This report describes mercury poisoning in a male, now 5 years old, who received hepatitis B vaccine for prophylaxis. (However, medical records did not confirm that the patient received Engerix B). The reporting attorney stated that his client during the time frame of March 1998 through September 1999, was exposed to cumulative, toxic levels of mercury, causing severe, permanent neurological injury and other damage. The attorney stated that the child also received vaccines manufactured by other companies. This report was received as part of litigation proceedings with subsequent forwarding of medical records. The following information was obtained via medical records provided by the plaintiff's attorney. On 2/17/98, the mother gave birth to a 6 pound, 14 ounce male infant, 20 inches in length. The child experienced hyperbilirubinemia. On 3/4/98, at 3 weeks of age, he was seen for follow up of hyperbilirubinemia. His total bilirubin was 11.5 with a normal direct bilirubin normal of 1.0. The child's abdomen was jaundiced. The child was described as well, healthy at his check ups between 4 and 24 months of age. History of mild iron deficiency anemia, irritable bowel, pharyngitis, rhinosinusitis, and frequent episodes of otitis medial requiring insertion of pressure equalization tubes. Allergy information included wheat allergy (causes moodiness and rocking); dairy product allergy (causes flapping of arms). Family history significant for attention deficit disorder (cousin). Has a 5 year old sister and a 5 month old brother, both of whom are developing well. On 2/18/98, the child received an injection of hepatitis B vaccine. He subsequently hepatitis B vaccines on 3/18/98 (lot # 0327E) and 9/8/98 (lot #1367E). He received combination diphtheria and tetanus toxoids and pertussis/Haemophilus influenzae type B conjugate vaccine on 4/20/98 (lot 449097) and 7/3/98 (lot 450497); Haemophilus influenzae type B conjugate vaccine on 9/8/99 (lot 0963420) and 7/22/99 ( lot unknown); diphtheria and tetanus toxoids and acellular pertussis vaccine on 9/8/98 (lot 0939740) and 9/2/99 (lot 7316BB); inactivated poliomyelitis virus vaccine on 4/20/98 (lot N0147), on 7/3/98 (lot N0492), and 9/2/99 (lot P0474); MMR on 7/22/99; and varicella virus vaccine on 3/5/99. On 4/3/00, at 25 months of age, the child was seen due to delayed expressive language development. The child was reported as understanding two languages. The child developed his first word at 18 months of age. At time of visit, his vocabulary consisted of ten words. He would cry or point to communicate his needs. There was no family history of speech or language impairments. He was assessed as having moderate expressive language delay (expressive language age of 14-16 months) and normal to mild receptive language delay (receptive language age of scatter to 20 months). He was prescribed speech therapy. Check up notes from 5/15/01, when the child was 3 years of age, indicate that he was felt to have autism. He was evaluated on 1/27/01. His autistic symptoms were generally mild and included hand flapping and jumping. He would avoid eye contact but his parents reported his eye contact improved once he was started on lactose free milk. He exhibited moderately abnormal verbal communication. There was no movement disorder. He was scored at a 27 on the Childhood Autism Rating Scale with mild abnormalities, the most remarkable being in the area of verbal communication (Moderately abnormal). On 11/14/01, he was assessed as having a developmental delay of 12-15 months and a speech delay of 12-18 months. 12/15/01: Hair element report revealed high levels of the following elements: antimony 0.86, arsenic 0.09, cadmium 1.3, tin 0.48, magnesium 32, potassium 72, boron 13, phosphorus 322, and titanium 1.4. Zinc was at the upper limits of normal at 190. 6/11/02: erythrocyte element analysis was within normal limits for aluminum, cadmium, lead, and mercury. 7/17/02: Urine element report revealed high levels of the following: aluminum 38, magnesium 240, copper 0.69, molybdenum 0.2. Manganese was at the upper limit of normal at 0.006. 3/2/03: Urine element report revealed high levels of tin at 8. Mercury was also noted for the first time. Level of mercury was 0.6. Notes from June 2003 indicate that he had made progress  at school. His speech was progressing. Treatment medications included DMSA and Risperdal. Medical note from 7/8/02 indicated that the child's primary diagnosis was pervasive developmental disorder and that the child had been under this particular physician's care since 11/14/01. The physician stated that I am also concerned about the number of immunizations children are receiving the first two years of life and the alarming increase of the diagnosis of Autism and Developmental Delay Disorders over the past 10 years. Following the reported onset of mercury poisoning, the patient experienced allergic rhinitis and allergic conjunctivitis. These were not reported as adverse events due to vaccine administration, but were found during the course of review of the medical records. Therefore, they are not coded as adverse events. The most recent information, received on 10Aug2004, did not provide the outcome of the reported events.