Age: 0.42
Sex: M
Vaccine: HEP, HIBV, IPV, MMR
Symptoms: Drug toxicity, Echolalia, Emotional disorder, Facial dysmorphism, Fall
Clinical narrative: Information has been received regarding a case in litigation concerning a minor male pt who was exposed to high levels of mercury from thimerosal through 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. Additional information has been received regarding a case in litigation via medical records concerning a male infant born at 39 weeks normal vaginal delivery with a birth weight of 9lbs 4 oz. Apgar score was 9 and 10. Family history was negative for consanguinity, mental retardation, and tics. There were no known inherited disorders or language disorders in the family, no hyperactivity, no seizures. A paternal cousin had learning disabilities. On 5/7/1993, 6/7/1993 and 12/14/1993, the pt was vaccinated with hepatitis B virus vaccine rHBsAg. On 8/1/1994 and 4/29/1997, the pt was vaccinated MMR II (lot 606582/0075A first dose, 619133/1250D second dose). The pt has a reflux for the first year and a half of life which was minimal and no medication was necessary. The pt had no significant history of ear infections. The pt has inverted feet and wore a cast for 2 or 3 months at age 2. At 34 months of age, the pt still fell alot and was clumsy. He would bury his head in his mattress at night and rock himself to sleep. He was sensitive to sound and crowds. An educational assessment performed on 10/12/1995 at the age of 34 months reported that the pt was at a gross motor level of 29 months, fine motor skills level of 23 months, cognitive skills at level of 19 months, language skills were at 16 month level, self help skills at 25 month level, and social emotional skills at were at 24 month level. It was reported that the pt was eligible for early intervention services due to developmental delays in the area of fine motor, cognitive, language, self help, ans social emotional skills. On 10/31/1995, a speech and language evaluation was performed with the following results, receptive language skills were significantly delayed and approx to 18 month level, oral expressive language skills were significantly delayed and approx 16 months with some scatter to 20 months, pragmatic at 18 months to 27 months. It was recommended that the pt receive direct speech, language therapy, occupational therapy evaluation be completed to investigate possible sensory integration difficulty, and placement in special education preschool outreach class. On 11/21/95, the pt was evaluated by a neurologist who indicated that the pt did not have any hospital admissions, surgical procedures, or serious accidents. The pt was not on any medicine and had no known allergies. Development was late compared to his siblings and he did not walk until he was 15 months of age. Speech began at approximately 2 years and consisted of 20 words and two word phrases. Toilet training had not even been attempted. On physical examination, the pt presented as a generally healthy appearing youngster who did make eye contact and was interactive. He weight 35 lbs while measuring 39 1/2 inches in height (90th percentile). His head circumference was 49 and 1/2 cm (50th percentile). The general physical examination was normal aside from a tendency to walk with his hips and knees bent and his feet inverted. On neurologic examination, the pt did point to his ear and wrinkled his nose when asked to point to it. The cranial nerve examination appeared to within normal limits. On motor exam, the tone was mildly diffusely decreased. In summary, the physician stated that the pt was a 3 year old boy with developmental delay who functioned closer to a 1 1/2 year level than his chronologic age of almost 3 years. In additional, he had hypotonia which appeared to be on a central basis in view of the intact to brisk deep tendon reflexes. The physician reported that the problem was serious enough to warrant some further diagnostic testing and suggested a CT scan of the head as well as blood for Fragile X determination. On 10/14/1996 and 10/16/1996, a speech and language evaluation was preformed with the following impressions from the evaluation. The pts attention to test items fluctuated and he often required more than one prompt to attend to a task. He exhibited a perseverative pattern when presented with objects to manipulate, pictures to look at or questions to answer. He had significant difficulty answering any questions. At times seemed to be somewhat anxious about participating in some of the activities. At time the pt had difficulty in controlling his volume. Overall, the pt evidenced significant difficulty in comprehending language and verbally expressing himself. A cursory oral peripheral examination revealed that the pts tongue and palate were adequate in structure and function for speech purposes. However, due to a significant overbite, he had difficulty imitating a number of oral motor movements. IN summary the pt demonstrated an articulation impairment in the moderate range, a receptive expressive language impairment in the moderate to sever range and a voice impairment in the mild range. Based on test results and observations, the disability of speech language impairment was documented. On 4/15/02, the pt was evaluated by a psychologist who indicated that the pt had displayed seriously delayed development in all areas since he was an infant. A number of medical test were done to determine the cause of his pervasive developmental delay, but no specified diagnosis could be made. In the assessment, most of the pts scores fell in the range of mild to moderately limited/deficient cognitive ability. His adaptive skills were also mildly limited, but he did display strength in socialization, He displayed strengths in vocabulary, attention to detail, long term visual memory, visual perception, and processing speed of verbal information.  Of concern was the pts seemingly lack of common sense and ability to function independently. He appeared to be functioning an average of 3 years behind his chronological age. The pt also displayed a number of non functional ritualistic behaviors which were of concern because they impaired his learning and social functioning. On 7/22/02, the pt was evaluated by a physician who reported that the pt had echolalia that lasted until the age of 4-5 years. Toilet training had be completed at age 3. At school, the pt was classified as speech and hearing delayed, but recently that designation has been changed to mental retardation. Diagnosis following examination included minor neuro motor dysfunction with hypotonia, borderline to mildly limited cognitive abilities, academic achievement commensurate with cognitive level, pervasive developmental disorder, not other wise specified, and minor dysmorphisms. Lab evaluations revealed amino acids were within normal limits as were the organic acids. The lactate and ammonia were both normal. The comprehensive metabolic profile showed two mild elevations. His calcium level was 10.6 (normal 8.4 to 10.5) and alanine aminotransferase was 60 IU/L (normal 0-40). The physician indicated that no etiology workup had been done for the pt. The pt was referred for a genetics evaluation. Upon internal review, the pts pervasive developmental delay, poisoning and mental retardation were considered on other medical events (OMIC). Medical record received 3/12/06 reported the following adverse experiences, esophageal reflux, vomiting, and headache. No further information is available. All available medical records will be provided upon request.