Age: 0.3
Sex: M
Vaccine: HEP
Symptoms: Laboratory test normal, Learning disability, Mental retardation severity unspecified, Metabolic function test normal, Metal poisoning
Clinical narrative: Information has been received from a legal firm regarding a case in litigation concerning a male, who was injected with vaccines reportedly containing Thimerosal. It is alleged that between 12 and 50 micrograms of toxic mercury were injected into the patient's body with each individual dose of Thimerosal and that the schedule of injections introduced a cumulative dose of 235 micrograms of mercury from birth through 18 months of age. It is further alleged that the patient was exposed to airborne vapors and mercury through food chain, as well as mercury through other mercury-laden products, including power plant emissions from continually inhaling and ingesting industrial mercury emissions from fossil fuel driven power plants. It is further alleged that the patient had a heightened vulnerability to suffer neurological injuries from industrial mercury as a direct result of thimerosal exposure. The patient suffered serious and permanent neurological incapacity and associated learning disabilities, disorders and impairments. Upon internal review, the patient's mercury poisoning, neurological injuries, incapacity (mental, intellectual, developmental (learning disabilities, learning disorder were considered to be other important medical events. Follow up information was received, which included the patient's medical records. The patient was the 8lb 3oz 20 inches, product of a full term vaginal delivery following an uneventful pregnancy. Apgar score at birth was 9/9. The mother did take progesterone during the first three months of pregnancy. There were no problems or concerns noted at delivery. Nursery course was essentially uneventful except for the presence of a moderate degree of swelling and superficial laceration of the scalp. PKU test were reported as normal. As an infant the child was described as friendly, loving and interested in everything. He was a colicky infant, and was fed with Nutramigen, but did not require surgery. The patient's documented developmental mile stones through 12 months of age were considered age appropriate and on Track. Family history included a mother with a history of lymphoma and chemotherapy in 1990, a father who had delayed language development (not talking phases until 2 1/2 years of age), two siblings, a brother with a positive health history of speech problems (onset at age two), hearing concerns related to enlarged adenoids, attention deficit disorder and possible obsessive compulsive disorder. The brother was being treated with Ritalin, and was working at grade level. He also had a sister with unspecified vision problems, a maternal uncle with attention difficulties, an uncle who may have bipolar disorder and paternal grandmother with Alzheimer's disease. On 18-May-1995 and 30-May-1995, at 20 months of age, the patient under went developmental evaluations due to parental concerns about his speech and language development. It was noted at this time that the patient had a significant history of recurrent ear infections, with no history of reported allergies, serious illness, injury or hospitalization. The patient's general health was reported to be good and child care immunizations, which were considered up to date, included the following: 11-Oct-1993 hepatitis B vaccine (Lot # 608119/1045W), 03-Jan-1994 hepatitis B vaccine, left thigh, (Lot # 611465/0595A), 08-Nov-1993 diphtheria toxoid (+) poliovirus vaccine inactivated (+) tetanus toxoid, left leg, (Lot # 335-930), 07-Jan-1994 Dtap/Ipv (Lot # 335-930), 10-Mar-1994 Dtap/Ipv (Lot # 356-913), 17-Apr-1995 Dtap/Ipv (Lot # 378-909), 10-Sep-1997 Dtap/Ipv (Lot # 7B81603), 08-Nov-1993 Bemiparin sodium, right leg, (Lot # M180KB), 07-Jan-1994 Bemiparin sodium (Lot# M130KE), 10-Mar-1994 Bemiparin sodium right leg, (Lot# M560KF), 04-Jan-1995 Bemiparin sodium (Lot# M290LC), 08-Nov-1993 Poliovirus vaccine (Lot# 354-964), 07-Jan-1994 Poliovirus vaccine (Lot# 354-964), 17-Apr-1995 Poliovirus vaccine (Lot# 390-917), 04-Jan-1995 MMR II (Lot# 611079/0405A), 20-Nov-1995 Varivax, left arm (Lot# 609302/0443B). An Early Learning Accomplishment profile was administered and the patient was within the normal developmental age and range. The Rossetti Infant Toddler Scales were used to access the patient's speech and language development. The results indicated the patient's receptive language skills to be at a developmental age and range of an 21-24 months, and expressive language skills to be at a developmental age of 6-9 months, indicative of a 25% delay, which qualifies him for service. Direct services were recommended. On-Feb-1996, at 29 months of age, An Early Learning Accomplishment Profile was repeated. Results indicated that the patient was bordering a 25% delay in the area of cognitive and