Age: 1.0
Sex: M
Vaccine: MMR, MMR, MMR
Symptoms: Pyrexia, Screaming
Clinical narrative: Post vax, the child developed a fever, he was crying hysterically on the floor as if he was in pain. The MD was phoned and the MD said "not to worry that he would be fine." The pt's condition did not change but has become worse. He experienced a loss of balance, he would cry and bang his head on the floor as if he was in pain. He was taken to the MD and the parent was told the child was fine, but he continued to get worse by loosing his speech and crying continuously and behaving irritable.   Follow up information received on 11/15/2000: "Information has been received from a consumer concerning her 12 month old Caucasian son with an erythromycin allergy (vomits) who on 04/22/1998 was vaccinated with the first dose of MMRII in the right deltoid (Lot # 624920/1317E).  Concomitant therapy included one dose of tuberculin (Mantoux) in the right forearm.  About two days post-vaccination, the patient cried hyspterically for about two days.  He was seen by doctorrs and they said he "was fine".  The reporter stated that he was "not fine because he was losing his balance a lot and banging his head on the floor."  "They examined him and said he was fine."  "As the weeks continued all these behaviors continued."  The reporter stated that she took him to a neurologist who diagnosed him as PDD/Autism.  The neurologist suggested that the patient be put in a program for these types of conditions.  The reporter stated "my son was fine before he took this vaccine."  She also reported that the patient was seen by an allergist who did a blood test and the "MMR came out with a positive reaction".  The reporter stated "MY son is alergic to the vaccine" and the allergist confirmed that he is allergic to MMR." The reporter also stated that the doctor gave her a letter stating that her son should not receive the vaccination again.  "He is improving witht he program".  "He still loses his balance but it was worse before, his speech is okay and his hearing is fine." The reporter saw another physician and was told that the patient will always have PPD/Autism.  The reporter wanted "people to know that a vaccine can cause this."  She stated that her son cried hysterically for 4 to 6 months and couldn't stop crying.  Upon medical review, the patient's "autism" has been considered an "other medical event".  Follow up information received on 08/18/2000 from a physician who stated that the patient had a history of viral illness (December, 1997), Bronchiolitis (December 1997) and otitis media (04/09/1998).  On 07/08 or 09/2000 the patient had allergy tests done for various substances.  The physician stated that the patient was "allergic to the MMR vaccine".  A pediatric neurologist evaluated the patient on 06/17/1999 who described the patient as a boy with severe speech delay as well as aggresseive behavior.  The physician stated that the patient's mother describes him as a child who never really communicated well with her since he was born.  She also says that he is very hyperactive.  She is unable to bring him to parties based on his severe behavioral problems.  He will go into severe temper tantrums when he doesn't get his way and he is unable to express what he would need at the time.  He does a lot of head banging as well as toher repetitive type of behavior.  He is stimulated by looking at pictures and playing with puzzles.  Otherwise, he really won't let anyone interact with him once he gets involved with an item, whether it's playing with pots and pans or playing with the curtains, he will go into an easily provoked temper tantrum if this is taken away from him.  He has been in early intervention since approximately 1-1.2 years of age. Also what is noted is that he has been a toe walker since he started walking at 1 year of age.  The patient was a full term child.  Premature labor at 31 weeks.  The mother was on medications for 7 weeks and approximately 12 hours later at 31 weeks he was born normal spontaneous vaginal delivery.  The patient was able to roll and sit appropriately and walk on time.  However, language, at this point the patient's mother says he says approximately only 5 to 8 words.  The patient has a sister who is 4 years old who has some learning disability involvement as well as language problems, however, no behavioral issues at this time.  There is no family history of autism, seizures or mental retardation.  The maternal niece was hypoxic at birth and has learning disability.  Socially, he cannot have anything introduced to him that is new.  She has to prepare him before she brings any new items or introduces him to new family members.  On physical exam, vital signs are stable.  Blood pressure 92/62, pulse 78, respiratory rate 20, weight 32 lbs, height 36.5 inches and head circumference 19.5 inches, placing him at the 50th percentile.  Generally, he was in no apparent distress, however, his exam was very difficult.  He had poor eye contact.  He was very difficult to examine.  Occasionally he would say the words "thank you" repeatedly as well as the word "nose".  He has not gained any new words since 1.5 years of age.  He was looking out the window for most of the exam and he refused to sit on the examining table and refused to follow directions.  