Sex: M
Vaccine: HEP, HIBV
Symptoms: Mental impairment, Mental retardation severity unspecified, Nervous system disorder, Nuclear magnetic resonance imaging brain normal, Obsessive-compulsive disorder
Clinical narrative: Information has been received regarding a case in litigation concerning a minor male patient who was expose to high levels of mercury from thimerosal through exposure to unspecified products. In additional, the patient was exposed to mercury from continually inhaling and ingesting industry mercury emissions from fossil fuel drive power plants. The mercury included in thimerosal laden products and power plant emissions together caused the patient to suffer from serious and permanent neurological injuries. The patient 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 patient 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 patient, minor male was caused to suffer serious and permanent neurological damage which include past and future mental, intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments. Additional information has been received through medical records. This report concerns an approximately 2 year old male patient with no known drug allergies who was vaccinated at birth with a first dose of hepatitis B virus vaccine. The patient was also vaccinated with a second and third dose of hepatitis B virus vaccine on 8/11/93 and 7/13/94, respectively and a first, second, and third dose of HIB conjugate vaccine on 9/25/92, 2/18/93, and 11/2/95, respectively. It was reported that when the patient was an infant and young toddler (up to 2 years old) he was normally developing and described as quiet. At about 2 years old, the patient began to exhibit an number of unusual behaviors. His initial psychological assessment was performed on 11/6/05 at 3 years 3 months of age. He was non-verbal, was resistant to change and noted to be in the Severely Autistic range. On 11/27/95, the patient was evaluated by a psychologist who reported that the patient demonstrated many characteristics of Autism. The two most salient aspects of his behavior was a lack of communication and his resistance to change. he does not speak any words, and was not observed attempting of pretending to communicate with words. However, several times he used cries, screams and humming to communicate (consciously and unconsciously) his feelings of anger and content. When he became angry or frustrated he would scream loudly. When he was enjoying a task, he would often rock lightly from side to side and hum softly or make a soft guttural noise. He demonstrated severe reactions (temper tantrums) to any attempt at change in routine and he often perserverated on fine-motor manipulatives. Other major behaviors that suggest Autism included abnormal emotional reactions, such as wildly different emotions for no apparent reason and practically non-existence imitation skills (both sound and motor). Currently the patient does not communicate verbally and has no recognizable words of imitation sounds. Also, the patient's mother noted that the patient was normally developing up until about 2 years old, which was typical for children with Autistic disorders. According to regulations for special education, the patient meets the criteria for the handicapping condition of Autism. It was reported that the patient was seen by the neurologist on 1/8/98 when the patient was 5 years, 6 months old. The patient was noted to have a regressive form of Autism, as the patient started speaking single words at 9 months, but later lost these words. On 2/2/98, the patient was evaluated by a developmental specialist and the concerning was the patient's aggressive behavior, which included hitting, throwing, kicking, and tantrums. A developmental assessment was performed and results included: cognitive skills at the 18 month level; perceptual skills, including visual problem solving fell at 3.5 years; language skills ranged up to 12 months; social skills fell at 9-12 months and motor skills were fairly age appropriate. Diagnosis of Autism and Mental Retardation were formulated. On 3/12/98, a 23 hour video EEG was performed and was normal. Results of the MRI of the brain, metabolic screening and chromosomal analysis were reported to be normal. In December 1998, it was reported that the patient was taking fluvoxamine maleate 25mg daily for compulsive behaviors. In March 1999, fluvoxamine maleate was discontinued due to side effects of frequent urination and sleeping difficulties. As of 9/14/99, he was not taking any medications. The patient had a psychological reassessment on 3/15/99 and he was described as primarily non-verbal and noted that he communicated using gestures, some sign language and symbols. An assessment was done and he was noted to be in the Severely Autistic range. His speech/language assessment resulted in Auditory Comprehension age equivalent 1 years 9 months, Expressive Communicative age equivalent of 1 year 6 months. On 9/14/99, his psychological assessment was suggestive of moderately deficient non-verbal reasoning abilities, which was consistent with his assessment from 3/99. No statistically significant relative strengths or weaknesses were evident in his non-verbal profile. Taken together, these results were consistent with functioning in the moderate range of mental retardation. It was considered changing his educational code to multiple disabilities to reflect both Autism and Mental Retardation. On 10/14/99, the patient, aged 7 years and 3 months, was seen by a neurologist. The neurologist reported that the patient carries a diagnosis of Encephalopathy characterized by language delays, social interactive impairments and abnormal symbolic play development. He returned for follow up as he was also diagnosed with Autism. He continues to be between adequate programs, specifically specialized for children with Autism. Since he had the emergence of language, the neurologist recommended that additional programs should be utilized. The patient was otherwise doing fine from a physical and neurological standpoint. On 9/26/01, the patient was again seen by the neurologist. His impression was Autism with Moderate-Severe Expressive Language Delay and Oromotor Dyspraxia. HIs recommendations including continuing with the patient's behavioral training and intensive speech and language therapy. On 11/29/01 the patient was seen by another physician who noted that the patient's Autism improved, the patient was less aggressive. It was noted that he was still being seen for follow up by his neurologist. The patient's immunization history included: a first and second dose of MMR 10/12/93 and 6/6/97; first, second, third dose and fourth dose of diphtheria toxoid (+) pertussis acellular vaccine (+) tetanus toxoid on 9/25/92, 2/18/93, 5/5/93, and 7/14/94; first, second and third doses of poliovirus vaccine inactivated on 9/25/92, 2/18/93, and 5/4/93. Additional information contained the following adverse experiences: elevated blood pressure (10/14/99); fever (11/29/01), otitis media (11/29/01) treated with amoxicillin and URTI (11/01). The patient's autism was considered disabling. Upon internal review, the patient's encephalopathy, mental retardation and cumulative mercury toxicity were considered to be other important medical events (OMIC). No further information is available. All available medical records are available upon request.