Age: 1.5
Sex: M
Vaccine: DTP, HIBV, IPV, MMR
Symptoms: Oral intake reduced, Otitis media, Pyrexia, Speech disorder
Clinical narrative: Information has been received from a mother concerning her 18 month old son who in approximately 1998, was vaccinated with a dose of MMR. Concomitant therapy included a dose of diphtheria toxoid (+) pertussis vaccine (+) tetanus toxoid, poliovirus vaccine and HIB conjugate vaccine. Less than six days later the patient began experiencing fever which were followed by his first seizure. The patient was taken to the emergency room but was not hospitalized. The patient had a total of three seizures before he was three years old. An EEG was performed but results were not reported. The reporter indicated that the patient was referred to a neurologist who prescribed an unknown brand of medication to treat any further seizures. The patient reportedly never took the medication because he did not have any other seizures. The reporter stated that she was unsure if the experienced caused a significant disability or not or if the MMR caused her son to have special needs now at 8 years old. The reporter described the special needs as communication disorders. According to a nurse in the patient's physician office, no further information was available. Upon internal review, seizures and communication disorders were considered to be other important medical events (OMIC). Additional information has been requested. In follow up information the physician reported that it was the patient's mother "perception that he had severe regression" after vaccination with measles virus vaccine live + Mumps virus vaccine live + rubella virus vaccine live. The physician reported that he "doubts that strenuously." It was also reported that the patient's mother was resistant to give her youngest child, who is approximately one and half years old, the measles virus vaccine live + mumps virus vaccine live + rubella virus vaccine live. The physician reported that the patient had been diagnosed with autistic spectrum for "sometime now."  In follow up information from the physician it was reported that the pt had a normal birth (VHAC). It was reported that the mother had a flu-like illness her seventh month of pregnancy. The physician reported that at the time of vaccination the child had a negative past medical history and was developing normally and had no known allergies. On 06Nov97 the pt developed a fever of 104 and was taken to the ER via ambulance. The pt's labs were as follows: WBC 11.9 hemoglobin 12.1, urinalysis normal, urine culture negative and blood culture was found to be contaminated by the lab. The child was treated with ibuprofen (Motrin) and fluids and was discharged home with a diagnosis of febrile seizure. In May98 the pt was seen in the office for his 2 year old well visit. He was doing well at that time. He could say 60 words but would rarely use two word combinations. It was reported that he also played with his brother. It was noted in his chart to recheck his language at 23/2 years of age. On 19May1998, the child was seen in the office for loose bowels, fever and local folliculitis on his skin. He was treated with local antibiotics for the folliculitis. On 20Oct98, the child was seen in the office and that time the pt's mother was not worried about his language. On 28Oct98 the pt received varicella virus vaccine live. In Nov98 the pt was seen in the office for picky eating and the mother reported that he was not eating well. The plan was to try to eliminate the pt's bottle. On 19Feb99 the pt had a fever (104-105) and was scheduled for an appointment that day. However, before the appointment the pt had a second febrile seizure and was taken to the ER. It was noted in the ER report that the pt had fallen off his chair and had contortion of his hand and body twitching. He had no color change and he awoke. The pt was diagnosed with febrile seizure and was sent home. The pt was seen in the office for follow up on 23Feb99 and was fine. On 24Feb99 the pt came into the office again with a cold, he was very congested. In May99 he came to the office for his 3 year old visit and the pt's other was concerned about his talking. The pt put words together but did not really progress. He was referred to an early intervention (birth to three) program. The reporting physician's partner saw the pt and was concerned about the child's behavior. The pt did not make any eye contact and did not make any sounds. In May99 the pt had a speech and language referral. The child was diagnosed with a severe expressive and receptive language delay. In May99 a hearing test was normal. In June99 the pt was seen by the reporter. In August99 the pt was seen by a child neurologist who noted that the pt has fever triggered seizure and displays behavior in the autistic spectrum. Subsequently the pt was seen by another child neurologist who gave a provisional diagnosis of pervasive developmental disorder. An EEG was done and was normal. The neurologist did not recommend neuro imaging. The pt underwent a video EG monitoring which was normal and showed no evidence of acquired ephasia. Hearing test and allergy and asthma evaluations were also normal. Genetic testing was done but results not available. It was reported that the pt had a bunch of ear infections through out all of this and he also had mild intermittent asthma. At this time the pt was receiving occupational therapy at home. It was noted that the pt's last seizure was in Sept99 and at that time he had otitis media and a high fever. On 05Aug02 at his 6 year old visit it was noted that the pt's language was getting better. He was getting occupational speech and physical therapy and was making some progress. The pt was still noted to be an atypical child. The pt was diagnosed with autistic spectrum disorder. On 27Feb04 the pt was seen again and was noted to be doing pretty well. He was getting special education help along with occupational, speech and physical therapy. The physician reported that the pt's mother had two other children, a boy born in 94 and a girl who is currently about 1 1/2 years old. Both these children are reportedly normal. According to the report the pt's mother did not start to worry about vaccination until her daughter was born. The physician reported that he did not think there was an association between the measles virus vaccine live  (Moraten) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) and the events. Upon internal review seizures, severe expressive and receptive language delay and autistic spectrum were considered to be other important medical events. (OMIC) Additional information has been requested.