Age: 2.0
Sex: M
Vaccine: DTAP, HEP, MMR, OPV
Symptoms: Neurodevelopmental disorder, Neuropathy
Clinical narrative: From faxed correspondence received on 06/102002, it was reported that this is in follow-up to report previously submitted on 12/21/01; 01/23/02. Initial and follow-up info has been received regarding a case in litigation concerning a male child who during the time frame of March 1993 and September 1994 was vaccinated with hep B vaccine recombinant, MMR II, Haemophilus B conjugate vaccine, Tripedia, and Orimune vaccine which allegedly contained the mercury laden preservative thimerosal. It is alleged that following these vaccinations the pt suffers from the toxic neurologic effects of mercury poisoning. In addition, it is also alleged that the pt has been exposed and continues to be exposed to highly toxic emissions from power production facilities within the environmental zone of this residence. It is stated that these emissions have contributed to the pt's total dose of poisonous mercury by inhalation and infestion. In addition to mercury, the emissions are unknown to contain nickel, chromium and other heavy metals. Upon internal review, the toxic neurological effects of mercury poisoning were determined to be other important medical events. No further info is available. From faxed follow up correspondence received at manufacturer on 6/24/02, it was reported: "A psychological evaluation was received as follow-up info. The evaluation as performed on 3/7/95, 3/13/95 and 4/19/95. The pt's age at the time of the evaluation was two years and threemonths. The pt lived at home with his parents and older brother. His mother worked patrt-time and spent much of the day with him. The pt was taking no prescribed medications at the itme of the evaluation but he did regurarly take an antihistamine for fluid in his ears. At the time of the evaluation the pt had recently had his hearing checked. There was no apparent hearing loss, but there was a difficulty with fluid build up in his ears. The pt's mother expressed concern regarding his limited use of and regression in language and his unusual behaviors such as muscle rigidity and hand flapping. The pt also failed to follow his parent's directives. The parents wanted to know the extent to which these behaviors could be controlled and if they could be improved. Per the parents, the pt was the product of a full term pregnancy. The umbilical cord was positioned around his head during delivery, but there was no need for administration of oxygen. The pt's birth weight was eight pounds. The pt's infancy was described a splayful, irritable, alert, active and fussy with frequently crying. Some developmental delays were noted by the pt's family, such as the fact that he didn't sya his first words until the age of 18 months, however, it was noted that as he reached 24 months he stopped saying these words and regressed to only vocalizing vowel sounds. The pt's sitting and walking were delayed also. The pt was previously evaluated in February 1995 and developmental delays were noted. At the time of the report, the pt was utilizing both speech and occupational therapies. He exhibited delays in social interaction in that he would rarely show interest in engaging in play with other children. Interactions with his brother usually were parallel play. The pt was often aloof with others but would show affection spontaneously with his mother. No significant life changes or stressors were reported as having occurred within the family since the pt's birth. The behavioral assessment included both a parent interview and direct observation sessions. Assessment tools included the Vineland Adaptive Behavior Scales: Survey Form, the Autism Behavior Checklist, the child behavior checklist, the Ritvo-Freeman real life reating scale, the childhool autism rating scale and the Baylay scales of infant development. The Vineland Adaptive Behavior Scales were administered in standare semi-structured intervie wformal to the pt's mother. The Vineland measures adaptive functioning in the areas of communication, daily living skills, socialization and motor skills. It also yields an overall measure of adaptive functioning, the Adaptive Behavior Composite. The pt's scores in the communication domain put him at a one year one month age level. His scores in the daily living skills domain put him at a one year eight month level. His scores on the socialization domain put him at the one year zero month level. His scores in the motor skills domain put him at the two year seven month level. The pt's relative strength in motor skills was further qualified by his mother's report that she perceived his greatest strength to be his gross motor abilities. The ABC was administered to the pt's mother. The ABC is a 57 item behavioral checklist. A total score of 67 or higher is considered indicative of autism. The pt's score was significantly lower than the cutoff score, indicating that the mother reported that he is not exhibiting many of the behaviors that are indicative of autistic symptomatology. The CBCL is a broad spectrum behavior rating scale designed to assess social competence and behavior problems in everyday environments. Per the info provided by the pt's mother, he scored above the 98th centile on the withdrawn subscale. In addition other behavioral problems were endorsed such as being easily frustrated, defiant, upset by new people or situations and chewing inedibles. The RLRS is a behavioral rating scale completed by a trained observer based on a 30 minute observation of the child's behavior. The RLRS was completed by one examiner based ont eh pt's observed behavior at the psychological services center. Behaviors rated as occurring repeatedly during hte observation period included repetitive vocalization, repetitive sterotypic behavior, hand flapping, ignoring interaction attempts, self isolation, watching objects in motion and noncommunicative vocalizations. The pt's overall score suggested the presence of a few pathognomic autistic symptoms. The CARS is a behavioral rating scale used for diagnosing autism. The CARS was completed by one examiner based on observations made in the clinical and the home environment. The CARS provides a measure of the degree or presence of autistic symptoms. The pt's total score indicated the presence of symptoms of moderately autistic behavior. He exhibited difficulties in inappropriate body and object use, imitations, listening response and nonverbal and verbal communication. The Bayley Scales of Infant Development consists of three scales, the mental scale, the motor scale, and the behavior rating scale. It was difficult to maintain the pt's attention on the test and he needed frequent shifting of items in order to cooperate with testing. He frequently did not respond to initial verbal prompting to engage in the task at hand, and he often required repeated prompting. On both the mental and motor scales the pt displayed mildly delayed performances. His performance on the Behavior Rrating Scale was non-optimal in areas of emotional regulation and motor quality. His orientation and engagement was in the questionable optimal range when compared with an age normed smaple. The pt was observed at home and in the clinical setting. Two home visits were conducted and behaviors observed included hand flapping, especially when new stimuli were presented, parallel play with brother, repetitive vocalization of vowel sounds and inappropriate use of objects. He also displayed inappropriate use of objects by mouthing on toys, coins, etc. Review of the DSM-IV criteria and the current psychological results indicate that the pt displayed several pathognomic features of autistic disorder. The testing results; however, were varied in the identification of significant signs of autism. The identified symptoms may be better accounted for by "pervasive developmental disorder not otherwise specified." A treatment plan was included with the purpose of increasing eye contact; increasing the amount of time spent attending to a taks or being spoken to by others; increrasing the number of vocalizations he uses to communicate his wants and needs. Chronic fluid in ears is considered to be an incidental finding.