fine motor skills. Skills in the area of gross motor, self-help and social/emotional are within normal limits. Based on the results and an informal observation of the patient, special instruction services were recommended two times a month to work with the patient, and the teaching staff in his daycare class, to provide possible strategies and activities for assisting the patient's development. On 11-Apr-1996 and 26-Apr-1996, at 31 months of age, the Peabody Picture Vocabulary Test-L, the Preschool Language Scale-3, and Expressive One Word Pictures Vocabulary Test were administered. Test results indicated that the patient's language comprehension and expression appear to be functioning at a 16-18 month level. Vocabulary comprehension and usage tested higher at a 24-26 month level. His articulation at that time appeared to be developing within normal limits. Based on the significantly low scores and fact that the patient had difficulty participating in group setting with same age peers, it was recommended that he be placed in a special education preschool to address his language deficiencies. Consultative speech and language services were recommended in addition to his preschool program. In 1997, at the time of the four year old visit, the patient was 34 1/4 pounds and 39 1/2 inches in height. At this time he demonstrated some echolalia. His interaction during the examination did not appear normal. He was unable to identify colors, and was not cooperative during testing. Phrases were noted in his speech, but no sentences. The patient's general health was reported to be good and child care immunization, which were considered to be up to date, included the following: 10-Sep-1997 MMR II (Lot #623505/0743E), 24-Oct-1997 poliovirus vaccine (unspecified) (Lot#446-715). 31-Oct-1997 the patient, at 4 years of age, was referred to a child neurologist for evaluation of developmental delay. The patient has a history of apparent regression of language skills at approximately 18 months of age with reported history of normal language and problem solving skill development at approximately 12 - 14 months. It was noted at this time that the patient had no history of seizures, other involuntary movements, recurrent otitis media, meningitis, or other significant medical illnesses. The history of language impairments as well as qualitative impairments in social interactions was suggestive of pervasive developmental disorder. During the examination the patient demonstrated some echolalia. The patient also demonstrated problem solving skills at a 30-36 month level, with reported improvement in language and socialization skills during the previous year. Recommendations included formal neuropsychological testing and socialization skills to obtain additional prognostic information. The suggested ideal placement for the patient would provide intensive individual and group language therapy as well as emphasis on social interaction. It was also suggested that the patient undergo formal audiological evaluation to exclude significant hearing loss, a waking and sleep EEG to assess epileptiform activity in association with language regression with Landau Kleffner syndrome, DNA studies to exclude Fragile X syndrome, MRI of the brain and metabolic studies to include amino acids and organic acids. In 1998, the patient as assessed, using the Wechsler Preschool and Primary Scale of intelligence-Revised (WPPSI-R) where he obtained the equivalent standard score of 75 on the Object Assembly subtest. He was assessed in March 1999 (age 5 1/2) where he was able to participate in 2 of the 4 subtests of the Leiter international Performance Scale-Revised (LEITER-R). His ability to understand the task was questionable. He obtained a raw score of five on the Figure Ground subtest and three on the Form Completion subtest. On 16-Dec-1999 at 6 years of age, the patient was evaluated at the Developmental Cognitive Neurology Clinic. At the time of examination the patient weight 18.7kg and was 114cm in height, which was at the 10th and 25th percentile respectively. Blood pressure was 109/68, pulse was 96 and regular. A Wood lamp examination revealed a crescent shaped 2x4 cm hypopigmented area over the mid left gluteus maximus and none over the trunk. The patient presented with regressive encephalopathy and a marked loss of language skills over the past two years. He now uses approximately two words, yet has retained normal motor skills. Two years prior he was estimated to have high functioning autism, no seizure have occurred. Standard EEG with sleep showed no seizure activity 2 years ago. DNA for fragile X was normal (1997). The patient was vary active, and vocalized using high pitched sustained sounds. He tended to mouth objects, and had very short or absent attention span. Mild proximal hypotonia was present, but no weakness, and deep tendon reflexes were 1+ symmetrically with bilateral plantar