Sex: M
Vaccine: HEP
Symptoms: Abnormal behaviour, Autism, Encephalopathy, Laboratory test abnormal, Social avoidant behaviour
Clinical narrative: Information has been received from two physicians regarding a case in litigation concerning a 3 year old male with iron deficiency, diary free diet and prophylaxis and a history of thalassaemia and otitis media who on 2/18/98, 3/18/98, and 9/8/98 was vaccinated with the first, second and third doses of hepatitis B virus vaccine. Concomitant therapy included the first dose of MMR, administered on 7/22/99; diphtheria toxoid (+) pertussis acellular vaccine (+) tetanus toxoid administered on 9/8/98 and 9/2/99; inactivated poliovirus vaccine administered on 4/20/98, 7/3/98, and 9/2/99; diphtheria toxoid (+) HIB conjugate vaccine (+) pertussis whole cell vaccine (+) tetanus toxoid administered on 4/20/98 and 7/3/98; HIB conjugate vaccine administered on 9/8/98 and 7/22/99 and varicella virus vaccine live administered on 3/5/99. Subsequently, the patient developed pervasive developmental disorder, autistic symptoms and encephalopathy. The reporting physician stated that the patient was followed for language delay, primarily in expressive speech and had normal hearing screening. At 31 months, the patient was functioning in self-help skills at about 22 months, cognitive testing at 20-23 months and fine motor at 24 months. In language functions comprehension revealed moderate delay at 24 months and expression 15-18 months. The patient had been displaying progress in speech therapy at 24-28 months of age. The physician stated that the patient played with his sister, but played in parallel with peers. A lactose-free diet led to increase in eye contact and sociability within a short time within one week. The patient's autistic symptoms included hand flapping and jumping, but no spinning or lining up objects. The patient had developed some imaginative play with toys and made animal sounds upon request. The patient's stool patterns had been normal. The Childhood Autism Rating Scale was completed with the parents and most areas were scored with mild abnormalities. The most remarkable was in the area of verbal communication and the total score was 27. The physician stated that on exam the patient made brief eye contact after 10 minutes and then related intermittently. He would reciprocate and followed visual directions for toy or tool use.  The patient's growth was normal with a height of 93cm at the 25th percentile, weight of 14.2kg at the 10th percentile, and head circumference of 49.5cm at the 50th percentile. The skin was clear. There was no organomegaly, and heart sounds were normal. There were no dysmorphic features. The physician stated that there was occasional hand flapping with excitement. The patient's tone was moderate and symmetrical. Few words were heard clearly, though he followed more receptively than he expressed. There was no tremor or movement disorder. Deep tendon reflexes were 2+ symmetrically and there was bilateral plantar flexion. No significant toe syndactyly was noted. There was no tremor. The physician stated that the physical exam findings were consistent with PDD/NOS and encephalopathy. Genetic testing revealed normal chromosomes and DNA for fragile X. There was no history of regression but the physician stated that the patient's speech acquisition reached a plateau from 15 months to 24 months. The physician also advised the patient to undergo additional testing of serum chemistries, and liver function studies to possibly indicate mitochondrial dysfunction. Another reporting physician stated that the patient had full immunity to diphtheria, pertussis, tetanus, MMR, and polio. The physician stated that in the patient's case, the risk factor of further immunization is greater than him contacting any of these infectious diseases. The fact that he had elevated titers or full immunity to the viruses puts other children at no risk of contacting rubella, mumps, diphtheria, and polio from him. Upon internal review, the patient's pervasive developmental disorder, autistic disorder and encephalopathy were considered other important medical events (OMIC). No further information is available. It has been determined that WAES #0403USA02022 is a duplicate report of WAES#0306USA01832. Therefore WAES 0403USA02022 is being deleted from our files and the reports consolidated into WAES0306USA01832.