Age: 0.75
Sex: M
Vaccine: DTP, DTPHIB, HEP, OPV
Symptoms: Lymphocytosis, Muscle twitching, Nervous system disorder, Psychomotor hyperactivity, Sensory disturbance
Clinical narrative: This case was reported by a lawyer and described the occurrence of neurological injury in a male subject who was vaccinated with hepatitis B vaccine (Engerix B) and or unidentified hepatitis B vaccine for prophylaxis.  On September 1995, the subject received a 3rd dose (dose not specified) of hepatitis B vaccine (Engerix B).  Previous doses were not specified as Engerix B vaccine with Engerix B, the subject experienced "serious and permanent neurological injuries: which were attributed to "toxic mercury exposure".  The following information was received via medical records. The subject was vaccinated with a 3rd dose (does not specified) of hepatitis B vaccine (Engerix B) on September 1995.  The subject had also received vaccinations with diphtheria and tetanus toxoids and acellular pertussis vaccine (Dtpa, manufacturer unspecified), Haemophilus influenzae type B vaccine (HIB), live attenuated oral poliomyelitis vaccine (OPV), and measles, mumps and rubella vaccine (MMR vaccine), inactivated polio vaccine (IPV) and Tetramune.  The subject's family history was significant for high blood pressure (grandmother), diabetes (father), allergies or asthma (mother), cancer (unspecified), hearing or speech problems (mother), alcohol or drug abuse (grandfather), attention deficit disorder (father) and family  violence (Aunt).  The subject's only medical history consisted of frequent ear infections, asthma and an umbilical hernia since birth.  In September of 2000, at almost 6 years of age, the subject was diagnosed with possible attention deficit disorder and questionable developmental delay.  The subject was psychologically evaluated on 24 November 2000, 01 December 2000 and on 07 December 2000 at the age of 6.  He was referred for assessment due to having significant behavior problems at home and in school.   He was described as being significantly hyperactive and impulsive in all places.  He had frequent temper tantrums, especially when frustrated.  The subject was also described as aggressive with other children.  Hyperactivity was noted as having been a problem all of his life.  It was reported that the subject's parents separated six months prior to testing. In summary following an extensive evaluation, cognitive testing indicated that the subject functions in the average range (full scale IQ=93).  He achieved at a higher level in the reading and spelling subjects as opposed to the math.  In attentional ability, the subject displayed difficulties in focusing, sustaining, encoding and executive functioning.  Emotionally, the subject showed significant problems with reading social dues and had  difficulty identifying and expressing his emotions which manifests itself in low frustration tolerance when faced with situations of tasks that are challenging.  It was stated that although the subject shows significant attentional difficulties, ADHD is not diagnosed if these symptoms occur within a pervasive developmental disorder.  A pediatric wall check (ambulatory treatment record) dated 01 July 2002, reported that the subject suffered from Asperger's syndrome and had developed a tic which may have been the result of treatment with RISPERDAL.  The subject continued to suffer from historical seasonal allergies.  The subject was having trouble sleeping.  An well child evaluation dating back to 05 June 2001 noted that the child had very irregular sleeping patterns.  An annual status report on the subject dated 29 April 2003 (the subject was 8) indicated that at the time, he showed inconsistent improvement in his social emotional development.  Breaks during the school year made it difficult for the subject to maintain his improved level of functioning.  He continued to require the assistance of one to one aide to assist him in negotiating peer conflict, coping with intense emotions, completing requiring work being a productive member of his class.  The skills, verbal/symbolic reasoning, language based critical thinking skills and articulation.  A well child evaluation performed when the child was 9 and a half on 22 July 2004 noted that the subject had feeding issues with sensitivity to texture and taste and he experienced "seizure-like episodes" of staring and twitching. At this time, the subject was noted as high functioning in reading and math.  A sleep deprived EEG was performed on 01 September 2004 to rule out seizure following staring and body twitching episodes.  Results revealed a normal awake and asleep electroencephalogram with hyperventilation and phobic stimulation.  No changes were noted on an evaluation dated 11 January 2005.  This case was assessed to be medially significant. (OMIC)