Sex: M
Vaccine: DTAP, HEP, HIBV, OPV
Symptoms: Speech disorder developmental, Tympanometry normal
Clinical narrative: This case was reported by a lawyer and described the occurrence of nerve injury in a male subject who was vaccinated with Engerix B, Dtpa, OPV, Hib, MMR II for prophylaxis. The subject was vaccinated with Engerix B on 27 January 1995, 01 March 1995, and 30 June 1995. According to the legal complaint, at an unspecified time after vaccination with Engerix B, the subject experienced "serious and permanent neurological injuries" which were "alleged to be caused by Thimerosal." The subject was also alleged to have experienced a neurological disorder. In November 1997, the subject was diagnosed with autism and mental retardation. This case was assessed as medically serious. Follow up information was received on 30 March 2007 via medical records. Pediatrician's progress notes dated 10 July 1996 indicated language delay/expressive speech delay. On 18 July 1996, the subject was seen for an initial neurodevelopmental evaluation. Impression following examination was of a significant cognitive delay manifested primarily in lack of speech. Language development was at a 7-month level, and problem solving skills were at an 11-month-level. Diagnoses included significant cognitive delay (expressive language at 6 months, receptive language less than 9 months, and problem solving at 11 months with scatter) and neuromotor abnormalities. Neurobehavioral diagnoses included bruxism and short attention span. A physical therapy evaluation was performed on the same date, and the subject was noted to be functioning "in line with gross motor development". A family history of speech delay was also noted. A psychological examination was performed on 02 January 1997 and confirmed neurodevelopmental diagnoses. A follow up neurodevelopmental evaluation resulted in diagnoses of "minor"neuromotor dysfunction (variable TONE), mental retardation, and neurobehavioral abnormalities (bruxism). There were "no physical findings suggestive of a specific recognizable syndrome". On 06 November 1997, the subject underwent a psychological evaluation due to concerns of lack of speech. He had previously been diagnosed with mental retardation in January 1997, in addition to neuromotor abnormalities. The subject had spoken his first word at 9 months of age, but had not spoken since that time. Examination including Bayley Scales of Infant Development showed cognitive abilities in the "significantly delayed" performance range, and adaptive functioning was in the low range according to the Vineland Behavior Scales. Diagnoses included mental retardation and autism, with educational problems noted. A speech and language evaluation was subsequently performed on 03 December 1997, with findings including severe delays in the development of receptive and expressive language, as well as atypical development of overall communication skills, Overall language function was at the 7-month level, and it was noted that the subject had made no progress in the development of communication skills in the preceding year. Recommendations included "intensive" speech and language intervention. On 01 July 1999, the subject was seen in a developmental pediatric consultation. Concerns included bruxism when excited, inability to feed or dress himself, and continued inability to communicate. Diagnostic formulation was mental retardation (mental age 18 to 21 months), verbal communication disorder, pervasive developmental delay NOS, and bruxism. In a letter dated 30 July 2000, the subject's pediatrician recommended speech therapy following evaluation for severe cognitive developmental delay and global speech delay. The physician noted that the subject exhibited many characteristics of a pervasive developmental disorder. An occupational therapy examination in October 2001 resulted in clinical impressions of moderate to severe delays in fine motor, social, and play skills, and atypical sensory processing. On 31 December 2001, evaluation for special needs program participation resulted in clinical impressions of moderate to severe delays in fine motor and play skills, atypical sensory processing, and severe expressive, receptive, and pragmatic (social) language disorder. In a subsequent letter dated 11 February 2002, the pediatrician described the subject as having a "severe communication disorder in association with his autism", characterized as an inability to communicate using spoken language. A behavioral psychological evaluation was performed on 03 June 2002 for provisional diagnoses of pervasive developmental disorder, mixed receptive expressive language disorder, enuresis and encopresis, and academic problems. At the time of vaccination, he remained nonverbal and communicated primarily by gestures and leading. He was enrolled in a special education program that included speech therapy, but had not progresses in school nor gained skills per the mother's assessment. The subject and his mother participated in family therapy through at least November 2002.