Age: 1.51
Sex: M
Vaccine: DTAP, HIBV, MMR, DTP, HIBV, IPV
Symptoms: Rhinitis, Sinusitis, Skin ulcer, Upper respiratory tract infection, Viral infection
Clinical narrative: Information has been received regarding a case in litigation concerning a minor male patient who was exposed to high levels of mercury from thimerosal through exposure to unspecified products.  In additional, the patient was exposed to mercury emissions from fossil fuel driven power plants. The mercury included in thimerosal laden products and power plant emissions together caused the patient to suffer from serious and permanent neurological injuries.  The patient was exposed to airborne mercury vapor and mercury through food chain.  The exposure to airborne mercury in the environment through inhalation, the food chain, and other sources contributed to the cumulative mercury toxicity and was a heightened vulnerability to suffer neurological damage.  It was noted that the patient had a heightened vulnerability to suffer neurological injuries from industry as a direct result of thimerosal exposure.  As a direct and proximate cause of the toxic mercury exposure to the patient, minor male was  caused to suffer serious and permanent neurological damage which include past and future mental, intellectual, developmental and neurological incapacity and associated learning disabilities, disorders and impairments.  Additional information has been received via medical records from a case in litigation concerning a 22 month old male with no known allergies to medication, foods or latex, physically well with occasional constipation, questionable developmental delay and a history of jaundice during neonatal period, pregnancy complicated only by Rh incompatibility and the mother's use of occasional tobacco during pregnancy, head injury (fall form a shopping cart to cement floor and hit his head at 8 and half months of age) and candidiasis.  It was noted that at 8 months of age the mother was concerned that he was not not developing normally (approximately November 1990).  On 03-OCT-1991 the patient was vaccinated with a first dose of measles virus vaccine live (+) mumps virus vaccine live (+) rubella virus vaccine live (lot#600924/1150T), in the left thigh.  Concomitant therapy that day included a third dose of diphtheria toxoid (+) pertussis acellular 4-component vaccine (+) tetanus toxoid (lot#308-975) (ADEL-IMMUNE), in the right thigh,  and a first dose of Hib vaccine (unspecified) (lot#M615HE), in the left deltoid.  On 03-OCT-1991 assessment was "physically well child may check hearing later date to see if accounts for developmental delay.  Questionable developmental delay was also reported.  On 12-FEB-1992 the patient presented to physician's office with concerns of "doesn't speak at all, walks uncoordinated, does not seem to be getting any smarter, not interactive hearing, like to bounce on bed, screams a lot".  Assessment was suspected developmental delay.  On 12-FEB-1992 the patient was vaccinated with a second dose of Hib conj vaccine (unspecified carrier) (lot#M160HH), in the right anterior thigh.  On 11-AUG-1992 the patient was evaluated by pediatrician and was diagnosed with severe mental retardation with an IQ equivalent of 25-30 and pervasive developmental disorder with autistic tendencies.  The patient's review of systems was essentially negative.  His only noted issues were dental caries.  On 03-NOV-1992 the patient's review of systems was essentially negative.  His only noted issues were dental caries.  On 03-NOV-1992 the patient presented to a doctor's office.  The patient was growing well and "physically OK".  Social, fine motor and language development was reported to be severely delayed.  Assessment was physically well with autism and severe retardation.  On 03-NOV-1992 the patient received a third dose of poliovirus vaccine live oral (ORIMUNE) (lot#334-951), a second of Hib vaccine (unspecified) (lot#M005JD), in the left thigh, and a fourth dose of diphtheria toxoid (+) pertussis acellular 4-component vaccine (+) tetanus toxoid (ADEL-IMUNE) (lot#334-931) (IM), in the right thigh.  On 19-APR-2003 MRI of the cranial region performed in the axial and sagittal projections without intravenous contrast injection for evaluation of CNS developmental abnormality for possible explanation of mental retardation with autistic features.  No other significant abnormalities were seen.  Some fluid-like signal noted probably reflecting some inflammation in the mastoid air cells.  On 28-APR-1994 the patient was seen by a pediatrician.  The pediatrician reported that the patient had been placed on a trial of methylphenidate hydrochloride (RITALIN) shortly before.  The methylphenidate hydrochloride (RITALIN) was increased to 5 mg in three daily doses at that time.  There was some beneficial effect lasting two to three hours after each dose.  The patient was also given chloral hydrate for use at bedtime for problems with sleeping.  The patient was currently taking methylphenidate hydrochloride (RITALIN), 5 mg TID at 8 am, noon, and 4 pm, 4 cc of choral hydrate on a when needed basis at bedtime.  The patient had normal karyotype showing 46 XY and negative for fragile X syndrome in August of 1992, and a normal MRI scan in April of 1993.  At this time the patient's mother stated that the patient's behavior was worsening.  The patient also had difficulty sleeping.  Choral hydrate was given 5 to 6 times per week.  On 28-APR-1994 the patient was diagnosed with severe global developmental delay, pervasive developmental disorder and severe behavior problems.  On 03-AUG-1994 the patient was vaccinated with a second dose of measles virus vaccine live (+) mumps virus vaccine vaccine live (+) rubella virus vaccine live.  Concomitant therapy that day included a fourth dose of polio vaccination and a fifth dose of diphtheria toxoid (+) pertussis acellular 4-component vaccine (+) tetanus toxoid.  On 04-FEB-1997 the patient was evaluated by a physician.  At the time the patient was medicated with clonidine, melapril, liquid chlorhydrate or liquid valium and vitamins.  The patient had intermittent diarrhea.  The patient had static encephalopathy of unknown etiology which had caused the autistic disorder and mental retardation.  On 11-APR-1997 and on 13-JUN-1997 the patient was vaccinated with hepatitis B virus vaccine rHBsAg (yeast) (manufacturer unknown) (also reported as been given on 11-APR-1998, 09-MAY-1998 and on 03-OCT-1998.  On 23-MAY-2000 the patient underwent CT without contrast.  The opinion of the physician was reported as sinusitis involving the sphenoid sinuses, no evidence to suggest an acute intracranial process and left anterior and right posterior plagiocephaly.  Information received on 12-SEP-2006, dental caries (11-AUG-1992), cough, chest congestion, fever (viral syndrome vs pneumonia) (19-DEC-1992), pharyngitis (01-FEB-1993), URI (09-FEB-1993), alopecia (09-FEB-1993), left otitis (23-SEP-1993), purulent rhinitis (23-SEP-1993), intermittent diarrhea (04-FEB-1997), sinusitis (23-MAY-2000), diarrhea (10-JUL-2001), weight gain (14-NOV-2001), viral URI/influenza (January 2002), right otitis (January 2002), rash (20-NOV-2002), lesions on face (20-NOV-2002), infected, ingrown nail (20-AUG-2003), head injury (injury to head on back of toilet 31-OCT-2003 requiring sutures).  Previous vaccinations included on 19-JUN-1990 (lot#275-931) (IM right thigh) and on 07-AUG-1990 (IM right thigh) a first and second dose of diphtheria toxoid (+) pertussis acellular 4-component vaccine (+) tetanus toxoid, respectively.  The patient also received on 19-JUN-1990 (lot#275931) and on 07-AUG-1990 (lot#281-934) a first and second dose of poliovirus vaccine, respectively.  Upon internal severe mental retardation, autistic tendencies, pervasive developmental disorder, developmental delay, static encephalopathy, plagiocephaly, cumulative mercury toxicity were considered to be other medical events.  A copy of the patient's medical records is attached as further documentation of the patient's experience.  All available medical records will be provided upon request. (OMIC)