Sex: M
Vaccine: MMR
Symptoms: Autism, Hearing impaired
Clinical narrative: Information has been received from a foreign legal firm concerning a male who on 10/6/94 who at age of 14 months was vaccinated  with MMR II (reported batch 859330 invalid). Subsequently, the pt experienced autistic spectrum disorder. Upon internal review, the pt's autism was considered another important medical event (OMIC). No further info is available. Reported on 02/04/2003: "Initial and follow up information has been received from a foreign legal firm regarding a case in litigation concerning a 13 month male who was born following a non eventful pregnancy and weighted 8 punds and 7 ounces at birth.  The patient's early development history was without remark.  There was no family history of any developmental difficulties or language problems.  The patient was the youngest of two children in the family.  The patient on 10/16/1994 was vaccinated with measles virus vaccine live (-) mumps virus vaccine live (-) rubella virus vaccine live (second generation) (reported batch# 859330 invalid).  Subsequently, the patient experienced autistic spectrum disorder.  On 10/06/1994, immediately following the vaccination, the patient began to drink excessively which continued.  In the evening of 10/06/1994, after the vaccination, the patient had a temperature and was given paracentamol (Calpol) that by the next day resolved the patient's temperature.  During the week following the vaccination, the patient's sleep pattern became disruptive which continued to remain disturbed.  On 10/14/1994, the patient and his family went abroad on a holiday when the patient suffered an episode of hysterical screaming.  During the 2 week holiday, the patient had loose bowel movements that persisted that were foul smelling and pale in color.  At the same time, the patient's appetite changed where he no longer ate foods that he had previously.  In December 1994, the patient's speech started to regress and he gradually lost all speech that he previously acquired.  The patient's appetite was erratic and he was passing loose stools.  The patient became extremely hot and sweaty (incidental finding), particularly during the night.  The patient became socially isolated, withdrawn, stopped waving to people and saying "bye-bye", began to lose previously acquired fine motor skills and failed to acquire gross motor skills that were ago appropriate.  Between January 1995 and October 1995, the patient's behavior deteriorated where he began to have tantrums and screaming episodes.  At the same time, the patient exhibited obsessive and repetitive behavior.  The patient became obsessed with the television and began watching the same videos over and over again.  It was noted that the patient stood with his nose up against the television screen.  The patient began to run up and down the room over and over again and no longer played with his toys.  He could not be engaged in games but liked but liked being tickled and chased.  The patient had no concentration.  From March 1995, the patient began to suffer from repeated ear infections (incidental finding).  In June 1995, following concerns about his speech regression, the patient was seen by an audiologist who noted that the patient had moderate bilateral hearing loss (incidental finding).  Testing was "done by distraction but the patient was unable to play cooperatively".  By approximately August of 1995, during his second year of life, it was noted that the patient's language development was very poor and he did not mix well with other children.  A physician report dated 09/11/1996 indicated that it was difficult to assess the patient accurately because of the patient's self-directed behavior.  The patient's motor skills appeared well developed but had moderate delay in his fine motor (manipulative) skills and had a severe language impairment.  The patient demonstrated some routine repetitive behaviors but did not have any elaborate routines or rituals.  The patient was affectionate and demonstrated reasonable eye contact.  The patient appeared not to have any visual problems but his hearing was difficult to assess because of his lack of cooperation.  The patient responded to very quiet chime bars at low and high frequencies (35db, at 500 and 2000 HZ) by another physician.  It was noted that various blood tests to seek a possible bio-chemical, genetic or hormonal cause for the patient developmental difficulties had all shown normal results.  In February 1996, a physician indicated that the patient had autistic tendencies.  In April 1996, the patient had grommets inserted.  By September 1996, the patient became increasingly aggressive and he craved certain foods which seemed to make him hyperactive.  It was noted at the same time that the patient continued to pass pale and offensive loose stools and was sleeping for approximately 2 hours each night and not at all during the day.  In March 1997, the patient had grommets inserted.  In April 1997, a physician diagnosed the patient with autistic spectrum disorder.  On 11/05/1998, the patient was vaccinated with a booster of with measles virus vaccine live (-) mumps virus vaccine live (-) rubella virus vaccine live (second generation)(reported batch# not reported).  