Age: 1.5
Sex: M
Vaccine: HEP
Symptoms: Drug toxicity, Immune system disorder, Laboratory test abnormal, Mental retardation severity unspecified, Neurodevelopmental disorder
Clinical narrative: This report describes the occurrence of Autistic Disorder in an 18-month old male who was vaccinated with hepatitis B vaccine recombinant for prophylaxis. This report was received as part of litigation proceedings, with forwarding of medical records. The subject's past medical history included deep hoarse cough, runny nose, not sleeping, poor appetite, yeast overgrowth between 12-18 months treated with antibiotics, viral syndrome, congestion, dry cough, pulling at ears, fever, slight temperature, restless, wet cough, productive greenish sputum, 101 temperature, crying, hay fever possibly, chronic ear infection from twelve months of age, and more then six colds a year. A spine sonogram was performed on 12/14/95. Perinatal history included: high blood pressure and yeast infection at 7 and a half months and Monistat was used to treat the infection, newborn summary impression on 7/28/95 was "term normal new baby.: Family history included hay fever, asthma, mental illness and depression on father's side, father had childhood asthma and allergies, paternal grandfather had stomach cancer, mother's siblings had stomach ulcers and migraine headaches, maternal grandfather had arthritis, maternal great grandparent had heart disease, maternal side had skin cancer, maternal grandparents and maternal aunts and paternal grandfather had high blood pressure, his sister also had asthma. Concurrent medications included unspecified medication to treat eat infections. The subject's school district had a problem with  his MMR because it was given prior to his first birthday. The child had no reaction from neither MMR nor DTP. Developmental history revealed that the subject had normal developmental milestones until 18 months old (pt screening/data questionnaire for TFLDS). The form noted the subject was babbling at approximately five months, walked at 12 months, first words were spoken at approximately thirteen months. He had used descriptive words from April 1998 to present. This report noted "had 10 words between 13 and 18 months and then lost them. He started talking again in April 1998 at two years, four months following therapy. He currently "has approximately 15 expressive words and 25-30 receptive labels. The subject also had "Vineland: composite 65 (19 months)," testing 5/27/98. Under "self stemming" it was noted "hand flapping, nose picking, dropping objects and watching them fall, splashing in water." His eye contact was reported as variable and described as "frequently avoids eye contact, has improved since he began therapy." Other development difficulties on the questionnaire included language delays, motor planning problems, auditory processing difficulty with onset at 18 months, auditory processing difficulties with both receptive and expressive language, "not sure if visual skill difficulty," and organization skill difficulty was described as "has trouble initiating a sequence or actions and speaking." Other strengths or weaknesses noted: strong analytical skills, short attention span and mild tantrums. Psychosocial included: the onset of behavioral issues was 18 months which were described as mild tantrums and "self-stims"; Fidgoty/Hyperactive sometimes when under stress; Can't concentrate/easily distractible at 18 months was described as "will gaze to avoid task or abandon task and move on to something else"; Obsessive/compulsive tendencies were described as "lined up objects, particular about order"; Frustrated when unable to communicate"; Activity level was noted as "normal" however, the subject had occasional staring spells and "tuned out" that was described as "gazes usually when demands are being placed on him." The subject had food cravings for "apples and apple juice." The Austistic/PDD profile indicated: "normal" until 18 months described as "lost all words and less social." Impairment in social interactions included: impairment with nonverbal behaviors at 18 months, described as avoided eye contact; failure to develop peer relationships at 18 months, described as "would move away if someone tried to interact with him or join his play; lack of sharing interests etc. at 18 months and described as loner; and lack of social or emotional reciprocity." Impairments in communications included impairment to sustain or initiate speech at 18 months described as "loss all his words," spontaneous play described as plays appropriately, but not varied and videos, trains and computer are his favorites (no longer allowed to watch videos). Repetitive and stereotyped patterns of behavior, interests, and activities included repetitive motor mannerisms with onset of 18 months described as flapping, splashing, and marching; persistent preoccupation with parts of objects at 2 1/2 years described as watches train wheels as he pushes train long track. According to the subject's father written history of the subject on 7/10/98, his development appeared normal for the first eighteen months. The