Sex: M
Vaccine: HEP, DTAP, HIBV, MMR, OPV, VARCEL
Symptoms: Conjunctivitis, Cough, Diarrhoea, Drug toxicity, Dyspnoea
Clinical narrative: Information has been received regarding a case in litigation concerning a minor male patient who was exposed 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 driven power plants.  The mercury included in thimerosal laden products and power plants 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,a nd 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 impairments and cumulative mercury toxicity were considered to be other important medical events.  Additional information has been received from a lawyer and medial records regarding a case in litigation concerning a male with a history of candidiasis, "rare otitis media" and no known allergies reported.  it was reported that the patient was born after a 38 week gestation.  It was reported that there were no significant complications during the pregnancy.  On 21-JUN-1996, the patient was vaccinated intramuscularly with the first dose of 0.5 cc of hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown).  It was reported that on 29-AUG-1996, the patient was vaccinated with the first dose of diphtheria toxoid (+) Hib conj vaccine (tet toxoid) (+) pertussis acellular Biken vaccine (+) tetanus toxoid (TRIHIBIT) (Lot#432-655), the first dose of poliovirus vaccine live oral (ORIMUNE) (Lot#433-390) and the second dose of hepatitis B virus (unspecified) (lot#2048A2).  On 04-NOV-1996, the patient was vaccinated with the second dose of diphtheria toxoid (+) Hib conj vaccine (tet toxoid) (+) pertussis acellular Biken vaccine (+) tetanus toxoid (TRIHIBIT) (lot# 438-088) and the second dose of poliovirus vaccine live oral (ORIMUNE) (Lot#434-218).  On 13-JAN-1997, the patient was vaccinated with the third dose of diphtheria toxoid (+) Hib conj vaccine (tet toxoid) (+) pertussis acellular Biken vaccine live oral (ORIMUNE) (lot#434-218) and the third dose of hepatitis B virus the first dose of measles-mumps-rubella (Lot#621081/0287E), the fourth dose of diphtheria toxoid (+) Hib conj vaccine (tet toxoid) (+) pertussis acellular Biken vaccine (+) tetanus toxoid (TRIHIBIT) (lot#443-263) and a tuberculin purified protein derivative (PPD TINE TEST) (lot#01757P).  On 15-AUG-2000, the patient, the patient was vaccinated with a fifth dose of diphtheria toxoid (+) Hib conj vaccine (tet toxoid) (+) pertussis acellular Biken vaccine (+) tetanus toxoid (TRIHIBIT) (Lot#472-655), the fourth dose of poliovirus vaccine live oral (ORIMUNE) (lot#R13662), the second dose of measles-mumps-rubella vaccine (Lot#635124/0399K) and a varicella virus vaccine live (lot#634842/1867J).  A physician note dated 03-NOV-2000 reported that the patient was evaluated and had been diagnosed with autism spectrum disorder (mild end of spectrum) and possible Asperger's syndrome.  AT that time the patient was referred to a developmental pediatrician.  An office note dated 17-NOV-2000 reported that the patient did not meet the criteria for infantile autism.  The patient appeared to have a communication disorder and may fall within the mild pervasive developmental disorder not otherwise specified spectrum.  It was believed that there was an unspecified familial etiology.  There was no evidence to suggest neither childhood distegrative disorder or a neurdegenerative process.  It was reported that his history of pica justifies an assessment of lead level.  The office note dated 17-NOV-2000 reported that the patient demonstrated some attention deficits as well as some impulsivity.  An office note dated 17-NOV-2000, reported that the patient had experienced minor neuromotor abnormalities including a visual motor delay.  An office note fated 19-JUN-2002 reported that the patient received a diagnosis of Pervasive Developmental Disorder at an approximate age of 4 1/2 years old after an evaluation with a developmental pediatrician.  An office note dated 19-JUN-2002 reported that the patient's vision and hearing had been assessed and felt to be within normal limits.  The office note dated 19-JUN-2002 reported that the patient had undergone a psychoeducational assessment in approximately May 2002 and the patient was reported to have a full scale IQ of 95.  On the Stanford Binet IV the patient was noted to have a verbal reasoning score of 93 and an abstract visual reasoning score of 89 with a quantitative reasoning score of 106 and a short term memory score of 94.  The office note dated 19-JUN-2002 reported that the patient's history and observation of his behavioral profile was consistent with the diagnosis  of Pervasive Development  Disorder.  It was reported that behavior, the patient appeared to be struggling with features of an attention deficit disorder including overactivity and a short attention span.  The patient's physical examination was within normal limits as well as he was reported to have a "classic neurological examination".  An office note dated 09-JUN-2003 reported that the patient was taken to th emergency room and diagnosed with acute behavioral crisis.  The patient was controlled with risperidone (RISPERDAL).  On an unspecified date, an office note reported that the patient had experienced an adjustment disorder with mixed disturbance of emotions.  The patient was treated with risperidone (RISPERDAL) increased to 0.5 mg, oral, twice a day.  An office note dated 16-JUN-2003, reported that the patient had been started on the (RISPERDAL) increased to 0.5 mg, oral, twice a day following an emergency room visit, however, the patient's mother had concerns over the medications and had given the patient 0.5 mg, oral "every bedtime".  The office note dated 16-JUN-2006 reported that the patient was on " the high end of the autistic spectrum" and it was reported that the patient had a good response to risperidone (RISPERDAL).  On 29-APR-2004, an office note assessed the patient with autism and reported increased symptoms were previously well controlled.  At the time of this report, the outcome of the events were unknown.  Follow up information received on 12-SEP-2006 contained the following adverse experiences; rash (13-JAN-1997), abdominal pain with gas (03-FEB-1998), chronic intermittent diarrhea with pain (17-JUN-1999), possible lactose intolerant (17-JUN-1999), probable increased fat induced gastrointestinal disturbances (01-JUL-1999), cold and upper respiratory infection (06-MAR-2000), stitches places (03-APR-2000), right leg pain (03-APR-2002), conjunctivitis (19-DEC-2002), impacted cerumen (24-FEB-2003), astigmatism disorder (19-JAN-2005), cough, trouble breathing, throwing up and mark left forearm (dates unknown).  Upon internal review, the events of pervasive developmental disorder and autism were considered to be other important medical events.  No further information is available.  All available medical records will be provided upon request.  (OMIC)