Sex: M
Vaccine: DTAP, OPV
Symptoms: Hypokinesia, Mental retardation severity unspecified, Nerve injury, Nervous system disorder, Speech disorder
Clinical narrative: This case was reported by a lawyer and described the occurrence of nerve injury in a male subject of unspecified age who was vaccinated with diphtheria and tetanus toxoids and acellular pertussis vaccine (Dtpa, manufacturer unspecified), live attenuated oral poliomyelitis vaccine (Polio vaccine), Haemophilus influenzae type b vaccine (Hib), live attenuated measles, mumps (strain not specified), rubella vaccine (MMR vaccine), measles, mumps and rubella vaccine and strain not specified (MMR vaccine) for prophylaxis.  The subject's medial history included bronchiolitis, recurrent otitis media and respiratory syncytial virus.  Previous and/or concurrent vaccination included diphtheria and tetanus toxoids and acellular pertussis vaccine; unknown given on 19 May 1999, 27 July 1999, 25 April 1990 and 23 June 1995; hepatitis B vaccine; unknown given on 4 October 2002, 9 November 2004 and 3 February 2006' live attenuated, measles, mumps (strain not specified), rubella vaccine; unknown given on 23 June 1995, live attenuated oral poliomyelitis vaccine; lederie; oral given on 19 May 1989, 27 July 1989 and 4 September 1991, measles, mumps and rubella vaccine, strain not specified; unknown given on 23 June 1995.  On 4 September 1991 the subject received 4th dose of Dtpa (unknown, right thigh).  On 25 April 1990 the subject received 3rd dose of Polio vaccine (unknown).  On 22 August 1990 the subject received unspecified dose of Hib (unknown).  On 22 May 1990 the subject received 1st dose of MMR vaccine (unknown, right thigh).  At an unspecified time after vaccination with Dtpa, Hib, MMR vaccine and Polio vaccine, the subject experienced nerve injury, toxic effect of mercury and its compounds, developmental delay, delayed motor skills, disturbance of fine motor skills, delayed speech, aggressive behavior, mental retardation, autistic disorder, pervasive developmental disorder and disruptive behavior.  According to the legal complaint, at an unspecified time after vaccination with diphtheria and tetanus toxoids and acellular pertussis vaccine, the subject experienced "serious and permanent neurological injuries" which were attributed to "toxic mercury exposure".  The following information was received via medical records.  The subject was born to a 33 year old mother, gravida 5 at 36 weeks of gestation via spontaneous vaginal delivery.  Infant weighed 5 pounds and 8 ounces, Apgar were 7 and 9.  On 22 May 1990, the patient was seen in the clinic and developmental delay was noted.  Minimal delay in gross motor and mild delay in fine motor was noted.  On 30 April 1991 it was noted that the subject was not speaking well.  Subject was babbling and this stopped between 3-6 months.  It was questioned if the patient was regressing.  At 2 and 7 years of age the mother noted that the subject had 3-4 words and does not seem to follow commands.  On 06 August 1992, it was noted that the hearing was probably normal.  Tympanometry Type B is suggestive of  conductive component. One year later, the subject was seen for acting out, choking children and stealing. On 06 August 1993, the subject was seen for a developmental pediatrics evaluation.  Physical examination unremarkable.  Neurodevelopmental examination revealed cranial nerves II through XII intact.  He was diagnosed with mental retardation with current developmental function at the 21-24 month level.  Behavior problems with noncompliance was also noted.  Work ups to determine the etiology of the mental retardation were recommended.  Blood lead level on 25 December 1994 was less than 3 mcg/dl (reference range less than to equal to 9). A behavioral psychology evaluation on 21 January 2003 indicated patient seen at 2 and ? years due to developmental delays in talking, walking and was diagnosed with autistic disorder/pervasive developmental disorder.  On 18 January 2003, it was noted that the subject is breaking windows when angry, verbal threats to mother and has tries to get out the car when riding with his mother.  On 08 February 2003, TENEX was started.  21 June 2003, it was noted that there was no family history of psychosis however the maternal grandmother side had a history of mental retardation.  Evaluated when he was 13 years old and the diagnosis was disruptive behavior, autistic disorder, rule out psychosis, versus anxiety disorder mental with the severity unspecified.  29 November 2004, a psychriatic evaluation note revealed that treatment with RISPERDAL was tried and this made him more aggressive.  It was noted that speech and language was non-spontaneous.  Motor coordination revealed that patient could write his name and draw shapes.  He makes comments "out the blue" that are unrelated.  Referred to behavior therapy. This case was assessed as medically serious.  At the time of reporting the outcome of the events were was unspecified. (OMIC)