father noted he began walking at age 13 months and at 16 months he had about 10 words. A home video showed that his eye contact and attending were good. In the winter of 1997 the father reported that the subject slowly lost the words he had gained. He also had many minor colds and the chicken pox. By spring of 1997 the child had lost "all" words and did not respond to loud sounds. His eye contact and attending were very low. The subject's hearing was checked, which was OK. He noted "we began doing play therapy with him at home, which improved his eye contact and attending almost immediately." In the summer of 1997, he noted that the subject was enrolled in a preschool program. His health was good for the first month, and his eye contact and attending continued to improve. He did speak words, such as "Hi" and "Don't," but very rarely. In August of 1997, he caught a few colds. The father noted "from September to December 1997, he was sick constantly with either a runny nose, a fever or both. Most of the time the colds were not severe enough to cause us to seek medical attention. When we did seek medical attention, generally he was prescribed very weak antibiotics, which seems to have no effect. We noticed that whenever he was well, his eye contact and attending would improve immediately, but when he became sick, his eye contact and attending would decline such that his development progress either halted or regressed. In November of 1997, he had regained about four words. During the last two weeks of November he had two colds back to back such that by December of 1997 he had low eye contact, attending and lost ALL of his speech. The therapists we were working with agreed that he regressed substantially when he was sick. From Mid-December 1997 to mid-February 1998 the father described this period as "he was completely well during the holidays and he was much more social to relatives." In late January, discrete trial training started and in February he was attending preschool. His eye contact and attending improved, however, during this period he had no speech. In mid-February 1997 through March 1997 he had chronic minor cold which seemed to stunt his progress. Sometime she would regress. During this period, his eye contact and attending improved significantly and he began to regain speech. In April 1997 his health was very good and he made excellent progress with his therapy, i.e., his eye contact and attending were very good and he developed several new words. In May, his eye contact and attending progress slowed. He had a runny nose much of the time, but no fever. In June 1997 to present the father reported "overall his health has been much better, but he often has a runny nose." The father further reported "when he gets sick he seems to go through sick-well-sick cycles. Sometimes he goes through two or three fo these sick-well-sick cycles over the course of two to three weeks. On an unspecified date, a child's health questionnaire revealed that specifically, at six months he had his first tooth, at 14 months he spolke 4-6 words, and weaned to a cup at 12 months. The subject received Engerix B on 8/28/95 (lot 1860A2), 9/28/95 (lot 1502A2), and 5/1/96 (lot 1972A2). He also received polio vaccine (9/28/95, 12/1/95, 1/29/97), diphtheria, pertussis and tetanus (9/28/95, 12/1/95, 2/6/96, 1/29/97), Hib vaccine (9/28/95, 12/1/95, 2/6/96, 10/28/96), MMR (7/23/96). On this immunization record sheet it was noted "1997 well child-baseline various." (The subject's school district had a problem with his MMR because it was given prior to his first birthday." The child had "no reaction from neither MMR nor DTP). His attorney's alleged claim: "As a result of the mercury in the thimerosal-containing vaccinations that the children received as infants. The children now suffer, and in the future will continue to suffer, from the toxic neurological effects of mercury poisoning." The following information was obtained from medical records. The subject remained under the care of his first primary physician from July 1995 to July 1996 who was the Engerix vaccine provider. From July 1996 to 7/30/98 the subject was seen by his second primary care physician. During the time from 18 months of age 1/29/97 to 7/30/98, the physician noted that the subject experienced cry intermittently, active bowel sounds-soft without "HSM"/masses, not "bad" chickenpox, when called does not respond at times, slightly painful to touch, erythematous papule, rubbing his eyes, tympanic pale canal, left ear lobe red and swollen that were very erythematous, runny nose with greenish mucus, croupy cough and increased irritability. During this time period, the subject reportedly was diagnosed with insect bites, questionable allergic conjunctivitis, upper respiratory tract infection, pharyngitis, and questionable viral syndrome. The physician impression: special delay, rule out hearing disorder and child was referred. The physician had recommended : ipecac syrup. The physician had prescribed infant Tylenol, polyflouride, chloral hydrate, Tylenol, Triaminic DM, Duricef. Additional history: the subject "appeared to have