Age: 0.8
Sex: M
Vaccine: DTAP, DTPHIB, FLUX, HEP
Symptoms: Speech disorder
Clinical narrative: This case was reported by a lawyer and described the occurrence of neurological injury in a male subject who was vaccinated with hepatitis B vaccine (Engerix B) and or unidentified hepatitis B vaccine for prophylaxis. On an unspecified date the subject received unspecified dose of hepatitis B vaccine.  According to the legal complaint, at an unspecified time after vaccination with hepatitis B vaccine, the subject experienced "serious and permanent neurological injuries: which were attributed to " toxic mercury exposure".  The following information was received via medical records.  The subject was vaccinated with hepatitis B vaccine (Engerix B) on January 1994, 28 March 1994, and 19 July 1994.  The subject was also vaccinated with combination diphtheria and tetanus toxoids, pertussis adsorbed and Haemophilus influenzae type B conjugate vaccine and strain not specified (MMR vaccine) for prophylaxis.  The subject had a history of recurrent ear infections/ middle ear effusion with insertion of ventilation tubes of 18 months of age, and treatment with antibiotic therapy.  According to the mother, the subject's development was normal until 15 months of age,  and he experienced regression at 18 months of age when he stopped speaking.  Upon examination on 09 August 1996, it was noted that the subject was seeing a speech therapist who felt he was "behind", although "definite (speech) retardation", was not seen.  Assessment included speech delay, question behavior related. On that date, Totramune and oral polio vaccines were administered as the subject was "behind on his shots".  On 19 November 1996, the subject was evaluated for a high fever of 104 degrees Fahrenheit, and it was noted that he had experienced possible febrile seizures in the past.  A progress note dated 10 January 1997 indicated that the subject's parents were seeking a referral to an autism clinic to determine why he was not speaking.  Following evaluation in August 1997, impression included developmental delay with questionable autism.  An audiological evaluation on 24 October 1997 resulted in a diagnosis of "grossly normal hearing in at least one ear".  In May 1998, the subject was diagnosed with attention deficit hyperactivity disorder, rule out mood disorder, and moderate mental retardation.  He was described as a danger to self, mom, dog, and others, and exhibited increasing aggression.  Medications included olanzapine and clonidine.  In June 1999 the subject was seen for concerns of aggression with jumping, lack of fear, frequent falling, destructiveness, head banging, and eating non food items.  Treatment at that time included PAXIL, olanzapine, and clondidine.  Per the subject's mother, RITALIN had made his behavoir worse.  It was noted that he had not been "formally" diagnosed with autism; however his mother referred to him as autistic.  The subject had very limited speech and made car noises and monkey noises.  He was successfully using sign language and a sign board.  According to an evaluation performed on 01 September 2000, the subject had also been diagnosed with attention deficit hyperactivity disorder, which had been treated in the past with PAXIL, Adderall, and ZYPREXA.  Additionally it was noted that the subject experienced episodes of bizarre behavoir which appeared to be associated with exacerbations of chronic gastrointestional distress.  By July 2001, the subject was described as capable of ambulation but only for short distances, after which he either tired out easily of refused to move.  In September 2001, a physician's letter described the patient as autistic with self destructive and harmful behaviors, and "virtually impossible" to toilet train.  In July 2002, the subject's autism was described as profound, and he required physical and  toilet train.  In July 2002, the subject's autism was described as profound, and he required physical and occupational therapy.  A psychiatric examination in November 2003 included a description of the subject as autistic and mentally retarded with profound violent tendencies.  In January 2004, the subject's medications included clonidine, DEPAKOTE, and trazodone.  This case was assessed to be medically significant.  (OMIC)