Age: 1.0
Sex: M
Vaccine: MMR, VARCEL, DTAP, HIBV, DTAP, HEP, HIBV, IPV, MMR, VARCEL
Symptoms: Electroencephalogram normal, Encephalopathy, Expressive language disorder, Flatulence, Food allergy
Clinical narrative: Information has been received from a legal firm regarding a case in litigation concerning an approximately 12-month-old male, who was injected with vaccines reportedly containing Thimerosal. It is alleged that between 12 and 25 micrograms of toxic ethylmercury were injected into the patient's body with each individual dose of Thimerosal and that the schedule of injections introduced a cumulative dose of 238 micrograms. It is further alleged that on approximately 01-MAR-1999, at approximately 12 months of age, the patient began to display symptoms of neurological damage consistent with mercury poisoning, not limited to losing his language skills engaging in repetitive and stereotypical behaviors, suffering from diminished cognitive ability and becoming socially withdrawn. At approximately 18 months of age the patient suddenly regressed developmentally. He became withdrawn, unable to speak and unresponsive to his environment. His injuries included a loss of language skills, motor skills, and effect. The patient has since been diagnosed as suffering with mercury poisoning and disintegrative (or late onset, degenerative or regressive) autism.  Follow up information was received from a legal firm that indicated that the patient was exposed to airborne vapors and mercury through the food chain, other mercury-laden products and power plant emissions. The patient was exposed to mercury from continually inhaling and ingesting industrial mercury emissions from fossil fuel driven power plants. The mercury included in the thimerosal-laden products and power plant emissions together caused him to suffer serious and permanent injuries, including mental, intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments. The patient had heightened vulnerability to suffer neurological injuries from industrial mercury as a direct result of thimerosal exposure. Follow-up information has been received from medical records regarding a case in litigation concerning a patient with allergies to various foods and a medical history of an upper respiratory infection (16-NOV-1998), croup (01-DEC-1998, and bilateral otitis media (05-DEC-1998) who on 01-MAR-1999 was vaccinated in the right leg with a first dose of MMR II (lot # 628901/1547H). Suspect vaccination received on the same day included a dose in the left leg of Varivax (lot # 628242/1842H). Other vaccination history included a first (left leg, lot # ENG2424A2), second (left leg, lot # ENG2492A2), and third (right leg, lot # ENG2727A2) dose of hepatitis B virus vaccine (unspecified) on 05-MAR-1998, 02-APR-1998, and 30-NOV-1998 respectively, a first (IM, right leg, lot # 450-639), second (IM, left leg, lot # 453-845), third (IM, right leg, lot # 453-845), and fourth (IM, right leg, lot # 462-314) dose of Dtap on 04-MAY-1998, 06-JUL-1998, 08-SEP-1998, and 03-JUN-1999 respectively, a first (IM, left leg, lot # M285RJ0, second (IM, right leg, lot # M010RN), third (IM, left leg, lot # 361453A), and fourth (IM, left leg, lot # 441003A), dose of Hib conj vaccine (unspecified carrier) on 04-MAY-1998, 06-JUL-1998, 08-SEP-1998, and 03-JUN-1999 respectively, and a first (SC, left leg, lot # N0291), second (SC, right leg, lot # N0492), and third (PO, lot # 786MI) dose of IPOL on 04-MAY-1998, 06-JUL-1998, and 01-DEC-1998) respectively. On 06-OCT-1999, he was seen by a physician for a repeat audiometric examination since a previous free field behavior observation audiometry on 01-SEP-1999 suggested a high frequency sensorineural hearing loss. This was of concern in that the patient had a delay in speech development. The impression of the exam was high frequency hearing loss, which may contribute to his delayed speech development. Further work-up was recommended and it was noted that he could be a candidate for hearing aid amplification. On 18-SEP-2000 and 21-SEP-2000, he was seen for a developmental pediatric evaluation where he was first diagnosed with autism. It was noted in the history that his immunizations were up to date. The diagnostic impression revealed that the etiology of his autism was unclear. Fragile X Syndrome would be considered as a possible cause though, he does not have characteristic physical features of this disorder. An amniocentesis revealed normal chromosomes. The lack of regression in areas other than language and social skills, along with the recent acquisition of some new language skills, was not suggestive of a degenerative disorder. Due to the somewhat later onset of regression, acquired epileptic aphasia may be considered, though was not felt to be likely. A head MRI could be considered, given his macrocephaly and history of regression. Hearing loss as a contributing factor to his language delays had already been appropriately ruled out. On 04-NOV-2000, a casomorphin urinary peptide was high at 46.5 (normal less than 2.5 ng/ml), a gliadorphin urinary peptide was high at 31.6 (normal less than 20 ng/ml), and a gliadin AB IGG was 98 units (greater than 30 units: moderate to strong positive). On 01-NOV-2000, autism was confirmed by another physician when he was taken for the evaluation of speech delay and possible autism. The impression revealed that he clearly had an autistic disorder which included delayed and deviant speech and language development and poor interaction. Current cognitive skills were in the borderline to mildly impaired range. There had been a history of developmental regression, particularly in language. The diagnoses were encephalopathy, autistic disorder, and cognition in the borderline to mildly impaired range. On 16-MAY-2001, he was seen by a physician and found to have significant improvement in language and behavior and decreased sensory sensitivities and stereotypes. On 01-JUN-2001, a hair analysis showed elevated arsenic. Significance and total body burden were unknown. The hair analysis also suggested low zinc, which is often seen in individuals on the autism spectrum. He was seen for a neurological evaluation regarding the diagnosis of autism on 08-AUG-2001. The impression noted that he demonstrated features of autism with an impairment in his language and communication development as well as social interactions and some very subtle stereotypic movements, although these were not prominent. He demonstrated some modest regression in language now with gradual recovery. He never truly of fully lost language, according to his mother. In terms of etiology, there was no obvious abnormality. The question arises whether there could be any cerebral dysgenesis contributing to his underlying condition. He dose have underlying condition. He does have a large head, although it does seem proportionate to the rest of his body. It was relatively unlikely that he was going to demonstrate any cerebral abnormalities to explain his condition, but given the large head, it may be worth pursuing that investigation with an MRI. There could also be underlying epileptic discharges or subclinical seizures during sleep contributing to the overall problem. An overnight EEG was recommended. An MRI on 17-NOV-2001 revealed mild prominence of the CSF Cotunnius spaces, otherwise, unremarkable examination of the brain. Posterior fossa cyst, probably representing an arachnoid cyst was noted. Upon internal review, autism, mercury poisoning, and central nervous system disorder were considered to be other important medical events. Follow-up information received on 28-MAR-2007 contained the following adverse experienced: diaper dermatitis (12-JUL-1999), ankyloglossia (22-JUL-1999) requiring frenulectomy, chronic otitis media (19-AUG-1999) requiring antibiotic therapy, viral pharyngitis (31-JUL-1999), croup (27-OCT-1999), tinnitus (onset unknown), viral upper respiratory infection (03-NOV-1999), bilateral otitis media (10-JAN-2000), right ankle injury (February 2000); croup (06-MAR-2000), upper respiratory infection (09-MAY-2000) treated with DIMETAPP, viral gastrointestinal infection (07-JUN-2000), viral syndrome (03-JUL-2000), motion sickness (onset unknown), seasonal allergies (onset unknown), loose bowels (onset unknown), abnormal stool pattern (16-MAY-2001), intestinal yeast over growth (16-MAY-2001), arachnoid cyst (17-NOV-2001) gastrointestinal gas (onset unknown), croup (08-JAN-2002) treated with ORAPRED. No further information is available. All available medical records will be provided upon request.