severe abdominal pain, crying, irritable and visit to the ER in January 1997." A stomacy x-ray at that time was normal. On 1/29/97 the physician ha  noted lead evaluation given. The lead evaluation form on 1/29/97 ha dnoted "that the child had lived in or regularly visited a house or building where paint was chipping or peeling." The physician noted on 7/2/97 well visit, fussy and tired during examine, difficult to evaluate behavior, and eye contact improved with increased hearing. At this time the mother reported that the subject was quiet, thoughtful, temprament which was similar to the father. The mother describes the child as enjoying gross motor activities. The mother did not feel description of communication was accurate in audiologist summary (physician did not have summary at that time). The physician had noted "has pica" and advised mother of safety issues. The mother had previously contacted the physician on 3/9/98 to inform him that the subject ingested paint at two years old. She confirmed that the room had been painted one and a half years ago. The physician noted that Pb level was needed. The physician impression on 7/30/98 indicated grow excellent, and pervasive development delay in "PTN." At this well child visit, the mother had "declined referral to immunologist." The pediatrician had recommended Mantoux (TB), UA and cholesterol. The subject was evaluated by another pediatrician on 7/13/98 who specializes in (attention-deficit disorder) ADD and autism and looks at the immune system. The physician noted the subject had some "mild wild-off-weepiness and letharpy" which were primary symptoms that lasted only a few days. At this time a pt screening/data questionnaire for TFLDS was completed on (age at time of "intake" evaluation two years, 11 months). The physician had entered diagnoses of "Autistic Disorder and Mental Disorder." The subject was diangosed with Autistic Disorder on 11/3/97 by clinical and forensic psychology, diagnosed with autism in December 1997 by a child psychologist and in January 1998 he was diagnosed with Autistic Disorder and Mental Disorder by the Director of Autism Partnership. The subject was only reported as having a learning disorder, not his sibling. Past medical histroy included: chicken pox at 20 months 3/15/97 and hay fever with onset at 18-20 months and noted as active with frequency congestion and colds, constipation, and diarrhea. The subject seemed "particularly sick (colds, congestion and runny nose) during September, October, November and December of 1997 (Pt's sister was hospitalized in September 1997 for asthma). Seizures were noted as "no." On the form, upon physical examination, it was noted muscle tone was "normal." The neurological examine indicated that coordination was abnormal on 5/27/98 described as "below tow years according to the subject's school district." It was noted that the subject was right handedness. The gross motor assessment reported on 5/27/98 indicated "below two years according to the subject's school district assessment." The child's health questionnaire reported frequent temper tantrums, can't concentrate (short attention span), and learning disability, (dates were not provided). From 7/13/98 to 6/27/01 the subject was under the care of the ADD specialist/pediatrician. The subject's father reported that his son woke up this morning with a runny nose. The pediatrician also noted the following negatives during this time period: tantruming, croupy cough, waking up congested, seasonal allergies, flu, vomited, hypersensitive to noise, squirmy at times, nail biting, rash, red small bumps on cheeks, back, leg, arms, and left side of face, processing varies, crabby, diarrhea, stool pretty loose, "self stimming," nasal congestion, speech decreased, increased "stim" four days, fuzzier four days, fuzzy eyes last four days, a little hyper when touched, he gets really sensitive, low grade fever, hyperness, chesty cough that produces mocous distracted, biting carpet, eating things he should not, every stimmy, coordination decreased, slight hoarseness in voice, slight fever, eye contact decreased for the past five days, he's been up and down, still a little fuzzy eyed/slightly feverish, cough and congested other days he's got better eye contact, on a sick-well-sick cycle, speech decreased, appetite was ferocious and the subject was hyper, language and social skills have not improved as much, he still makes progress but then regresses." The physician note don 7/31/00 "all of a sudden while having fun playing basketball a stricken look came over his him" (sentence not legible). There was a notation, "they were concerned about him having seizure." On 4/8/99, the subject's mother reported "per your direction, we administered the Biaxin and within a few days, he was completely clear. His eye contact was the best ever and his speech increased and he began to imitate other children and interact with our daughter." The mother further reported, "we stopped giving him Biaxin two days ago and today his eyes were down, his speech is down, and I have a general feeling that his health is going down again. He