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 hepatitis B vaccine. According to the legal complaint, at an unspecified time after vaccination, the subject experienced "neurological damage" which was attributed to "cumulative mercury toxicity". The following info was received via medical records: The subject was vaccinated with DTAP on 3/29/91, 6/3/91, 9/11/91, 7/23/93 and 8/22/95. The subject was also vaccinated with Hib vaccine, Polio vaccine, MMR for prophylaxis. The pregnancy was notable for maternal toxemia requiring induction of 38 weeks gestation. On an unknown date, the subject was dx'd with developmental delay, possible seizures, behavioral problems, delayed speech and autism. The subject was notable for chronic otitis media with right sided hearing loss. The subject underwent a psychological evaluation in 4/94 for violent and disruptive behaviors that escalated in the preceding 6 months. He exhibited anger, screaming, crying, temper tantrums, banging his head on the wall and difficulty calming down. He was not toilet trained and was noted to hit, kick and scratch his mother. Evaluation revealed that the subject as at the 2 1/2 year old level in the area of personal and social skills, with gross motor skills at the 3 year old level. Impressions included hyperactivity, oppositional defiant behavior, separation anxiety and language delay. During a well visit on 10/28/94, the subject's mother reported that his speech was still not good and he exhibited worsening behavior at home. Additional concerns included poor sleep treated with sertraline (Zoloft) and melatonin. The subject attained functional language at 5 years of age. The subject's mother reported that the first indication that something was wrong occurred when he was in kindergarten and was unable to color within the lines and experienced difficulty learning. He continued to experience difficulty with fine motor control. A trial of Ritalin in 1996 was of questionable benefit. On 5/10/96, a history of diffuse encephalopathy was noted. By 1/7/98, the subject was doing better in school with improved speech; however, his behavior worsened overall, and he continued to experience staring spells/ possible seizures. He subsequently continued to act aggressively toward his mother and to exhibit hyperactive and disobedient behavior. A trial of Dexedrine was initiated in 9/98 but was discontinued due to inability to sleep. In 3/99, the subject was dx'd with a generalized tonic clonic seizure that occurred at the onset of sleep and lasted less than 1 minute. A trial of Depakote was initiated, but was stopped because it "made him mean". Prozac therapy was also attempted but was stopped due to headaches. He underwent a neurological evaluation on 8/12/99. Concerns included attention difficulties, difficulty with inflexibility to change, lining up objects frequently without apparent purpose, social difficulty, and staring at things. No history of regression was noted. Assessment included pervasive developmental delay with mild mental retardation and signs of attention deficit hyperactivity disorder. In 4/01, treatment included paroxetine (Paxil) without benefit. Audiological testing in 11/99 showed central auditory processing disorder. A progress note dated 11/26/01 stated "has poor self esteem; advised karate". By 3/27/02, the subject experienced reduction in echolalia but exhibited obsessive thoughts, social withdrawal, and difficulty making friends. A trial of trazodone was initiated for persistent sleep problems. On 5/17/04, the subject was seen for follow-up of "high functional" autism. The subject exhibited stuttering when excited, but otherwise fluid speech. He required repetition of verbal instructions and experienced difficulty writing, apraxia of motor movements and difficulty alternating hand movements. He remained unable to tie his shoes or to use scissors. Difficulty with sleep onset  persisted. This case was assessed to be medically significant by mfr.