Age: 0.78
Sex: M
Vaccine: HEP
Symptoms: Mental retardation severity unspecified, Psychomotor hyperactivity, Speech disorder
Clinical narrative: This case was reported by a lawyer and described the occurrence of neurological damage in a male subject who was vaccinated with hepatitis B (Engerix B) and/or unidentified hepatitis B vaccine for prophylaxis. On an unspecified date the subject received unspecified dose of prophylaxis. According to the legal complaint, at an unspecified time after vaccination with hepatitis B vaccine, the subject experienced "neurological damage" which was attributed to "cumulative mercury toxicity". The following info was received via medical records: Family history included mood disorder, substance dependence and behavioral problems. The subject was exposed to nicotine in utero. The subject received hepatitis B immunization on 4/10/99 and Engerix B on 10/11/99 and 1/1900. A progress note dated 11/27/00, indicated that the subject presented with chief complaints of behavior problems including screaming and aggression. He was described as having a "very strong temper", with temper tantrums and hitting. On 4/11/01, when the subject was 2 years old, concerns included a speech delay described as "not talking that much, uses 10 to 15 words and phrases; "jargoning". At aorix, 2 1/2 years old, the subject initiated speech therapy with speech pathologist. The subject was not toilet trained as of May/June/2003. At that time, the subject's parents were in the process of divorcing and it was noted that he experienced difficulty separating from his mother which had worsened since his parents' separation. On 10/20/02, the subject underwent a speech/language screening, which he passed but demonstrated problems with articulation and sentence structure. On 1/5/04, at 4 years 8 months of age, the subject underwent evaluation for "out of control" temper tantrums and verbal and physical aggression towards his siblings and mother. According to history given by the mother, the subject's symptoms began as early as 1 year old, when he exhibited hyperactivity and impulsivity. As the subject aged his temper tantrums increased to as frequently as 1 episode per day and included behaviors such as scratching himself on the face until he bled, "racing back and forth", flapping his hands in a "repetitive rhythmical way", crying, shrieking, throwing things, and hitting. Additional concerns included oppositional and defiant behavior and dislike of interaction with other children. Developmental milestones were reportedly within normal limits (standing at 9 to 10 months, walking at 11 months). At the time of exam, the mother described the subject's speech difficulty as a "power struggle issue", stating that he would speak whenever he wanted to. He was potty trained at that time and able to dress himself with assistance. The subject's father committed suicide in 10/03; however, the evaluating physician noted "this does not seem to have had a major impact on the child". Diagnoses included disruptive disorder, pervasive developmental disorder (rule out attention deficit disorder and mood disorder). A trial of risperidone (Risperdal) was initiated. It was noted that the mother "has also tried some herbal supplements which she was advised strongly against to combine with Risperdal". As of 3/04, the subject was receiving Seroquel, which had been initiated on an unknown date. By 4/04, the subject's tantrums had decreased in frequency and severity. The subject was dx'd with bipolar disorder, pervasive development disorder and social anxiety disorder as early as 9/05. An assessment based on the Wechsler Intelligence Scale for Children was performed on 10/10/05 and showed the subject to be functioning within the average range for verbal comprehension, working memory and general intellectual ability and within the superior range for perceptual reasoning. On 8/18/06, the subject was admitted to a behavioral health program. Upon admission he was receiving clonidine and Zyprexa. He was discharged on 8/24/06 on clonidine, Focalin XR and Seroquel for treatment of behavioral problems. Discharge dx included bipolar disorder, anxiety disorder NOS, encoparosis, nocturnal enuresis, pervasive developmental disorder, and "severe" sibling rivalry with primary support issue.