Sex: M
Vaccine: HEP, HEP, IPV
Symptoms: Speech disorder, Upper respiratory tract infection
Clinical narrative: Information has been received regarding a case in litigation concerning minor male patient who was exposed to high levels of mercury from thimerosal through exposure to unspecified products.  In additional, the patient was exposed to mercury from continually inhaling and ingesting industry mercury emissions from fossil fuel driven power plants.  The mercury included in thimerosal laden products and power plant emissions together caused the patient to suffer from serious and permanent neurological injuries.  The patient was exposed to airborne mercury vapor and mercury through food chain.  The exposure to airborne mercury in the environment through inhalation, the food chain, and other sources contributed to the cumulative mercury toxicity and was a substantial factor in causing his neurological damage.  It was noted that the patient had a heightened vulnerability to suffer neurological injuries from industry mercury as a direct result of thimerosal exposure.  As a direct and proximate cause of the toxic mercury exposure to the patient, he was caused to suffer serious and permanent neurological damage which include past an future mental intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments.  Upon internal review, serious and permanent neurological damage which include past and future mental, intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments and cumulative mercury were considered to be other important medical events.  Follow up information has been received from medical records concerning a 24 month old male who on 01-JUN-1995, at birth, was vaccinated with a first dose of hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown).  On 23-JUN-1997 the patient was noted to have a language delay and was scheduled for a developmental assessment.  On 29-SEP-1997 the patient was seen for a psychological evaluation and was diagnosed with autism, and had greater than 25% delays for his age in all areas of developmental and adaptive functioning.  It was noted that he was at high risk for mental retardation.  Recommended treatment included special instruction, speech and language therapy, behavior management services, and placement in a special education preschool program specifically designed for children with autism.  On 17-JUL-1998 results of lab tests noted that the patient's chromosomes were normal (46XY) and fragile X was negative.  Upon internal review, autism was considered to be an important medical event.  Additional reported vaccinations: On 14-AUG-1995 the patient was vaccinated intramuscularly with a first 0.5 ml dose of diphtheria toxoid (+) Hib conj vaccine (CRM197) ( +) pertussis whole cell vaccine (+) tetanus toxoid (TETRAMUNE VACCINE) (lot#427839), a first 0.5 ml dose given subcutaneously in the right thigh of poliovirus vaccine inactivated (IPOL) (lot##0457), and a second 0.25 ml dose given intramuscularly in the right thigh of hepatitis B vaccine, recomb (lot#613671/1288A).  On 06-NOV-1995 the patient was vaccinated intramuscularly in the left thigh with a 0.5 ml second dose of diphtheria toxoid (+) Hib conj vaccine (CRM197) (+) pertussis whole cell vaccine (+) tetanus toxoid (TETRAMUNE VACCINE) (lot#429968), and a second 0.5 ml dose given subcutaneously in the right thigh of poliovirus vaccine inactivated (IPOL) (lot#X0457).  On 29-JAN-1996 the patient was vaccinated intramuscularly in the thigh with a 0.5 ml third dose of diphtheria toxoid (+) Hib conj vaccine (CRM197) (+) pertussis whole cell vaccine (+) tetanus toxoid (TETRAMUNE VACCINE) (lot#429321), a third 0.5 ml dose given subcutaneously of poliovirus vaccine inactivated (IPOL) (lot#K1014), and a 0.5 ml third dose given intramuscularly in the right thigh of hepatitis B vaccine, recomb (lot613671/1288A).  On 09-SEP-1996 the patient was vaccinated intramuscularly in the left thigh with a 0.5 ml fourth dose of diphtheria toxoid (+) Hib conj vaccine (CRM197) (+) pertussis whole cell vaccine (+) tetanus toxoid (TETRAMUNE VACCINE) (lot#434812), a first 0.5 ml dose given subcutaneously in the left arm of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#612888/1373A), and a first 0.5 ml dose given subcutaneously in the right arm of varicella virus vaccine live (lot#616338/05592).  On 22-JUN-1997 the patient was vaccinated with a fourth 0.5 ml dose given subcutaneously in the left thigh of poliovirus vaccine inactivated (IPOL) (lot#M0216). On 04-OCT-1999 the patient was vaccinated with a fifth 0.5 ml given intramuscularly in the right thigh of diphtheria toxoid (+) pertussis acellular 3-component vaccine (+) tetanus toxoid (INFANRIX) (lot#DTPa902A2), a fifth 0.5 ml dose given subcutaneously in the left thigh of poliovirus vaccine inactivated (IPOL) (lot#P0553), and a second 0.5 ml dose given ), subcutaneously in the left thigh of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#630630/0544J).  On 05-NOV-2003 the patient was vaccinated with a 0.5 ml first dose given intramuscularly in the right arm of influenza virus split virion 3v vaccine inactivated (FLUZONE) (lot#01260AA) and a first 0.5 ml dose given in the arm of hepatitis A vaccine (inactive) (lot#646570/0739N).  On 11-JAN-2005 the patient was vaccinated with a second 0.5 ml dose given intramuscularly of influenza virus vaccine (unspecified) and a second 0.5 ml dose intramuscularly of hepatitis A virus vaccine (manufacturer unknown).  Follow up information received on 12-SEP-2006 contained the following adverse experiences, chronic cough and rhinorrhea (July 1995), upper respiratory infection, eczema and cyst in mouth (03-MAR-1996), cellulitis right foot and bilateral otitis media (10-JUL-1997) dislocated elbow  (28-AUG-1997), MVA (Dec 1997), diaper rash (1998), obesity (12-DEC-2000), enuresis (13-DEC-2001), boils in axilla, tinea corporis and nocturnal enuresis (05-NOV-2003).  No further information is available.  All available medical records will be provided upon request. (OMIC)