flexion. Behavioral difficulties had become prominent. The regression in language, cognitive function, and behavior was thought to be consistent with the severe type of pervasive developmental disorder termed childhood disintegrative disorder. In Dec 2000 the patient was assessed, using the Wechsler Preschool and Primary Scale of Intelligence-Revised (WPPSI-R), and the Leiter International Performance Scale0Revised (LEITER-R). In 1998 he had obtained a raw score of five on the Figure Ground subtest and three on the From Completing subtest and upon retesting in Dec 2000 obtained raw scores of zero and one respectively. In addition, assessment with the Vineland Scales of Adaptive Functioning Classroom Edition resulted in reduced raw scores between two assessments, indication lack of progress in adaptive functioning. On 17-May-2000, at approximately age 7, the patient was re-evaluated at the Developmental Cognitive Neurology Clinic. He had no history of allergies or use of any medications at that time. At the time of examination the patient used only high pitched sustained sound and had decreased auditory perception, though testing of hearing was normal, initially when his regression began. He continued to be restless, and demonstrated repetitive behavior triggered by frustration. A Brainstem Auditory Evoked Response test (BAER) previously performed was normal. Recommendations for treatment at this visit included a lumbar puncture to rule out any chronic infection or altered protein synthesis, and overnight EEG to determine the need for a trial of anticonvulsant medication, and evaluation of fasting serum lactate, pyruvate and carnitine levels. On 14-Jun-2001, at approximately 8 years of age, the patient returned for a follow up visit. At this time he weighed 23.3 kg, his height was 123cm, and his BP was 98/61. Recent testing obtained included an overnight EEG that showed no seizure activity. A fasting lactic was normal. Urinary organic acids, previously normal, showed elevations consistent with physiological ketosis suggesting possible abnormalities. The carnitine profile was normal. The patients activity level and history were suggestive of possible bipolar subtype. An organic profile was to be repeated to rule out mitochondrial disorder, prior to implementing a trial of seizure medications for mood stabilization, and possible trial of steroids. The family was made aware of the need of respite care for the patient. On 25-Oct-2005 at age 9, the patient underwent an evaluation and assessment by the department of occupational therapy services. Adaptive functioning at this time is (11/2) age equivalent scores around the 1 year level. Educational assessment (11/02) skills ranging from 40-51 months to 0-8 months of age. Overall the patient continued to display in fine motor and visual motor skills. Due to his behavior and attention fluctuations, his responses to his sensory diet were not consistent. On 07-Nov-2002, at which time the patient was a student in the third grade, he underwent a speech and language evaluation. It was noted that the patient's overall language profile was indicative of severe to profound delays when compared to his chronological age in the following areas: receptive language, expressive language and pragmatic language. Moderate to severe delays are present in sensory-motor and attentiveness. His skills ranged from 40-51 months to 0-8 months of age. These weaknesses were thought to negatively affect the patient's academic progress. Recommendations at this time included a functional program for the patient where he could begin learning skills and sequence of personal management behavior. On 11-Nov-2002, the patient was re-evaluation for developmental, adaptive and behavioral functioning as part of the Individualized Education Program (IEP) team review to assess intellectual and adaptive functioning, and determine if the current level of service and IEP goals were appropriate. At that time the patient continued to be classified as code 14 (Autism) under IDEA. His skills levels fell around the one year old range, with the exception of motor skills. His performance was at levels comparable to the previous assessments, indicating little gain. He appeared to have made little progress in adaptive behavior. On 13-Jan-2003, at 9 years of age, 4 months, the patient underwent a physical education assessment, to determine the need for adapted physical education needs. The patient appeared to have adequate balance and locomotor skills, but was only able to attend to activities for 1-2 minutes. It was reported that it was difficult to assess the patient's motor performance due to this behavior. Information received on 28-Mar-2007 included: Chronic rhinitis (31-MAR-97), sinusitis (31-MAR-97) and otitis media bilateral (31-MAR-97), thrush (02-MAY-97), crescent shaped 2x4 cm hypopigmented area over the mid left gluteus maximus (16-DEC-1999).