrums, during which he attacked and bit his mother, resulting in bruising. He appeared to have little idea of consequences, no recognition of authority and was said to become distressed and frightened in crowded and noisy places. His parents were also concerned at what appeared to be repetitive behaviors, episodes of opening and closing of his hands and unusual eye movements, during which their son was able to stop there movements on request. On Jun 15 2001, a blood sample for mutation analysis was performed. Two apparently normal fragments were detected by PCR approximate repeat sizes given. This analysis provided no evidence that this patient carried a mutation but did not exclude other genetic conditions. It was reported to be unlikely that the patient had myotonic dystrophy. On Sept 10 2001 the patient was seen by a pediatric neurologist who believed that the patients movements fell within the realms of an obsessive compulsive disorder. On Dec 23 2003 the patient was given amoxicillin, indication not reported. ON mar 19 2004 the patient had a special needs review and the findings were as follows: global developmental delay, behavior problems and mild visual defect. On Apr 15 2004 it was noted the the patient received learning support at school, as well as speech and occupational therapy review. On Apr 29 2004 the patient was given clobetasone butyrate  (+) nystatin (+) Oxytetracycline calcium (Trimovate cream), indication not reported. Upon internal review developmental delay was considered to be other medical event. Information has been received on Sept 21 2005; upper respiratory infection 02/08/1996. Medical records are attached as further documentation of the patients experience. All medical records are available upon request.