Sex: M
Vaccine: DTAP, HEP, PNC
Symptoms: Enuresis, Learning disability, Mental impairment, Mental retardation severity unspecified, Mixed receptive-expressive language disorder
Clinical narrative: This case was reported by a lawyer and described the occurrence of nerve injury in a male subject who was vaccinated with Engerix, Infanrix, Hib, OPV, Ipv, MMR and Varivax for prophylaxis. The subject was vaccinated with hepatitis B vaccine on 22 June 1997, and with Engerix B on 22 August 1997 and 05 January 1998. The subject was vaccinated with Infanrix on 22 August 1997, 22 October 1997, and 05 January 1998.  On 5 January 1998 the subject received the third dose of Engerix B and the third dose of Infanrix. According to the legal complaint, at an unspecified time after vaccination with hepatitis B vaccine, the subject experienced "serious and permanent neurological injuries", in addition to a "neurodevelopmental disorder", which were "alleged to be caused by Thimerosal." In December 2001, the subject was reportedly diagnosed with pervasive developmental disorder. In January 2002, the subject was diagnosed with autism, which was reportedly confirmed in August 2002. The events of autism and pervasive developmental disorder were assessed as medically serious by manufacturer. Follow up information was received on 30 March 2007 via medical records. Pediatrician's progress notes dated 06 January 1999 indicated problems including temper tantrums. Examination on 05 June 2001 indicated "sensory learning disability". In September 2001, physician's notes indicated"? slow mentation, ? autism", and a speech delay was noted. On 26 October 2001, the subject underwent a speech and language evaluation which revealed "severely delayed" receptive and expressive language skills and significant delays in pragmatic language skills. Voice and fluency skills were within normal limits, and prognosis for improvement was assessed to be "good" given compliance with recommendations which included speech-language therapy. On 19 December 2001, the subject was evaluated by a school psychologist for concerns regarding language delay and behavioral difficulties. The psychologist assessed the subject's presentation to be "similar to that of other children who have been diagnosed with Autism disorder", including deficits in communication and reciprocal social interaction, and "restricted and repetitive patterns of behavior"; it was noted that these symptoms were "in evidence prior to age three years". On 17 January 2002, a school evaluation indicated that the subject exhibited "an approximate two year delay in developing language". The subject underwent a psychological evaluation on 28 January 2002. According to the parents' report, the subject met motor milestones normally, but experienced a "regression" in speech skills at approximately 24 months old. The subject exhibited weak social skills including reduced eye contact. He was assessed to be "high-functioning", and was within normal ranges in noverbal cognitive skills. Verbal skills were "well below" average, and daily living skills were delayed for his chronological age. It was noted that the subject's "inattention and high activity level seemed to be the primary factors precluding more functional motor abilities". He was diagnosed at that the time with Autism Spectrum disorder. on 14 March 2002, the subject threw a temper tantrum at school, and his right arm went through the window, resulting in a wound that required treatment in the emergency room. An occupational therapy evaluation dates 04 June 2002 indicated weaknesses in the subject's ability to process touch and oral sensory information and exhibited a "high pain tolerance". On 19 August 2002, a behavioral/developmental pediatric evaluation was performed. The subject had been enrolled in a school for children with disabilities from February 2002 to June 2002, and his mother reported improvement in his language skills. Upon examination, concerns included upset when routines were changed, chewing "on everything", echolalia, encopresis at school and bedwetting, and increased aggressive behavior/temper tantrums. According to the Childhood Autism Rating Scale, the subject was "at the cusp of moderately autistic to severely autistic"; diagnosis at that time was "austism moderate". In April 2004, the subject continued to experience below average language skills. He remained enrolled in an autism class, and speech and occupational therapy were continued. Upon examination on 03 February 2006, the subject was seen for a "well child" examination. Notes indicated "autistic and receives special education". There were no health concerns at the time, vision and hearing were assessed as "normal in the past". It was also noted that he had never been to the dentist. In September 2001, the subject was hospitalized for surgery to repair a fractured elbow. This was considered to be an incidental finding upon review of medical records.