Age: 1.0
Sex: F
Vaccine: MMR
Symptoms: Abdominal discomfort, Aggression, Aphasia, Asthenia, Bacterial infection
Clinical narrative: Information has been received from a case in litigation concerning a patient who on Jun 10 1996 was vaccinated with a dose of measles virus vaccine live  (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3) (lot 615850/0308B). It was alleged that the patient experienced an unspecified injury from the from the MMR vaccination. The patients outcome was unknown. Additional information has been received from medical records concerning the case in litigation. The patients immunization schedule was reported as follows: diphtheria toxoid (+) Hib conj vaccine (unspecified carrier) (+) pertussis vaccine (unspecified) (+) poliovirus vaccine inactivated (unspecified) (+) tetanus toxoid (Aug 07 1995), (Sep 04 1995) and (Oct 10 1995) diphtheria toxoid (+) poliovirus vaccine inactivated (unspecified) (+) tetanus toxoid (Sept 15 2000). The patient has a familial history including a maternal grandmother had had hereditary spastic paraplegia, as did a distant cousin of the grandmothers. her grandmothers sister had syringomyelia. A parental aunt had 2 boys with Attention deficit hyperactivity disorder who were both in mainstream education. At the time of the vaccination with measles virus vaccine live  (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3), the patient was crawling and cruising along furniture, but not walking. She was able to say mum, dad and hiya. the mother reported that after the vaccination these skills were lost. The patients mother noted that on Jun 12 1996, 2 days post vaccination, the patient was very irritable, developed rigors and a very high fever. There was no evidence of skin reaction. On Apr 22 1998 the patients mother sought medical attention for the patients slow speech and aggression towards other children. It was reported that the patient did not walk until the age of 25 months. She wears Pedro boots for bilateral flat feet with insoles to get foot position right. Upon examination she was found to have mild low muscle tone and to be delayed in all areas of development. She was recommended for physiotherapy and early language work. On Nov 10 1998, the patient had a urinary tract infection. The patient presented with fever, rigors and abdominal discomfort. At that time her urine revealed Escherichia Coli urinary tract infection with greater than 100 white cells. The patient was treated with trimethoprim. A urine culture completed on Nov 18 1998 revealed 5-20 white cells and significant growth of Pseudomonas. the patient was placed on therapy with trimethoprim. 30mg, HS for prophylaxis. On an unspecified date, the patient had an ultrasound of her kidneys and bladder which were reported as normal. In Nov 1999, progress notes indicated that the patient was enrolled in a mainstream school with extensive one on one support. She was receiving speech, occupational and physical therapy. In June 2000, it was reported that the patient was making very slow progress, In Dec 2000, the patient had moved from a mainstream nursery into a specialist teaching facility. ON Dec 07 2000, the patient was seen by a geneticist. The patient was found to be physically dysmorphic with accessory left nipple, low set, low ear pit and spindle shaped fingers and the patient had still not achieved bladder or bowel control. Investigations in the form of Karoytpe and Fragile X studies were reported to be normal. She also had investigations for metabolic diseases IE SMAC, serum creatine kinase, organic and amino acids and thyroid function test that were all normal. Her basic blood tests, including liver function test and renal function test were normal as well. It was reported on Apr 21 2001 that the patient was found to have been delayed in areas of development including poor locomotor skills, she had a limited vocabulary and was not potty trained. She also had been noted to be hypotonic and weak. On Sep 07 2001 the patient developed vomiting symptoms. On Feb 07 2003 the patient developed cystitis. On mar 11 2004 the patient was seen for vomiting symptoms and was treated with fluids. On Dec 17 2004 the patient visited a neurologist with absence episodes. The events was described by a teacher as she switches off and then comes back. The parents also described other events that occurred at night. it was reported that these events had occurred 5 or 6 times a night, but had become less frequent. The parents say that they would hear a noise and go to find the patient staring and stiff with occasional jerking. On Feb 16 2005, the patient was seen by the neurologist. It was reporting that through the patient had been fully investigated, no underlying causes for her learning disabilities have been found. the patient global developmental delay persisted. Global developmental delay was considered to be disabling. Follow up information was received on Sep 21 2005 following vaccination with measles virus vaccine live  (Enders-Edmonston) (+) mumps virus vaccine live (Jeryl Lynn) (+) rubella virus vaccine live (Wistar RA 27/3). This information contained the following adverse experiences: upper respiratory infection (11/25/1997), Croup infection (05/06/1998), Pyrexia (11/06/2000), scalp laceration (01/04/2002) left ankle sprain (01/08/2003), left ankle and foot sprain (06/11/2003), Chickenpox (07/03/2003), viral upper respiratory tract infection (11/06/2003), vesicular rash (06/18/2004), Pyrexia (03/03/2005), Tonsillitis (03/19/2005) and left wrist fracture (05/25/2005). No further information is available. All medical records are available upon request.