Age: 1.34
Sex: M
Vaccine: MMR
Symptoms: Screaming, Speech disorder, Stupor, Viral infection, Vomiting
Clinical narrative: Information has been received from medical records regarding a case in litigation concerning an 18 month old male child who was born at 36 weeks, with no known allergies, a cold, and a history of a slight small umbilical hernia who on 31-JAN-1995 was vaccinated with a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#612575/0822A).  On 26-APR-1995 the patient was seen in the office for being very fussy, and crying alot, on examination the patient was found to be very irritable, and seemed to be "unusually pained".  In approximately April of 1995, the patient regressed in behavior.  It was also reported that the patient was exposed to abuse at the age of 18 months when his 'dad tried to hit him with his car".  On 16-APR-1996 the patient was evaluated by a speech therapist and early childhood specialist, it was noted that throughout the evaluation the patient's attention to task was very limited.  He was observed to combine consonants and vowels in speech-like intonation  patterns, he did not imitate facial movements or sounds upon request.  The patient took the therapist's hand to request bubbles and he took his mother's hand to initiate other activities.  The patient showed no response to most task presented and he displayed no interest in pictures or toys.  The patient did not respond to verbal requests and his eye contact was poor.  It was reported that his speech and language skills were moderately to severely delayed.  On 29-JUL-1995 the patient was seen in the office and was noted to have separation anxiety with temper tantrums and uncontrollable crying.  On 09-AUG-1996 the patient was seen in the office, and it was noted that he was seeing a speech therapist, it was reported that the speech therapist felt that the patient was behind but that " they didn't see any definite retardation", the speech therapist recommended a complete psychological evaluation to rule out autism.  On 17-OCT-1996 the patient was determined to have pervasive developmental delay.  On 10-JAN-1997 the patient was seen in the office for a routine check up prior to moving, the patient's parents were trying to get an referral to an autism clinic in order to obtain a definitive diagnosis of exactly what was going on with the patient and why he wasn't speaking.  At the time of the visit, the patient was not having acute problems and his status was stable concerning his progressive developmental disorder.  On 15-MAY-1998 the patient had a developmental pediatrics evaluation, during this it was noted that the patient had attention deficit hyperactivity disorder (ADHD), probable pervasive developmental disorder and cognitive functioning in the moderate to sever mental retardation range.  It was reported by the patient's mother during the evaluation that the patient "is just mean", that the patient head bangs, claws, chokes and strangles his mother and the family dog, and that he had recently hit another child and that he will run away if left unrestrained for a moment.  During the appointment it was necessary for the physician to site with the chair barricading the door to keep the patient in the room.  On 31-JUL-2001 a psychiatric evaluation was performed, it was noted that the patient had a history of aggressive behaviors in the home, with multiple incidents of attacking his mother, that he is easily aggravated by external stimuli and that when agitated he will cover his eyes, bang his head and punch himself.  The patient has enuresis, encopresis, a poor appetite and pica.  The patient engages in self-abusive and aggressive behavior towards others.  The patient has problem behaviors that have persisted for years including tantrums where he screams, bangs his head, bites and scratches others, throw objects, and engages in other self abusive behaviors.  The patient was also described as being highly active, distractible, and unable to focus on a simple task for very long, he would escalate in agitation as the slightest demands were placed on him.  The psychiatrist diagnosed the patient as having autistic disorder inclusive of parasomnia, disruptive behavior disorder, pica, enuresis and encopresis.  The patient was also diagnosed to have mental retardation, severity unspecified.  At the time of this psychiatric evaluation on 31-JUL-2001 it was reported that the patient took a daily vitamin and acidophyllus.  The patient's vaccination history included first, second, third and fourth doses of diphtheria toxoid (+) Hib conj vaccine (CRM197) (+) pertussis whole cell vaccine (+) tetanus toxoid (TETRAMUNE) on 15-NOV-1993 (lot#358-919), 26-JAN-1994 (lot#360-915), 28-MAR-1994 (lot#366-949), and 09-AUG-1996 (lot#433-565) respectively, first, second and third doses of poliovirus vaccine live oral (ORIMUNE) on 15-NOV-1993 (lot#360-939), 26-JAN-1994 (lot#360-939), and 09-AUG-1996 (lot#433-385) respectively, first, second and third doses of hepatitis B virus vaccine rHBsAg (yeast) (ENGERIX B) on 26-JAN-1994 (lot#Eng1266B2), and 19-JUL-1994 (lot#ENG1318A2) respectively.  On 15-NOV-1993 the patient also had tuberlin purified protein derivative (lot#00843P).  It was reported that the patient had multiple medication trials using the following, alone or in combination, clonidine hydrochloride (CLONIDINE), quetiapine fumarate (SEROQUEL), Nefazodone hydrochloride (SERZONE), risperidone (RISPERDAL), methylphenidate hydrochloride (RITALIN), amphetamine aspartate (+) amphetamine sulfate (+) dextroamphetamine saccharate (+) dextroamphetamine sulfate (ADDERALL), clanzapine (ZYPREXA), and paroxetine hydrochloride (PAXIL).  The patient's family history is significant for his paternal grandfather having had Lupus and Bipolar Disorder for which he required "institutionalization" after two attempted suicides.  The patient's father is described as having a violent temper and a history of abuse toward the patient's mother.  The patient's mother had been diagnosed with anxiety.  Diabetes was noted to be present in the patient's maternal and paternal extended family.  Information was received on 12-SEP-2006 which pertained to events that occurred within the six years following vaccination with measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live.  This information contained the following adverse experiences, recurrent ear infections (dates unspecified), chickenpox (1995), crying all of the time (1995), listlessness and not doing much (1995), a severe strange cough with which he coughed to the point of vomiting (1995), chronic loose stools (2000), abdominal pain (2000), gaseousness (2000), lactose malabsorption (2000), a systolic heart murmur (2000), and poor appetite (2001).  Upon internal review, the patient's autism and pervasive developmental delay were considered to be other important medical events.  Additional information is not available.  All available medical records will be provided upon request. (OMIC)