seems worse in the morning and seems to improve later in the day. Please advise us on how to proceed." The pediatrician had recorded the following positives: seemed a little more tactile sensitive, socialization increased, rash fading, overall demeanor better, overall health has been very good, eye contact is good, speech increased, and interaction with other children has increased, his teacher says he's been great, bright eyed lately, "an increase in receptive speech," decreased "stim," increased coordination, increased good behavior, increased eye contact, increased toilet training, and doesn't seem awkwardly sick, continuing to say alphabet, teachers reported improvement in the table work and circle time, wrote his first word on the chalk board at school, eyes were reported as "clear/alert, sleeping well, and waking rested." The pediatrician reported "benefit with Zoloft, increased language, focus, attention pretty good, a little hyper today, but he questioned to keep, however, sleep was good, waking up rested, and staying healthy." The pediatrician reported "not hyper with banana flavored Eryped and not at same level as when on Biaxin in terms of eye contact and very sensitive." The physician noted, that when Valtrex was given the subject had been "a little off," not tuned in and minor regressions. The pediatrician believed within a half hour after Valtrex, the subject perks up as if hyper, but then it wears off and leaves him a little "spacey," cognition not as good, not progressing as good, as less compliant." The pediatrician further noted, increased dose of Paxil, if not make a difference in terms of increasing his speech. Prozac improved speech but made him "hyper and restless." The pediatrician questioned if "running increased low grade temps was due to food allergies or drug allergies i.e. (word not legible) and Zyrtec." The pediatrician questioned if "allergic as due to Zyrtec. The pediatrician also prescribed, Valproate, Amoxicillin, Claritin, Zoloft, Valtrex, Nasonex, Zyrtec, Celexa, Lamisil, Diflucan, Pamvir, Nizoril, Sudafed, Depakote, Paxil, Prozac, Cefzil, flintstone vitamins, vitamin B6, magnesium, rynatan, Cefzil. The subject's having "negatives to food dyes, corn chips, high sugar food, regular and diet pepsi, ear medications and sometimes silly, giggly and laughing after cornchips." the pediatrician noted that the subject was seeing an allergist pinpoint all food allergies. On 7/30/98, the mother had "declined referral to immunologist." On 7/13/98, and in July 98 lab analyses performed. Lab analyses were performed on 3/30/00 and in March 01, lab analyses were performed in April and June 01. In March 2000 an EEG was performed which was abnormal. On 4/11/01 mumps antibody panel revealed "no evidence of Ig classes or subclass deficiency." On 4/26/01 Myelin Basic Protein lab analysis was abnormal. The subject was evaluated by immunologist on 8/14/00 to at least 3/26/02 because the mother states "that child is autistic and she wants heavy metals investigated." Health history noted: check for heavy metal toxicity, discuss allergies, and nutrition. Symptoms from health history included: nervousness, numbness (perhaps mouth and tongue), feet and hands hypersensitive, bloating, bowel changes, constipation, diarrhea, excessive hunger, excessive thirst, gas, questioned rapid heart beat, hives, itching, rash, hay fever, questioned double vision and blurred vision, bleeding gums, sinus problems, questioned vision flashes, questioned vision halos. An initial pt info sheet reported additional diagnoses of : disease Immune Dysregulation and Allergy Syndrome by the ADD specialist/pediatrician in July 98. Allergies were listed as: inhalant allergies and possibly wheat, peptides for casein and gluten. At that time, the subject's mother reported the child was fine the first year - walked and talked by end of first year. Family moved around the first birthday and moving boxes had dust or mild or pesticide. The mother could not sleep nor breath easily around her. Around age 19 months, he had a few words, but stopped talking then (June-July). He will blink  lights rapidly and squints at chandelier. He will chew on fibers and clothes and rugs." The mother had reported "many evidence of autisms." The subject's mother also reported that a central vision test was performed and it was fine. The subject "has been on an ADA home program for 12-15 hours weekly and has occupational therapy." The mother also reported that "he sniffs food before he eats it." Corn was an issue - "causes giggling for the rest of the day and possible cantaloup. He becomes very hyper and giggly and giddy after sugar, then the next day his attention is down, this can last up to a week." She also reported that he had been two years on constant anti-fungal and antiviral. The subject's mother reported that he was taking Famvir and was on Valtrex. Originally on Nizoral, then Diflucan and recently Lamisil. He had external signs which included: rash around rectum, palms of his hands are hypersensitive, very sensitive taste sensation, upper teeth are very sensitive - he does not want them to be brushed."  