Age: 2.0
Sex: M
Vaccine: DTAP, HEP, HIBV, MMR, OPV
Symptoms: Abnormal behaviour, Autism, Cognitive disorder, Drug toxicity, Drug withdrawal syndrome
Clinical narrative: Information has been received regarding a case in litigation which concerns a male child who during the time frame of March 1993 and September 1994 was vaccinated with several vaccination which contained the mercury laden preservative thimersol. It is alleged that the pt received a dose of MMR II. The pt allegedly suffers from the effects of mercury poisoning. Upon internal review, suffers from the effects of mercury poisoning was determined to be an other important medical event. No further information is available. It is alleged that the pt also received a dose of Haemophilus B conjugate vaccine and a dose of hep B vaccine. In addition, it is also alleged that the patient has been exposed and continues to be exposed to highly toxic emisission from power production facilities within the environmental zone of his residence. It is stated that these emission have contributed to the patient's total dose of poisonous mercury by inhalation and ingestion. In addtion to mercury, the emissions are known to contain nickel chromium and other heavy metals. Upon internal reveiw, the toxic neurological effects of mercury poisoning were determined to be other important medical events. No further information is available. (OMIC) The follow up states that a psychological evaluation was received as follow up info. The evaluation was 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 three months. The pt lived at home with his parrents and older brother. His mother worked part-time and spent much of the day with him. the pt was taking no prescribed medications at the time of evaluation, but he did regularly take an antihistamine for fluid in his ears. At the time of the evaluation the pt had recently had his heairng 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 pt's directives. The parents watned 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 as playful, irritable, alert, active and fussy with frequent crying. Some developmental delays were noted by the pt's family, such as the fact that he didn't say 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 sound.s The pt's sitting and walking were delayed also. The pt was previously evaluated in Feb 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 engagin in play with other children. Interactions with his brother usually were parallel play. The pt was often aloof with others, but would show affection spontaneoulsy 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 vneland adaptive behavior scales: survey form, the autism behavior checklist, the child behavior checklist, the Ritvo-Freeman real life rating scale, the childhoold autism rating scale and the Rayley scales of infant development. The vineland adaptive behavior scales were administered in standard semi-structured interview format 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 gretest 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 rpeorted that he is not exhibiting many of the behaviors that are indictive of autistic symptomatology. The CBCL is a broad spectrum behavior rating scale desinged to assess social compstence and behavior problems in everyday environments. Per the info provided by the pt's mother, he scored above the 98th centile ont he wihtdrawn 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 on the pt's observed behavior at the psychological services center. Behaviors rated as occurring repeatedly during the observation period included repetitive vocalization, repetitive stereotypic 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 prresence of autistic sympotoms. The pt's total score indicated the presence of symptoms of moderately autistic behavior. He exhibited difficulties in inappropriate body and object use, imitation, 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 ot 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 rating scale was non-optional in areas of emotional regulation and motor quality. His orientationand engagement was in the questionable optimal range when compared with an age-normed sample. The pt was observed at home and in the clinical setting. Two home visits were conducted and behaviros observed included hand flapping, especially when new stimuli were presented, parallel play with brother, repetitive vocalizaiton 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 theh current psychological results indicated htat 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 play was included wiht the purpose of increasing eye contact; increasing the amount of time spent attending to a task or being spoken to by others; increasing the number of vocalizations he uses to communicate his wants and needs. Chronic fluid in ears is considered to be an incidental finding. Upon internal review, the toxic neurolgoical efffects of mercury poisoning and pervasive developmental disorder were determined to be other important medical events (OMIC). No further info is available.