Age: 1.26
Sex: M
Vaccine: HIBV, MMR, MMR
Symptoms: Autism, Blood lead normal, DNA test for fragile X, Developmental delay, Expressive language disorder
Clinical narrative: Information has been received from a legal firm regarding a case in litigation concerning an approximately 18-month-old male who was injected with vaccines containing Thimerosal. It is alleged that between 12 and 25 micrograms of toxic ethylmercury were injected into the patient's body with each individual dose of Thimerosal and that the schedule of injections introduced a cumulative dose of 238 micrograms. It is further alleged that on approximately 01-MAR-1999, at approximately 12 months of age, the patient began to display symptoms of neurological damage consistent with mercury poisoning, not limited to losing his language skills engaging in repetitive and stereotypical behaviors, suffering from diminished cognitive ability and becoming socially withdrawn. At approximately 18 months of age the patient suddenly regressed developmentally. He became withdrawn, unable to speak and unresponsive to his environment. His injuries included a loss of language skills, motor skills, and effect. The patient has since been diagnosed as suffering with mercury poisoning and disintegrative (or late onset, degenerative or regressive) autism.  Further information was received alleging that the patient has been exposed to mercury from continually inhaling and ingesting industrial mercury emission from fossil fuel driven power plants. He was also exposed to airborne mercury vapors and mercury through the food chain and other mercury laden products. It as alleged that the patient had a heightened vulnerability to suffer neurological injuries such as mental, intellectual developmental and neurological incapacity from industrial mercury as a direct result of thimerosal exposure. Upon internal review autism, mercury poisoning, mental/intellectual/developmental incapacity were considered to be other important medical events. Follow up information as received, which included the patients medical records. On 15 Mar 1997 - an initial intake was performed on the patient due to parental concerns about speech and language development. The patient, an only child, was the 7 lb 41/2oz 20inches, product of vaginal delivery following an uneventful full term pregnancy. The pregnancy was remarkable for first trimester nausea, medication management for a urinary tract infection and a Group B strep infection, treated with antibiotics. Meconium was present when the mother's membrane rupture, where upon oxytocin was administered to facilitate delivery. There were no problems or concerns noted at delivery. The patient's apgar at birth was reported as being high, and there was no need for special medical attention. As a newborn, the patient was considered sleepy and floppy with low tone. The patient had difficulty nursing, and at three months was switched to a bottle and formula. He had difficulty tolerating a variety of formulas evidenced by vomiting and digestive problems. The mother reported that the patient may have been a "failure to thrive" his first three months, although it has not been diagnosed. The patient's medical history is remarkable for frequent occurrence of Otitis media in the first year of life, milk and wheat allergies (diagnosed at 18 months), and digestive problems occurring since birth. It was noted that at about 22 months, without milk products in his diet, the patient became less depressed and lethargic, and was able to make more eye contact, and seemed to "come out of his shell". The mother reports that at approximately 18 to 20 months of age, she noticed the patient's language skills did not seem to be progressing. He had been using 10-15 single words up until that point, but his word usage diminished around this age to about 6 words. Up until that point the patient's development mile stones were considered age appropriate. At 18-24 months a change in the patient's behavior was also noted when he no longer showed a reaction to his father's homecoming. At 18 months of age, the patient was involved in a motor vehicle accident. He underwent medical evaluation at that time, but did not sustain any injuries. The mother reports that at approximately 18 months oaf age the patient received his MMR vaccination, and experienced a high fever and acted sick. She further reports that she noticed that his ability to make eye contact reduced in frequency as did his use of language. At the mother's request the patient did not received "the vaccine boosters". He was classified, by his pediatrician, as Pervasive Developmental disorder, NOS. The patient's immunization record to date is as follows: 15-JUL-1996 MMR II, 12-JUN-1995 Dtap/Ipv (Lot# 386-986), 15-AUG-1996 