He was occasionally playing with some on the otems in the room.  He did not want to play with the toys and he was turning the light switches on back and forth.  I had seen him at previous appointments with his sister and he had similar like behavior.  He is in constant motion and the mother really can't keep her eyes off of him for a few minutes since he would probably run out of the room.  He had a normal tone.  Cranial nervies 2 through 12 were grossly intact.  No dysmorphic features.  No ataxia.  Coordination was fair for age.  The impression was of severe expressive language delay and pervasive developmental delay.  The physician noted that at this point, the patient does not fall into all of the realms for autism, however, it is early on in the examining time and I am believing that if he doesn't get better behavior modification as well as speech and lanaugage therapy, he may fall into the autistic spectrum.   The physician felt that his hearing evaluation should be done, especially since he is having poor language skills.  The physician indicated that CPK, lead and thyroid function tests and a sleep EEG will be ordered.  The patient was referred for further evaluation.  On 05/25/2000 the paient had a follow up visit with the pediatric neurologist who stated that he has pervasive developmental disorder.  The physician noted that the patient is doing well now that he is in an "ABA program".  He is memorizing questions and giving out answers by showing that he knows his body parts and animal sounds.  He doesn't have a lot of spontaneous language, however, in the office he was able to say "mama" a couple of times.  His mother describes him as a child who still doesn't like crowds.  He does a lot of self stimulation also with small objects, shapes and puzzles.  He is imitating his sister, such as brushing his teeth, and he is socializing mostly with his sister only.  On physical exam, vital signs were stable, BP 92/72, pulse 74, respiratory rate 19, weight 40.5 lbs.  Generally, he was in no apparent distress.  He had fleeting eye contact.  He was smiling appropriately at times.  He was showing that he can undress and dress himself.  He was in constant movement through the office and climbing.  There was no ataxia and no dysmetria noted.  He said "baba" appropriately at the end of the exam and he was albe to repeat again answers that were memorized from the mother's questions.  The impression was of pervasive developmental disorder, most likely now showing signs of true autism.  The plan is to continue the ABA program.  In the fall, he will be entering school.  He will be getting 10 hours of schooling with ABA and this should be beneficial.  He has so far had a negative work-up including negative EEg.  An imaging study was not done, however, at this point there is no need.  Information from the patient's parents stated that "before the MMR vaccination, my son was a normal one year old".  He was immitating me and talking.  he was able to identify parts of the human face, such as nose, ears, eyes, mouth, feet and also shirt.  He was also able to cunt from one to ten and starting to dress himself, trying to put on his shoes, shirt and pants.  He was a happy child who enjoyed playing and immitating his siters and also playing with other children.  After the MMR vaccination he developed a fever.  He was crying hysterically on the floor as if he were in pain.  The paretn's called the physician and told him what the patient was experiencing and the doctor said not to worry that he would be fine.  The parent's reported that the patient's condition did not change.  He began to lose his balance at times.  He would cry and bang his head on the floor as if he was in pain.  The patient saw a physician who stated that he was OK, but he continued to get worse by losing his speech and crying continuously and behaving irritable.  As of 08/01/2000 the parents noted that the patient has not recovered.  The patient's parents indicated that the fever, crying hysterically, pain, lose his balance at times, bang head on floor, losing his speech and behaving irritable were disabling.  Follow up information received on 08/23/2000 from an allergist indicated that on 07/06/2000 the patient was tested for allergy to MMR vaccine, along with other antigens.  The test was done by injecting a small amount of dilute vaccine subcutaneously.  There was no immediate reaction.  However, on 07/05/2000, a "mild to moderate" size skin reaction was observed and this is the objective basis for his statement, "the patient is allergic to MMR vaccine".  The physician volunteered that he ahd desensitized the patient via the injection of extracts of MMR vaccine and that the mother has recently reported ot him that the child is doing better is speaking more words, and is making more eye contact.  Follow up information received on 10/03/2000 from a physician stated that the patient is speaking in phrases and responds to questions.  He was referred to an allergist for consult regarding possible allergies.  He was also evaluated by a physician for the Pervasive Developmental Disorder.  The reporter stated that otherwise the patient is doing well.  Follow up information received on 11/06/2000 indicated that on 08/02/2000, the patient was seen for a neurologic evaluation.  Additional information has been requested.