Age: 1.17
Sex: M
Vaccine: MMR
Symptoms: Drug withdrawal syndrome, Malaise, Neurodevelopmental disorder, Psychomotor hyperactivity, Pyrexia
Clinical narrative: Information has been received from a foreign legal firm concerning a 14 month old male who on 10/12/94 was vaccinated with MMR II (609505/1503W; batch 85170U). It was noted that the pt was developing "normally" before the vaccination was administered and that the pt's maternal uncle had a learning disability caused by complications at birth. On approximately 10/12/94, the pt experienced a high fever, color was "off" and was generally unwell that lasted 24 hours. In November 1994, the pt's behavior changed were he became very hyperactive, appetite disappeared and he experienced diarrhea which remained ongoing. From December 1994 to January 1995, the pt became withdrawn, did not react to his parents, lost all eye contact, speech disappeared and he began screaming a lot. Subsequently, the pt experienced attention deficit hyperactivity disorder with autistic tendencies and delayed development. Upon internal review, the pt's attention deficit hyperactivity disorder with autistic tendencies and delayed development were considered important medical events (OMIC). No further info is available.  A 15-day follow up report dated 01/14/2003 adds: Pt was born at 37 week gestation by emergency lower segment caesarean section and weighted 6 pounds 9 ounces. The pt's mother went into premature labor at 27 weeks which was stopped by treatment with intravenous drugs. The pt's temperament was placid, easy to settle and he slept through the night from 17 weeks of age. The pt was bottle fed and took his food well. The pt said his first words at approximately 8 months of age. The pt's mother had Stargardt's disease and her brother attended a school for children with speech and language difficulties/disabilities that were caused by complications at birth. It was noted by February 1994 that the pt began flapping his hands and did not tolerate a room with more than two people in it. The pt on 10/12/94 was vaccinated with measles virus vaccine live (+) mumps virus vaccine live (-) rubella virus vaccine live (second generation) (lot #609505/1500W: Batch #8517900). It was noted that the pt was developing 'normally' before the vaccination was administered. At approximately the same time, the pt gained weight rapidly and the pt's parents had severe problems in communicating with him to manage his behavior. Subsequently, the pt experienced attention deficit hyperactivity disorder with autistic tendencies and delayed development. A physician assessment summary indicated that the pt was seen in May of 1996 because of concerns regarding the pt's speech and language development, hyperactivity and lack of play skills. The pt's father felt that the pt's development regressed in the last year but the pt's mother felt that the pt 'always had a problem'. The pt's parents indicated that the pt had a 'weakness' of the right foot and sweated and drank profusely. It was noted that the pt had severe temper tantrums when directed in any way and had a limited diet but had recently been accepting more variety of different type foods. The pt's speech and language skills were significantly delayed and a main area of concern was his behavior and attention which had a great influence on his ability to develop communication. The pt's chromosomes 'investigation' was noted as negative. The physician's conclusion indicated that the pt had developmental delay in all areas but more in the language area. It was difficult for the physician to determine the pt's exact functioning because of his severe behavior. A child psychiatrist's assessment dated 08/08/1997 indicated that the pt was being evaluated because he created 'mayhem' around him. In the assessment, the pt constantly rushed around the room, clambering over furniture and his parents, opening and shutting drawers of both desk and file cabinet. The pt demonstrated very little respect for parental boundaries. It was noted that the pt had persistent problems that included clumsiness, recklessness, constant over activity, seemingly inexhaustible energy, limited range of play, absence of speech, rapid loss of interest in any activity, his constant 'flitting' from one area of interest to another and his lack of any sense of danger (except for fire). The pt had a major problem in eating a healthy diet and lacked progress in acquiring bowel and bladder control. The pt was agile and had good manipulative skills. The pt communicated by pointing to objects that he wanted and had limited use of sign language. He made meaningful eye contact and was able to feed himself with a spoon. It was noted that the pt in the past displayed flapping of his hands in the periphery of his visual field but it was no longer prevalent. The child psychiatrist concluded that the pt who was 4 years old displayed significant learning disabilities and speech delay. The pt functioned at an approximately a 2 year old level and demonstrated extreme levels of hyperactivity. The child psychiatrist was considering treating the pt with dexamphetamine for the pt's overactivity but felt the pt's long term behavioral control would depend on the pt's parents ability to undertake a behavioral program. A child psychiatrist report dated 06/18/1998 indicated that many of the pt's behavioral difficulties were being 'gradually ironed out' by the application of consistent and firm behavioral management plan. The pt was making some progress with his learning but this was noted to be a slow process. The pt's spoken language remained at the level of a simple 'one word' utterances but his vocabulary had increased significantly. The pt had no generative linguistic capacity and made use of Makaton sign language. It was noted that the pt displayed some autistic features, in particular his reaction to any changes in his daily routine are extreme but his ability to engage socially both with other children and adults, together with his capacity for symbolic plays suggested that the pt did not 'have the full blown syndrome'. The pt remained very hyperactive and was continued to being treated with methylphenidate. The pt had a surge in hyperactivity when the pt missed a dose of methylphenidate. A letter dated 07/07/1998 from the medicine control agency indicated that the pt may have experienced severe side effects from being vaccinated with measles virus vaccine ilve (-) mumps virus vaccine live (-) rubella virus vaccine live (second generation) that included abnormal behavior, developmental delay and hyperkinetic syndrome. Upon internal review, the pt's attention deficit hyperactivity disorder with autistic tendencies and delayed development were considered important medical events. No further information is available. A copy of the pt's complete medical file is available upon request.