Sex: M
Vaccine: HEP
Symptoms: Drug withdrawal syndrome, Echolalia, Nervous system disorder, Neurodevelopmental disorder, Speech disorder
Clinical narrative: Information has been received regarding a case in litigation concerning a 30 month old circumcised male who on 7/3/98 was vaccinated with hep B vaccine (manuf unk). It is alleged that through the vaccinations administered during the period from July 1998 through October 1999 that the pt was subjected to very high doses of mercury contained in Thimerasol. It is further alleged that through the vaccination administered to the pt during the first two years of this life that the pt was poisoned by the cumulative doses of mercury in the Thimerasol. It is alleged that as a result of the vaccinations that the pt received as an infant that he now suffers and in the future will continue to suffer from the toxic neurological effects of mercury poisoning. It is further alleged that, because of the pt's heightened vulnerability to heavy metals poisoning and his compromised condition related to the mercury, he was and is unable to process heavy metals and suffers neurological compromise as a result of heavy metals contributed by the fossil-fuel burning utilities. His impaired condition is compounded by these exposure and his injuries made worse by them. In an initial speech and language assessment performed on 1/30/01, a speech and language therapist report indicated that the patient was been evaluated because the patient's mother questioned whether the patient falling and hitting his head as the cause of lack of speech. The patient's mother indicated that the patinet began to lose his language between 18 and 19 months of age. At the same time, the patient became less social, used gestures to communicate and begun to imitat words. The patient's mother also indicated that the patient's comprehension appeared to be at a higher level than his expressive abilities and followed simple commands with prompts. The other concerns that the patient's mother had were the patient's increased eye contact in the past few weeks, appeared to be sensory defensive to sounds, chewed on anything, liked to control his world and occasionally did dangerous climbing. It was noted that the patient's hand flapping had decreased and his attention had increased since the beginning of his diet. The patient was very affectinate to those he was familiar with. The speech and language therapist observed in the assessment that the patient used gestures as his primary means of communication and his speech was very limited and consisted of only 4 or 5 words. When the patinet was asked to communicate with the speech and language therapist, the patient would withdraw from a task or continue with his toy not responding at all. The Rossetti-Infant Toddler Language Scale test was administered to the patient. The results of the interaction-attachment section was that the patient achieved 100% of the skills at 9-12 months and 30% of the skills of the skills at 6-9 months, 30% of the skills at 9-12 months and 0% at the 12-15 month level. The results of the Gesture section indicated that the patient achieved 100% of the skills at 9-22 months and 60% at the 12-15 month level, 40% at 18-21 months, 50% at 21-24 months and 0% of the skills at 24-27 months. The results of the play secion indicated that the patint achieved 100% of the skills at 15-18 months and 33% oat the 18-21 month level, 66% at 21-24 months, 66% at 24-27 months and 0% of the skills at 27-30 months. The results of the language comprehension section indicated that the patient achieved 100% of the skills at 3-6 months, 55% at thee 6-9 month level, 16% at the 9-12 months, 50% at 12-15 months, 50% at 15-18 months, 20% at 18-21 months, and 0% at 21-24 months. The results of the language expression section indicated that the patient achieved 100% of the skills at 6-9 months, 50% at the 9-12 month level, 23% at 12-15 months, and 0% at 15-18 months. The speech and language therapist concluded that the patient had a severe receptive and expressive language delay. The patient's prognosis was good. In an assessment performed on 3/7/01, a physician reported that the pt was born at term, birth weight 7 lbs. 13 oz. He did well in the nursery period and was discharged to home on the second day of life. His general health was good with no hospitalizations or surgeries. He had no history of convulsions, meningitis or encaphalitis. He was dropped and bumped his head during infancy, when an infant carrier in which he was riding was dropped. He had no real change in behavior after this head bump, nor was there any loss of consciousness. He did not have neuroimaging performed. The parents did not remember many of the pt's early milestones but did state that he walked prior to one year of age. Around one year of age, he began to use a few words although never really said momma or dada. He was able to initially say phone, all gone, hot, sissy and bye-bye, although never very consistently. He had lost these words and had very minimal speech by the time of the assessment. Occasionally the pt exhibited some echolalia, some babbling and jargon type speech but very little communicative speech. His eye contact was poor, he exhibited a fair amount of flapping of his hands, he was resistant to change in his routine and seemed to crave being in closed spaces such as under cabinets. At the time of the assessment, the pt had been noted to have a marked speech delay, using no words and did not follow commands. Hearing evaluations had been performed which were not thought to show significant hearing loss. He had been followed by speech therapy with their assessment being consistent with severe both expressive and receptive language delay. On examination, the pt was very active but somewhat fussy. Head circumference was 49.5cm, height 90cm and weight 14.9kg. There were no dysmorphic facial features. His neck was supple, chest was clear to auscultation, heart rate and rhythm were regular, abdomen was soft without hepatosplenomegaly and skin was clear without stimata of neurocutaneous disorders. He was very active during the examination and would not follow commands. When he was able to, he crawled under the cabinet under the sink, closed the door and  was content in that setting. His pupils were equal, round and reactive to light, he had a red reflex noted times two and he would track with full extraocular movements. There was no facial asymmetry, this tongue was midline and he was exhibiting no drooling. Motor examination showed normal strength and tone. He did occasionally tend to have some toe walking, tone was within normal limits. The pt's sensation was intact to light and touch and deep tendon reflexes were 2+. It was also reported that the pt sometimes stared off into space and it was difficult to get his attention. The physician's impression was that the pt appeared to have decreased social interaction, a limited range of interest and markedly deficient speech most likely representing an autistic spectrum disorder. This was discussed with the pt's family. On 6/20/01, the pt was seen a physician for intermittent diarrhea since the age of 15 months. Stools could be watery and mucusy, 8-12 times per day with no visible blood and acidy and irritating ot the pt's skin causing severe diaper rash. It was reported that in May 2001, the pt had a three week episode of diarrhea. At the onset, he had two to three days of watery stools, five to six times per day, with some vomiting after most every meal. There was no associated fever. After two to three days of vomiting and diarrhea, he would be better for one to two days and then have the vomiting recur. He had no history of chronic reflux and vomiting but may have had some reflux and reswallowing. He was placed on a gluten and casein-free diet in October 2000 and the stools were of more normal consistency. He had no joint pains, oral or anal lesions. He did have a fine rough rash on his arms and face and low grade fever with the acute illness. It was reported that the pt's maternal great grandfather had Crohn's disease, family history was negative for Celiac disease and a brother had chronic allergies and otitis. It was also reported that, at the time of examination, the pt's history included autism. His mother reported an intellectual improvement since making the dietary changes. On physical examination, the pt's weight was 15.4 kg and height was 94.8cm. The pt was an active toddler who was not as socially engaging as expected for his age. Examination of the pt's head, eyes, ears, nose and throat showed that tympanic membranes were clear, nose and throat were clear, neck was supple and lungs were clear. His heart rate and rhythm were regular without murmur. The pt's abdomen was soft, nondistended, nontender with no palpable masses nor hepatosplenomegaly. genitourinary and rectal exam were deferred. His extremities had no clubbing, cyanosis nor edema. Neurological examination showed that the pt's reflexes were II/IV in the upper and lower extremities. The pt's gait was normal for his age. The physician's impression was that the pt had chronic diarrhea and autism. The physician discussed chronic diarrhea in children with the pt's mother and reported that "the association with autism has been proposed but there is no real proof and that probiotic agents may or may not help with the pt's autism." Upon internal review, autism, neurological effects and mercury poisoning were considered other medical events (OMIC). No further info is available.