Sex: M
Vaccine: HEP
Symptoms: Convulsion, Developmental delay, Disturbance in social behaviour, Electroencephalogram abnormal, Electroencephalogram 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, Recombivax HB, DTPa-HIB, DTap, Hib, Ipv, OPV, MMR II, Varivax for prophylaxis. On 14 February 1997 the subject received the first dose of Engerix B (unknown). According to the legal complaint, at an unspecified time after vaccination with hepatitis B vaccine, the subject experienced "serious and permanent neurological injuries" which were "alleged to be caused by Thimerosal." The subject also reportedly experienced a neurodevelopmental disorder. In May 1999, the subject was diagnosed with mental retardation and autism. The events of autism and mental retardation were assessed as medically serious by manufacturer. Follow up information was received on 30 March 2007 via medical records. According to a pediatrician's notes dated 19 June 1998, the subject experienced delayed walking. Examination revealed legs, hips, and plantar responses that were within normal limits. On 11 February 1999, concerns included language delay and possible conginitive delays. At that time, he was reportedly babbling but was speaking no words. The subject was evaluated by a neurologist on 11 May 1999 for evaluation of global developmental delays including lack of verbal expressive language. According to his parents, the subject walked at approximately 18 months of age, and exhibited poor social skills including eye contact. The parents reported that there had been no regression of previously acquired language development or loss of previously acquired cognitive skills. The neurologist noted that the subject's severely impaired language development and qualitative impairments in social interaction appears to be clinically consistent with autism". He was seen for a follow-up neurological examination on 22 June 1999 to review "minimally abnormal" electroencephalogram results. Cognitive development was reportedly between nine and eleven months, fine motor skills between 11 and 12 months, gross motor skills between 16 and 19 months, and social skills between 8 and 9 months. He was enrolled in an educational program for language therapy and social skills development. In October 1999, notes indicated concern about the muscle development of the tongue and a "somewhat shortened lingual frenulum", which per the evaluating pediatrician did not "in any way delay language development except in the area of pronunciation of certain sounds. "On 17 August 1999, the subject underwent a speech and language evaluation. It was noted that the primary language spoken in the home was foreign, and that the subject has spoken any words. Assessment by the speech pathologist was of "severe"delays in the development of receptive and expressive language consistent with a diagnosis of autism spectrum disorder. On 28 October 1999, the subject underwent a psychological evaluation. ON the Bayley Scales of Infant Development, the subject's mental development index score corresponded with an age equivalent of nine months. Adaptive functioning was moderately delayed, and he evidenced delayed and atypical patterns of language and communication. Behaviors and patterns were assessed to be consistent with diagnoses of autistic disorder and mental retardation. A developmental pediatric consultation took place on 13 September 1999. At the time, the subject continued to babble, and it was noted that his parents estimated that he "receptively recognizes fifteen to sixteen familiar words", including, recently, his name. Behavior was not considered to be a significant problem. Diagnostic formulation was mental retardation with the majority of the subject's abilities at the eight to ten month level, and autistic spectrum disorder. The subject was enrolled in a special education program which included physical, speech, and occupational therapy. On 23 November 1999, the subject was seen in a dental consultation for a second opinion concerning the attachment of the lingual frenulum. Impression was "tongue tie", and excision was recommended. According to a report of collaborative assessments performed by the subject's school system on 28 October 2002, the subject continued to demonstrate limited cognitive and adaptive behavior skills across all domains and consistently demonstrated characteristics of autism including limited use of communication and social interaction skills, stereotypical movements, and self stimulating behavior. Continued needs included cognitive skills, social emotional skills, adaptive behavior skills, independent living skills, communications skills, and symbolic representation, and continued speech and occupational therapy for diagnoses of mental retardation, autism, and profound speech language deficits was recommended. In February 2004, the subject underwent an electroencephalogram following an episode of loss of consciousness and a clinical indication of seizures. Findings were within normal limits.