Age: 1.26
Sex: M
Vaccine: HIBV, MMR, HIBV, MMR
Symptoms: Rhinitis allergic, Speech disorder, Viral infection
Clinical narrative: Information has been received regarding a case in litigation concerning a child who was exposed to high levels of mercury from thimerosal through exposure to unspecified products.  The alleged result was that the patient experienced serious and permanent neurological injuries and damages which included past and future mental, intellectual, development; and neurological incapacity and associated learning disabilities, disorders and impairments.  It was also alleged that the patient experienced cumulative mercury toxicity.  Additional information has been received via medical records from a case in litigation concerning a 36 month old male with frequent ear infections, hypertonia, allergic rhinitis and chronic nasal con gestation, constipation, penicillin allergy (hives), nickel allergy, pollen allergy and history of mild hypo pigmented patches on face, mild scale ness of scalp, mild upper respiratory infection, breech vaginal delivery, blisters on buttocks, infection, incubation due to jaundice, congential torticollis, fibroid nodules in sternocleidomastoid muscle with significant limitation of range of motion, atopic dermatitis, seborrheic dermatitis, fever, mild cold, perseverating crying, eczema, right otitis media, rash due to questionable (AMOX) reaction, mouth bleeding from car accident and family history of ADHD.  On 15-DEC-1992 the patient received a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#604269/1184V), subcutaneously.  Concomitant therapy included a fourth dose of Hib conj vaccine (manufacturer unknown) (lot#M66DJ).  On 09-MAR-1993 the patient received a fourth dose of oral polio vaccine and a fourth dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid.  On 16-SEP-1994 the patient was seen for a well child doctor's visit.  The patient's mother stated that he was hyperactive and "hard to discipline".  Diagnosis at that time was questionable developmental delay.  On 29-SEP-1995 the patient was seen for a doctor's visit.  The patient's mother was concerned about for last month won't have bowel movement on his own, requires stool softener.  The patient was also not toilet trained yet.  The mother was also concerned that he "repeats everything said to him, doesn't engage in conversation".  The assessment of the patient was reported to be constipation, allergic rhinitis and developmental delay.  On 16-FEB-1996 the patient was seen for a speech and language evaluation.  A speech language pathologist stated that the patient's expressive language evaluation.  A speech language pathologist stated that the patient's expressive language ability appeared to be severely delayed.  The patient presented with severe receptive and expressive skills.  Prognosis for improvement was favorable provided appropriate speech and language intervention.  On 29-FEB-1996 the patient was evaluated by an education/developmental specialist.  The patient presented with cognitive skills that were significantly delayed.  Stereotypical motor movements, lack of joint attention, emotional distancing and language and cognitive delays indicative of pervasive developmental delay.  On 18-SEP-1996 the patient received a second dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#618611/0468D).  Concomitant therapy that day included a fifth dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid (lot#6J71104) and a fifth (also reported as fourth) dose of poliovirus vaccine live oral (ORIMUNE) (lot#436956).  On 18-NOV-1996 the patient was seen by a doctor in a neurology clinic.  The physician reported that the patient presented with some but not all of the critical features of autism.  He has pronounced symptoms of inattention, hyperactivity, and impulsitivity.  The physician stated that a diagnosis of ADHH was not made when it superseded by a pervasive developmental disorder diagnosis. The patient's conglomeration of symptomology concurred with the following DMS-IV multiaxial diagnosis: axis I- pervasive developmental disorder, not otherwise specified; mild mental retardation; axis I- pervasive developmental disorder, not otherwise specified; axis II mild poor social skills, lack of cooperative palsy, uncontrollable behavior at school, sub average academic skills.  Global assessment on axis V showed impairment in school and social functioning.  The mother stated that in the previous past six months his behavior had changed from on of hyperactivity and inattention to becoming more violent and extremely loud, with yelling, throwing and hitting.  He had a tendency to be violent.  On 18-NOV-1996 the patient had a CBC, thyroid tests metabolic screen, fragile X, chromosomes, MRI and EEG; all of these diagnostic tests were normal.  Neurological examination was also normal.  On 13-JAN-1997 the patient was seen by a physician who thought, based on the history of the mother and observation of the child, the patient would be labeled with autism.  On 10-JUL-1997 the patient was vaccinated with a first dose of hepatitis B virus vaccine rHBsAg (yeast) (lot#622478/0399E).  On 04-SEP-1997 the patient was seen by a physician for a visit.  The assessment was reported as developmental delay, no speech delay, Asperger's possibility.  On 04-SEP-1997 the patient was vaccinated with a second dose of hepatitis B virus vaccine rHBsAg (yeast) (lot#622477/0071E), in the left arm.  On 04-SEP-1997 the patient was also vaccinated with varicella virus vaccine (lot#623556/0709E), in the left arm.  On 14-JAN-1998 the patient was seen by a physician and the assessment was Asperger syndrome and developmental delay.  On 14-JAN-1998 the patient received a third dose of hepatitis B virus vaccine rHBsAg (yeast) (ENGERIX-B) (lot#2356A26100), in the left arm.  On 31-AUG-1999 the patient was seen by a physician who assessed autism.  On 12-FEB-2003 the patient was seen by a neurodevelopmental pediatrician.  The physician's impression was reported to be a history of autistic disorder previously confirmed in 1999 after a comprehensive evaluation by a child psychiatrist.  The physician stated that he appeared to meet many criteria that would suggest Asperger's versus high functioning autism.  Information received on 12-SEP-2006; otitis media (early May 1993), laceration and hematoma to forehead from fall off the chair (12-NOV-1993), pityriasis rosea (30-NOV-1993), viral gastroenteritis (11-MAR-1997), frequent urination (10?-JUN-1997), atopic dermatitis (04-SEP1997), cold symptoms (26-DEC-1997), cotton in left ear (29-MAY-1998), nickel allergy (29-MAY-1998), insect bites (02-SEP-1998), urinary frequency (24?-aug-1999).  Previous vaccinations were also reported: On 04-NOV-1991, 06-JAN-1992 (lot#M180H), and on 11-MAR-1992 (lot#M660HH) the patient received a first, second (intramuscularly right thigh), third dose (intramuscularly 11-MAR-1992 (lot#M660HH) the patient received a first, second (intramuscularly right thigh), third dose (intramuscularly right thigh) of Hib conj vaccine (manufacturer unknown).  On 04-NOV-1991, 06-JAN-1992, and on 11-MAR-1992 the patient received a first, second and third dose of oral polio vaccine.  On 04-NOV-1991, 06-JAN-1992 (308-975) (intramuscularly left thigh) and 11-MAR-1992 (308-975; 316957) (intramuscularly left thigh) the patient received a first, second and third dose of diphtheria toxoid (+) pertussis vaccine (unspecified) (+) tetanus toxoid (ADEL-IMUNE).  Upon internal review developmental delay, pervasive developmental delay, mercury toxicity and autism were determined to be other important events.  No further information is available.  A copy of the patient's medical records is attached as further documentation of the patient's experience.  All available medial records will be provided upon request. (OMIC)