Dtap/Ipv, 16-OCT-1995 Dtap/Ipv (Lot# 427-839, 21-OCT-1996 Dtap/Ipv (Lot# 386-986), 15-JUN-1995 Poliovirus vaccine live oral, 15-AUG-1995 Poliovirus vaccine live oral, 16-OCT-1995 Poliovirus vaccine live oral, 21-OCT-1996 Poliovirus vaccine live oral, 13-APR-1995 hepatitis B virus vaccine, 18-MAY-1995 hepatitis B virus vaccine, 18-JAN-1996 hepatitis B virus vaccine, 12-JUN-1995 bemiparin sodium, 15-AUG-1995 bemiparin sodium, 16-OCT-1995 bemiparin sodium, 15-JUL-1996 bemiparin sodium. On 24-APR-1997, at 24 months of age, the patient was assessed due to parental concerns about speech and language development. The instrument used was the Hawaii Early Learning Profile Checklist (HELP). The patient was considered to an active 24 month old toddler, eager to learn. The patient demonstrated age appropriate skills in all areas, with the exception of a slight delay in expressive language, The patient demonstrated good gross motor skills, with good eye hand coordination. He was able to sequence events, and engage in symbolic play, indicative of good cognitive development. The patient's oral skills were judged to be adequate for feeding and speech development. Overall communication skills were at or slightly below age expectancy. On 12-Sep-1997 the patient was re-assessed, at the mother's request, due to concerns that his language skills were not progressing. Upon observation was noted that the patient's use of words to communicate had decreased. It was reported that the patient now engages in repetitive behavior, such as pacing back and fourth and flapping his fingers. The patient is reported to enjoy music and gross motor play, such as climbing, but rarely interacts with other children. The recommendation at this time was to have the patient receive diagnostic speech and language therapy. On 24-Sep-2++8, at 29 months of age, the patient was referred for evaluation due to parental concerns regarding his speech, language development and socialization skills. The Hawaii Early Learning Profile Checklist (HELP) was used to determine the patient's developmental levels. The results demonstrated age appropriate skills in area of fine motor, gross motor an self help. He was observed to play well with manipulative toys. It was noted that the patient had a significant communication delay, using gestures, single word utterances, and whole body language to communicate. His spatial relationship skills are in the age appropriate range, while his ability to identify body parts (pointing to pictures) was not. Recommendations at this time included cognitive therapy, as well as a Speech and Language Pathologist. The patient's parents expressed concern regarding the probability of a diagnosis of Autism. In 1998, at approximately 3 years of age, under the supervision of his doctor, the patient is been treated with vitamin as well as anti-fungal therapy. He is enrolled in a variety of activities which are social in nature, whit other children and Mom's present. The parents expressed concern that the patient has behavior consistent with pervasive developmental disorder (PPD). During therapy sessions the patient engages in good eye contact. His gross motor skills are age appropriate at this time. The patient's hearing for speech has been assessed as normal, in a least the better ear, therefore severe hearing loss has been ruled out. Due to the fact his oral communication skills were not improving it was recommended that speech and language services be provided as part of his individualized Education Program (IEP). It was concluded that based on his demonstrated abilities that occupational therapy was not needed as part of his specialized instruction. On 26-Jan-1999, at 3 years 9 months of age, the patient underwent an occupational therapy evaluation, due to concerns regarding fine motor development and sensory processing. Grasping skills and pre-writing skills were noted to be areas of relative strength for the patient. He had more difficulty with manipulative activities and activities that required hand strength. These delays were thought to be related to mild hypotonia and difficulty processing proprioceptive information. On 05-MAY-1999, at 4 years 1 month of age, the patient was assessed due to parental concern to establish appropriate means to expand the patient's communication skills. At the time of the assessment he was using a combination of sign language, vocalizations, true words and gestures to make his needs known. A recommendation at this time is the introduction of a voice output device, which was thought to be a means of encouraging the patient's verbal speech. On 16-Mar-200, 23-Mar-2000, 24-Mar-2000 and 28-Mar-2000, at 5 years of age, the patient was evaluated through the training program for graduate studies at a college