She reported that "has had varicella on 3/17/97, but was recently re-exposed." It was shortly following initial varicella that he began retrogressing. Initial one was severe, in scalp and ears, etc. His coordination would leave at the cycles of illness, *e.g. arm would flap above shoulder; 2 days later would become sick.* How constant cycles of illness - but less severe and less frequent... He formerly did not sweat - now he perspires some and then he is doing better. His "body temperature was low, when normal: it is a fever." *F/UP report on 12/27/02: On physical exam, the MD noted, "His speech was below average. His affect and behavior were appropriate." He creceived the results of metabolic testing performed by another MD; please see Lab Data section. The MD's impressions were "1) Autism. 2) Probable environmental toxicity. 4) [sic] Possible immune dysfunction. 5) Gastroenteritis - functional." On the receipt for the office visit, he recorded his Dx's as "1) 277.5 Metabolic disorder. 2) 985.9 Minerals, toxic, unspecified." He prescribed dimathylsaccinic acid (IMSA) and "Stone Age diet". Hair analysis performed on 8/14/00 and fecal analysis performed on 8/21/00 revealed abnormal results. Please see Lab Data section. The subject remained under the care of this MD until at least 3/26/02. On 11/20/00, he was "Vocalizing more - repeating words and using phrases including some new words... He is creating playing scenarios. Imprement in recall". On 8/27/01, the MD noted "Some better word use - putting words together. Pointing but more sound sensitive again; Hair minerals - now some Hg [mercury] coming out... Hg and [silver] probably contaminante." On 9/25/01, the subject was 'Handwriting his name now. Counts to 20." During this time, fecal, urine, and hair analyses revealed abnormal results. Please see Lab Data section. The MD made add'l Dx's of mineral metabolic disorder (10/11/00), allergic rhinitis (1/16/01), unspec'd allergy y(1/16/01), viral syndrome (1/16/01), immune mechanism disorder (5/29/01), "Copper toxicity?" (6/21/01), nutritional deficiency (7/21/01), and pyroluria (3/26/02). He prescribed amoxicillin / clevulanate (Augmentin), disethyl sulfone (MSM), penicillaming (Cuprimina), IMPS, "EPO", and fluconazole (Diflucan). The subject was evaluated by a neurologist and a neuropsychologist on 3/22/01. Awake and sleep electroencephalograms (EEG) revealed abnormalities. Please see Lab Data section. The neuropsychologist administered the Peabody, which demonstrated "a vocabulary level of a 2 and 8 mts child. He was just able to follow one command at a time and he has conflicts for a verbal reasoning." Under 'Fonologic Aspect', she recorded "Apparently normal". Under "Cognitive Area", she recorded, "He is in a preoperational level between 5 & 6 yrs old." Psychomotor abilities were evaluated using the Pick Vayer scale. Dynamic hand coordination and balance were rated at a developmental age of 5 yrs. Dynamic general coordination and spatial organization were rated at a developmental age of 5 yrs. Under "Visomotor Area", the neuropsychologist recorded, "He is in a 3-yr child level." Under "Final Conclusions", she wrote "[The subject] is an autistic boy with; 1) Vocabulary age in 2 and 8 months. C) Visual motor coordination in a 3-year level. C) In 4 yr level motor development. D) Good cognitive abilities." She recommended fibroblast growth factor, continuation of "the special school and program therapy", and an in-home reading program. The neurologist prescribed fibroblast growth factor (FGP2) and valproic acid. The subject remained under the care of the neurologist until at least 5/9/02. EEGs performed 9/21/01 and 5/9/02 showed improvements. Please see Lab Data section. The subject was also evaluated by the neuropsychologist on 9/21/01. The Peabody instrument indicated that his vocabulary improved "from 2.8 yrs to 3.3 yrs. He keep [sic] was just able to follow 2 commands at a time and he has conflicts for a verbal reasoning." Under "Cognitive Area", she recorded, "He is improving the conservation area and keeps in a prooperational level between 5 & 6 yrs old." Using the Pick Vayer scale, dynamic hand coordination, dynamic general coordination, balance, and spatial organization were rated at a developmental age of 5 yrs. Under "Visomotor Area", the neuropsychologist wrote, "He is in a 5-yr child level, 2 yrs more than in the past test." Under "Final Conclusions", she wrote, "[The subject] improved: A) Vocabulary age in 3 mts. B) Hand coordination, general coordination and balance in 2 yrs." On 9/21/01, the neurologist continued fibroblast growth factor and walproic acid therapy, and prescribed "SHCA". On 5/9/02, the neurologist continued valproic acid therapy and prescribed "Neuro-Pro C". From 4/12/01 to at least 4/23/02, the subject was under the care of a neuroimmunologist. The MD's assessment was "autism". The MD conducted a phone consultation on 5/29/01. He recorded the following note. "During each late spring, he regresses, loses words, he has more stimming [self-stimulation], less eye contact, up to June, then in August gets worse. The wetter the