A psychologist report dated 05/26/1999 indicated that the patient had suffered from ear infections in the past and had grommets.  The patient had a range of specific difficulties that included extreme language delay, poor social interaction, extreme poor attentional skills and no appreciation of danger.  The patient's social skills were impaired with limited sensory motor level eye contact.  It was noted that the patient was able to sit at 6 months of age and walked at 12 months of age but at the time of the assessment was unstable with skills that required more fine coordination.  The patient was toilet trained and was able to assist with his dressing and ate with a fork.  The patient's social independence skills had been developed in advance of other cognitive skills, most marked was his inability to play imaginatively with toys and materials.  The patient's obsessional behavior had lessened somewhat at the time of the assessment.  It was noted that the patient's diet had been highly selective and restrictive, but had improved.  The psychologist concluded that the patient be "labeled" as autistic and appeared to have rather limited cognitive skills with very few words and had a single channel attention.  Follow up information was received from a foreign legal firm regarding a case in litigation included a physician autistic disorder assessment dated on 10/01/1999 and 10/15/1999.  The patient was 6 years and 1 month old at the time of the assessment.  It was noted that the patient's parents became first concerned regarding the patient when he was around 17 months of age.  At that time, the patient lost his expressie speech.  As a result of the patient's communication difficulties, several health care facilities evaluated the patient and concluded that the patient's difficulties were in keeping with those found in a child with autism.  The patient's parents indicated that the patient's language development had been significantly delayed where he said single words at 14 months of age but at 17 months of age, lost these words and did not begin to use single words again regularly until the patient was 18 months of age.  At the time of the assessment, the patient did not have phrase speech although he did use 6 different words during the assessment.  The patient did not regularly point to express interest or use a range of spontaneous conventional or instrumental gesture.  The patient did not exhibit spontaneous imitation of actions, imaginative play or extensive imitative social play.  The patient was able to use non-verbal behaviors to regulate his social interactions such as appropriate reciprocal social smiling.  The patient demonstrated little interest in other children and did not approach them.  He did not engage in imaginative play with his peers and did not have any peer relationship which involved selectivity or sharing.  The patient demonstrated difficulties showing and directing attention.  The patient demonstrated repetitive use of objects and preoccupation with certain parts of an object in the past but not at the time of the assessment.  In the past, the patient regularly smelled people and toys and also jumped up and down flapping his hands and arms when excited.  The patient did not have a history of circumscribed interest, unusual preoccupation of non-functional rituals.  In the assessment, the patient demonstrated limited amount of verbal language and his use of eye gaze was poorly modulated.  The patient used a limited range of facial expressions and did not attempt to direct these to adults.  He did not smile in response to an adult smile and did not express pleasure in interacting with the adults.  The patient demonstrated no evidence of symbolic play.  The patient demonstrated evidence of unusual sensory interests and used peripheral inspection of his hands and toys.  The patient did not exhibit any hand or other compulsive mannerisms but demonstrated a repetitive interest in two specific toys.  The physician concluded that the assessment revealed that the patient had qualitative abnormalities in patterns of communication, reciprocal social interactions and had exhibited repetitive stereotyped behaviors that included complex motor mannerism, repetitive non-functional use of objects and unusual sensory interests.  The patient's developmental problems occurred before he was the age of 3 years old.  The patient's clinical history indicated that patient had childhood autism and the severity of the patient's autism was underlined by the patient's current lack of phrase speech.  Immunization history: Pertussis, Diptheria, Tetanus, Polio and Hawmophilus Influenzae B on 10/07/1993, 11/11/1993, and 01/18/1994; Booster if Diptheria, Tetanus, Polio on 11/05/1998.  Incidental finding included extremely hot and sweaty at night, moderate bilateral hearing lose and repeated ear infections.  Upon internal review, the patient's autism was considered another important medical event.  No further information is available.  A copy of the patient's complete medical file is available upon request. A 15-day follow up report received 02/01/2003 added no new information.