Age: 0.16
Sex: F
Vaccine: HEP, HIBV, DTAP, HEP, HIBV, MMR
Symptoms: Hypotonia, Insomnia, Laboratory test abnormal, Mental retardation severity unspecified, Nervous system disorder
Clinical narrative: Information has been received regarding a case in litigation concerning a female minor who was exposed to high levels of mercury from thimerosal through exposure to unspecified products. The patient was exposed to mercury from continually inhaling and ingesting industry mercury emissions from fossil fuel driven power plants. It was alleged that the mercury included in thimerosal laden products and power plant emissions together caused the patient to suffer serious and permanent neurological injuries. The patient's exposure to airborne mercury vapor and mercury in the environment through inhalation, the food chain, and other sources contributed to the cumulative mercury toxicity and was a substantial factor causing neurological damage. It was reported that the patient had heightened vulnerability to suffer neurological injuries from industrial mercury as a direct result of thimerosal exposure. Subsequently, the patient experienced serious and permanent neurological damages which included past and future mental, intellectual, developmental and neurological incapacity, and associate learning disorders, disabilities and impairments. At the time of this report, the patient had not recovered. Additional information has been received from medical records via a physician concerning a 36 month old white female with a family history of the following: attention deficit disorder (step sister via father), emotional and behavioral problems (step sister via father), depression (father, father's sister, father's mother, mother's brother), intermittent explosive disorder (father), childhood seizures with behavioral problems and brain damage (father's brother). The infant was vaccinated IM in the right lateral thigh with a first dose of hepatitis B virus vaccine (lot # 609255/1233W) on 1/26/94, as a newborn. The patient was vaccinated with a second and third dose of hepatitis B virus vaccine on 3/23/94 and 1/27/95, respectively. Concomitant suspect vaccinations included a first dose of MMR administered on 1/27/95; and a first dose of HIB conjugate vaccine administered 3/23/94. Other concomitant vaccinations included five doses of diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid, administered on 3/24/94, 5/25/94, 7/27/94, 1/27/95, and 1/23/98, four doses of poliovirus vaccine administered on 3/24/94, 5/25/94, and 7/27/94, 1/23/98, and three more doses of HIB conjugate vaccine administered on 5/25/94, 7/27/94, and 1/27/95. A second dose of MMR (lot # 622896/0740E) was administered on 1/23/98. It was reported from medical records dated 7/3/96 that the patient walks on inside of feet and that she had problem with sleeping. Medical records dated 1/24/97, indicated that the patient was seen by the physician because she did not want to potty train. The physician noted that she doesn't signal and that she could be afraid of water shakes, screams. It was also noted that she had poor coordination and that she was hypotonic. On 1/23/98, the patient was seen by the physician because of problems with potty training and she no longer speaks spontaneously. The physician noted on exam that she had fleeting eye contact, didn't seem to understand commands, body parts, flops hands, has a splayed foot joint and generally decreased tone. The patient was evaluated as having developmental delay with loss of speech. She was described as being functionally at less than 18 months of age. The physician referred the patient for evaluation to confirm a diagnosis of Rhett syndrome. Medical records dated 3/24/98 indicated that the evaluating physician did not believe the patient conformed to the diagnosis of Rhett syndrome. The physician remarked that she had excellent hand use and follows simple commands. Also, in lieu of the fact that she was able to stack five blocks and was able to scribble with crayons, I do not believe that she has Rhett syndrome. The physician remarked: Of concern is the fact that she has lost language and has a strong family history on both sides for psychiatric disturbances. An inpatient evaluation for pervasive developmental disorder was ordered. On 5/22/98, the patient was assessed as having pervasive developmental disorder. The patient was placed on Prozac, 1cc, daily. MRI (head) and EEG was ordered. An assessment report from the patient's school noted that, cognitively, she was performing at a 12 month level according to the Battelle Developmental Inventory. Communication and socialization skills were averaging near a 9-10 month level according to the parent rated Vineland Adaptive Behavior Scales. Daily living skills and Motor skills were slightly higher with scores at a 1 1/2 to 2 year level of development. Results from the Gilliam Autism Rating Scale revealed scores within average range when compared to children with autism (standard quotient 98). It was noted: Her stereotypical behaviors, limited social interaction skills and early developmental indices are highly suggestive of autism. On 8/3/98, the physician noted that the patient had no response to Prozac. She was having severe tantrums. The physician discontinued Prozac and started her on clonidine 1/8 patch. MRI was normal. On 8/31/98 her clonidine was reported at 1/4 patch with no effect. The physician increased the clonidine to 3/4 patch. EEG on 9/24/98 was consistent with the presence of focal/multifocal epileptiform abnormality. Medical records from 3/20/00 indicated that the patient started repeating words 3 weeks ago. Additional records from 9/26/00 noted continued problems with sleeping, echolalia and crying spells. She was considered hyperactive but did not tolerate methylphenidate hydrochloride; overall doing well with PPD. A re-evaluation on 2/21/01 had indicated that she continued to live with her parents and older sister. It was also noted that she had experienced acute gastrointestinal issues that required hospitalization. She continued on clonidine, which had significantly improved her ability to attend. The report also noted the following: she is a youngster with the educational disability of Autism. This disability continues to be present as [she] presents with impairments in her communication and social interactions. Furthermore, she continues to engage in stereotypical behaviors. The patient's pervasive developmental disorder was considered an other important medical event (OMIC). Follow up information received on 9/14/06 contained the following adverse experiences: all night coughing (approximately 10/24/94), nasal congestion with green discharge (10/24/94), which was treated with amoxicillin; pinworms (6/18/96); flexible pronated foot (7/3/96); otitis media (4/14/97); vomiting 2 days (4/14/97); rash (4/14/97), which was treated with amoxicillin, TID for 10 days; upper respiratory illness--strep (7/20/97); accidental overdose of clonidine, somewhat pale, sleepy and walking with a very unsteady gait which was monitored in the emergency room for 4-6 hours; discharged after improvement (9/2/98); right otitis media and upper respiratory infection (2/20/99); monilial vaginitis (8/6/99) which was treated with nystatin cream and hydroxyzine hydrochloride; upper respiratory infection (10/17/00); probable fungal infection or tinea of the wrist measuring 2cm (left), which was treated with Lotrimin plus hydrocortisone 2.5% TID for 10-20 days until rash is gone (11/9/00); rotavirus (1/16/01), amblyopia bilaterally from significant farsightedness and astigmatism (4/17/01); chicken pox (7/95). No additional information was available. All medical records will be made available upon request.