and underwent the following standardized examinations: Learning Accomplishment Profile Diagnostic Standardized assessment (LAP-D), Stanford Binet Intelligence Scale-Fourth Edition, The Goldman Fristoe Test of Articulation, Preschool Language Scale-3, Peabody Picture Vocabulary Test, Clinical Evaluation of Language Fundamentals-Preschool, Preschool Language Scale-3, Kaufman Assessment Battery for Children (KABC) Nonverbal Mental Processing Composite. Gilliam Autism Rating Scale (GARS) - Teacher as Rater, Gilliam Autism Rating Scale (GARS) - Mother as Rater it was unclear whether the patient understood what was expected of him for the tasks associated with tests. it was no possible to determine standardized scores abase on the patient's inconsistent performance, and need to modify some test materials to obtain a more accurate assessment. The Vineland Adaptive Behavior Scales: Interview Edition Survey Form is a rating scale to measure a student's ability to communicate, take care of personal needs and interact with others. The patient's scores ranges from the moderately deficient to the moderately low range. Test results showed a strong interest in interacting with others, despite the patient's inability to initiate interactions and engage in interactive play with others. The patient's motor skills domain fell within the moderately deficient range. The patient's ability to communicate and care for his personal needs fell within the mildly deficient range. The Battelle Developmental Inventory test results showed significant delays in overall development, with an overall age equivalent of 27 months at a chronological age of 59 months. Most significant weaknesses were noted to communication, with skills at approximately a 21 month level. In April of 2000, the patient underwent an audiological assessment. The findings indicated a mild bearing impairment under sound-field test conditions with evidence of middle ear function bilaterally. In May of 2000, an optometry assessment was performed. The results indicated that the patient presented with an ocular fixation and ocular movement disorders. It was recommended the patient be enrolled in a program with visual and conceptual development. The patient is currently being treated with secretin. He first began injectable therapy about 4 and half years ago (Oct/NOV 1999). He now received trans dermal applications of secretin, nightly. On 19-Oct-2000, at 5 years 6 months of age, 45.5 inches and 65 pounds, the patient underwent a battery of tests, including Peabody Pictures Vocabulary Test, Expressive Vocabulary Test, Preschool Language Scale-3, and the Structured PDD/Autism Interview. Test findings demonstrated moderate to severe delays in overall language function, as well as atypical development of communication consistent with diagnosis of autism spectrum. The patient's overall intelligibility was fair to good. Immunizations are not up to date, the MMR and chicken pox vaccines were held. There are no proven allergies. At the time of examination the review of systems was remarkable for constipation. The parents reported that between the ages of 2 to 3 years of age the patient exhibited what they termed as "seizure-like" convulsions as approximately six occasions. During these convulsions. which lasted approximately 30 seconds each, the patient's neck would stiffen, his arms would vibrate, and he would utter distress signals. It was further reported that no episodes have occurred in the past two years. Based on clinical findings the diagnostic impressions are as follows: Autistic Disorder, Moderate Mental Retardation, Mixed Receptive-Expressive Language Disorder, R/O seizure disorder, Overweight and Global Assessment of Functioning (GAF) -30. Based in the diagnoses, recommendations for the patient's treatment was made, as well as genetic counseling for the parents. On 15-Aug-2001, at 6 years of age, the patient was evaluated to determine his level of fine-motor ADL functioning, along with ruling out Sensory processing disorder. The Sensory Profile testing was administered, and results showed significant behaviors related to poor sensory processing. The patient was observed to be hypersensitive to use of his hands, as well as sound and smell. He attempts to seek way to calm his sensory system, such as chewing clothing and pacing. It was thought that the patient was showing slow, steady progress to a sensory diet. Information received on 28-Mar-2007 included: Overweight (Oct-2000), Strept throat (Mar 2004), Mold allergy (2005), Hyperoxalurais (Feb 2005), Dental Caries (cavity filled Feb 16 2005), Chronic Constipation, Allergies, Allergic Rhinitis, Recurrent Otitis Media, Sinusitis, and Headaches (dates of onset unspecified). All medical records are available upon request.