Sex: M
Vaccine: DTP, HIBV, HIBV, MMR
Symptoms: Hypotonia, Injection site swelling, Lip ulceration, Loss of consciousness, Metal poisoning
Clinical narrative: Information has been received concerning a male patient who was exposed to high levels of mercury from thimerosal through exposure to unspecified products. In addition, the patient 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 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 proximate cause of the toxic mercury exposure to the patient, male minor 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. Follow-up information has been received from medical records concerning a male with a history of jaundice during the neo-natal period who on 05-NOV-1990 was vaccinated with a first dose of Hib conj vaccine (Lot "1908D") concomitant with a second dose of poliovirus vaccine live oral (Orimune). On 11-JAN-1991, the patient was vaccinated with a second dose of Hib conj vaccine and a third dose on 29-OCT-1991, the patient was vaccinated with a third dose of Hib conj vaccine (HIBTITER) and a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (600926/1370T). It was reported that  at "the age of 12 months" the patient received a vaccination with diphtheria toxoid (+) pertussis whole cell vaccine (+) tetanus toxoid (TRI-IMMUNOL) the patient developed a fever of 103 (also reported as 104), extreme crying, a lump the size of a baseball at the injection site. The patient slept for 18 hours (also reported as 8 hours) and was difficult to awaken. The fever was treated with acetaminophen (TYLENOL). On an unspecified date, the patient developed attention deficit disorder (ADD). In December 1991, at 18 months of age, the patient developed starring episodes. The starring episodes would occur 10-15 times daily and last for 30 seconds to greater than 1 or 2 minutes. Also at 18 months (also reported as 15 months) of age the patient's parents noticed that his speech had decreased and more babbling was present. He had increased temper tantrums (would hit head on floor and objects), decreased eye contact and increased impulsivity. On 04-FEB-1992, the patient was vaccinated with a fourth dose of diphtheria toxoid (+) pertussis whole cell vaccine (+) tetanus toxoid (TRI-IMMUNOL) and a third dose of poliovirus vaccine live oral (ORIMUNE). In April 1992, at 22 months of age, the patient underwent development and speech and language testing. According to parental report, the findings indicated a mild degree of delay in communication abilities. On 18-AUG-1992, at 26 months of age, the patient presented with significant delays in both receptive and expressive aspects of language development with skills clustering around the 12 to 14 month age level and scattered through the 18 month level. Poor attention and delays in symbolic play behavior were also observed. On 15-OCT-1992, at age 28 months, the patient presented significant speech and language delays. His cognitive function was delayed but with some scatter slightly above age on non-verbal tasks. In addition the patient exhibited generalized hypotonia with motor development in the low normal range and significantly decreased social interaction most noticeable was unsustained eye contact. The patient was diagnosed with pervasive developmental disorder (PDD). The patient had and EEG and a MRI which were both normal. On 19-AUG-1996, at age 6 years, the patient was at 4 - 4.5 year old level and reportablely lost hand dominance. At the time the starring spells had gradually decreased in frequency down to 4 or 5 times a day. The patient was admitted to the hospital to evaluate the starring episodes and to rule out any organic cause of the PDD. He underwent a 24 hour standard video EEG using 10/20 electrode montage system as well as the T1 and T2 electrodes. Results indicated a normal awake and asleep 24 hour video EEG. The episodes of starring were recorded on several occasions but were not associated with any EEG abnormalities. On 30-AUG-1996, the patient underwent a MRI which resulted as a normal study. On approximately 06-NOV-1998, blinking eyes, facial grimacing and some clearing of the throat were observed by the patient's parents. The patient was diagnosed with tic disorder. On an unspecified date the patient was placed on therapy with Adderall and the tics were reported to have gotten worse. Therapy with Adderall was discontinued and the patient was placed on Ritalin 10 mg in the morning and 5 mg at 1 PM. In June 2001, the parents reported that the tics improved but then unusual eye movement began which were described as "blinking or twitching on the right involving the eyelids which then progress to the left side and then is followed by a bilateral nystagmus with a turning of the heat to the side." These episodes lasted approximately one minute in duration and occurred more frequently in the evenings. On 24-SEP-2001, it was reported that his behavior had seemed to worsened and that he was yelling and more verbal when he became frustrated. The patient was started on Concerta. On 24-SEP-2001, it was reported that therapy with Concerta also resulted in some increased twitching. On 12-APR-2002, it was reported that therapy with Concerta was discontinued because the patient's mother thought that it caused the tics. On 03-MAR-2003, the patient was restarted on therapy with Concerta. On 07-OCT-2003, the patient was placed on therapy with Strattera. On 20-OCT-2005, the patient was vaccinated with a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot #615614/0882B). Previous vaccination on 20-AUG-1990 included poliovirus vaccine live oral (ORIMUNE) and diphtheria toxoid (+) pertussis whole cell vaccine (+) tetanus toxoid (TRI-IMMUNOL). It was reported that the patient's mom attributed the patient's PDD to therapy with diphtheria toxoid (+) pertussis whole cell vaccine (+) tetanus toxoid (TRI-IMMUNOL) and MMR vaccine. Follow up information reported the following adverse events: three ear infections (April 1992), excessive weight gain (October 1997), occasional abdominal pain (approximately 19-JUL-1998) and bowel pattern with diarrhea alternating with constipation at 2 week intervals, treated with Konsyl, foul smelling stool, urinary problems (October 1997), fell with loss of consciousness for 2 minutes (approximately 06-NOV-1998), nonspecific eye irritation and eye pain (07-JUN-1999), furuncles on buttock and groin area (19-APR-2001) treated with Keflex, Bactroban and Tobrex, fall with mild neck strain (August 2001), seasonal allergies (12-APR-2002) treated with Astelin, Allegra-D, and eye drops, ulceration and vesicles on lips (23-JUL-2002) treated with Zovirax, rash (01-OCT-2003) treated with Desitin, enuresis at night (04-APR-2003), back and left pelvic crest pain (08-DEC-2004) and gastroenteritis (04-DEC-2003) treated with clear liquid diet for one day. Upon internal review, pervasive developmental disorder was considered to be an other important medical event (OMIC). No further information is available.  All medical records are available upon request.