weather, the worse." He "strongly" encouraged the use of IMSA for cholation and recommended the use of bifodobacterium. He prescribed transdermal glutathione, loratadine (Claritin), and nimodipine (Nimotop). On 9/4/01, the subject's gross motor skills were "almost age appropriate. Running great now. Fine motor skills: improving. Social skills: does want to interact w/kids... Receptive skills: improving. Verbal skills: has shown increased words." He noted that the subject was receiving fibroblast growth factor. He prescribed "Zym Prime" and "Peptizide". On 1/15/02, the MD noted that the subject was saying the following phrases: "Are you OK?", "Good morning", "Get away", and "I want cereal." He was potty trained for urine. The MD prescribed N-acetyl glucosamine, glutamine, ascorbic acid, Vitamin E, sclenium, intravenous betacarotene, and ketoconazole. As of 4/23/02 he was playing hide-and-seek w/his sister, was "More social w/relatives, very friendly." His receptive skills were "improving". He was "a bit weepy." The MD wrote, "He is doing quite well." The subject was under the care of another MD from 1/14/02 until at least 6/19/02. At the time of the initial evaluation, the subject was receiving carein- and gluten-free diet, ascorbic acid, co-enzyme Q-10, cranberry extract for "yeast control", "BrainChild Nutritionals Spectrum Support II", calcium w/Vitamin D, ProEPA, "Citramin II", melatonin for insomnia, transdermal glutathione, "DMPS" injections for chelsation, sublingual fibroblast growth factor (FGF2), "Homeopathic SHOC", citalopram (Celexa) for treatment of "weepy moods", occupational therapy, advanced behavioral analysis, and speech therapy. At the initial evaluation, the parents reported "one possible seizure"; electroencephalography subsequently revealed "possible seizure activity" according to the parents. The MD noted echolalie, "repetitive", "poor" expressive language, ability to follow single step and simple two-step commands, inadequate protein intake, "hypoglycemic Sx's, paca, "compulsive eating", parallel socialization, isolation, "little" interaction, flazus, stuffy nose, mood swings twice/month, "Jekyll/Hyde" mood, sadness, angst, "foggy brain", occasional nervousness, fear of flying and of the dark, and ritualistic lining up objects. He was reported to be easy-going, however. Eye contact "varies with how he's feeling." The subject was a "master at puzzles." He "acts strange" when he ate corn and drank only bottled water. He had "frequent mycoplasma, buge, fungal. Gastrointestinal tract." He had "very loose stools, rare firm stools. Gives probiotics. Was on Diflucan [flucconazole[ and went thru dis-off reaction." The MD noted that the subject was "treated for yeast for over 1 yr 1999 but quit for chalation." The following Sx's were noted on a "Symptom Record": "severe" focus/attention, "severe" attention deficit disorder Sx's, "moderate" hyperactivity, "severe" perseverates/fixates, "moderate" foggy brain, "moderate" fine motor, "moderate" eye contact, "moderate" divergent gaze, "moderate-to-severe" fears/phobias, "moderate" nervousness, "severe" repetitive behavior, "severe" self stimulation, "mild" hand flapping, "moderate-to-severe" sound sensitivity, and "moderate-to-severe" tactile sensitivity. The "Problem List/Assessment" included "speech, socialization, fixated on toys, attention, repetitive behavior, views objects w/peripheral vision and holds close to face, sound sensitive, craves tickling, towels and carpot biting, yeast prob's". Hair and blood analyses performed on 1/14/02 yielded abnormal results. Please see Lab Data section. The MD made Dx's of "copper/zinc imbalance, zinc deficiency, elevated histamine, copper overload, pyroluria." The MD rated the elevated histamine concentration and pyroluria as "severe" and the other diagnoses as "mild". He prescribed ascorbic acid, vitamin B6, "PSP", trimethylgycine, methionine, acidophilus, "Cal/Mag", cod liver oil, inositol, and "MTP". He recommended continuation of the casein- and gluten-free diet, and continued use of only bottled water. Stool analysis performed on 4/10/02 revealed the presence of Diantamate (?) fragilis. On 5/23/02, the subject's mother reported that he was "doing really well, working independently, more echolalia. Also more OCD [obsessive-compulsive disorder] behaviors. MD instructed to increase zinc". Following the reported onset of autism, the subject experienced feveres, coughs, an ear infection, URI, viral pharyngitis, infected insect bites, allergic conjunctivitis, allergic rhinitis, and multiple food allergies. He also ingested paint. These events were not reported as adverse events due to vax admin, but were found during the course of review of the subject's medical records. Therefore, they are not listed as adverse events. The most recent info, received on 12/10/02, did not provide the outcomes of the reported events. Info. received on 8/23/02 indicated that the autism persisted as of 6/19/02. At that time, the subject was "doing really well, working independently, more echolalia. Also more OCD behaviors." The outcome of the alleged mercury poisoning was not provided.