Sex: M
Vaccine: HEP, DTAP, HEP, HIBV, IPV, MMR, VARCEL
Symptoms: Abnormal behaviour, Affect lability, Autism, Drug toxicity, Dyskinesia
Clinical narrative: Information has been received regarding a case in litigation concerning a female pt and her son who received injectable globulin products containing the mercury based preservative thimerosal. The mother, while pregnant with her son, received injectable globulin products containing thimerosal. During the first two years of his life, the son was vaccinated with thimerosal containing vaccines. It was alleged that as a result of cumulative exposure to the injectable globulin products and thimerosal containing vaccines the son suffered and will continue to suffer from the toxic neurological effects of mercury poisoning. Follow up information from medical records indicated the mother's first pregnancy ended in miscarriage at three months and her son was an only child. The pregnancy was uncomplicated. No alcohol, smoking, nor drugs were reported. Labor was spontaneous  and without complications at term. On 09Aug1997 at 36 years of age, the mother gave birth to her son. Delivery was normal vaginal. Birth weight was 6 pounds and 0 ounces. On 09Aug1997, the son was vaccinated with a first dose of hep B virus vaccine rHBsAg (yeast) (manufacturer UNK). Subsequent vaccinations included hep B virus vaccine (14Oct1997; 10Mar1998), measles virus vaccine live (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (MSD) (14Sep1998), oral poliovirus vaccine (14Sep1998), poliovirus vaccine inactivated (Vero) (IPOL) (14Oct1997), Hib conj vaccine (OMPC) (manufacturer UNK) (14Oct1997; 15Jan19998; 10Mar1998; 14Sep1998), diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid (14Oct1997; 15Jan1998; 10Mar1998; 14Sep1998) and varicella virus vaccine live (Oka/Merck) (08Dec1998). The neonatal period was notable for a weeklong stay for the treatment of jaundice. From 19Dec1997 to 24Dec1997, the pt was hospitalized for a high fever. In the fall of 1999, the pt began receiving speech-language therapy. The Rossetti Infant-Toddler Language Scales had the following results: Interaction Attachment 15-18 month mastery level; Language Comprehension 12-15 month mastery level; Language Expression 3-6 month mastery level. On 08May2000, the pt was evaluated for suspected developmental delays, disruptive behavior disorder and pervasive developmental disorder. The pt had no known drug allergies and there were no current medications. Infant motor milestones were acquired at appropriate ages, but speech/language milestones were delayed. Eating problems included restricted food choices and difficulty with chewing. Sleep problems included difficulty getting to sleep and head banging against the mattress. Tactile problems included head and neck defensiveness. Auditory problems included hypersensitivity and neglect. Oral problems included mouthing and a hyperactive gag reflex. Pain responses were decreased. Atypical body movements included hand flapping and rocking. Self injurious behaviors included teeth grinding and head banging. The pt had mood liability, excessive responses, poor consolability, lack of fear response and tantrums. The pt had a lack of show and tell behavior, poor eye contact, inconsistent response to non-verbals, excessive shyness, aloofness, preference for solitary play and limited social reciprocity. The pt had speech/language delays, limited non verbal communication and used only a few single words inconsistently. The pt had a restricted range of interests in toys, preservation with objects, lack of imaginative play, poor imitation skills and banged/ threw objects. Behavioral problems included tantrums and hyperactivity. Physical examination showed no physical abnormalities. Formal vision screening could not be obtained due to the pt's developmental level. He was not observed to track objects across midline. A complete audiological evaluation revealed hearing within normal limits in at least one ear. Type A (normal) tympanograms were obtained bilaterally, indicative of normal middle ear function. The Vineland Adaptive Behavior Scales had the following results (age equivalents): Communication 10 months; Daily living skills 1 year, 5 months; Socialization 7 months; Motor skills 1 year, 8 months. The Rossetti Infant Toddler Language Scales had the following results: Interaction Attachment 9-12 month mastery level; Pragmatics no mastery; Gesture no mastery; Play 3-6 month mastery level; Language Comprehension 6-9 month mastery level; Language Expression 3-6 month mastery level. The impression was the pt met DSM IV diagnostic criteria for Autistic Disorder, moderate. This was substantiated by developmental history, observed behaviors, number of identified symptoms, the presence of social and communicative impairment, atypical sensory responses, limited and unusual play skills/object use, motor stereopathies, difficulty modulating emotional responses and poor imitation skills. Upon internal review, autism and mercury poisoning were considered to be other important medical events (OMIC). No further information is available. Follow up 12/06/04: From information received from the manufacturer on 11/09/04, there was no update provided for the patient's recovery outcome. Follow up information was submitted on 11/18/04.