This case was reported by a lawyer and described the occurrence of neurological injury in a male subject who was vaccinated with hepatitis B vaccine (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 with hepatitis B vaccine, the subject experienced "serious and permanent neurological injuries" which were attributed to "toxic mercury exposure".  The following information was received via medical records.  The subject was vaccinated with hepatitis B vaccine (manufacturer unspecified) on 23 July 1997.  The subject was also vaccinated with tetanus and diphtheria toxoids absorbed (DT vaccine), hepatitis B vaccine (Recombivax), combination diphtheria and tetanus toxoids, pertussis adsorbed and Haemophilus influenzae type b conjugate vaccine (Tetramune), live attenuated oral poliomyelitis vaccine (OPV), measles, mumps and rubella vaccine, strain not specified (MMR vaccine) and Haemophilus influenzae type b vaccine (Hib vaccine) for prophylaxis.  On 09 August 1999, the subject presented with concerns of possible developmental delay and was able to clearly speak only two words.  Assessment included developmental delay and speech delay.  On an unspecified date, the subject was diagnosed with autism.  A psychological evaluation was performed on 29 February 2000 for behaviors including temper tantrums.  The subject under went a neurology evaluation on 05 October 2001, at which time the subject's mother reported a history of lead poisoning at one year of age.  She also reported that the subject walked at 15 months, spoke his first words at four years, and had no language regression.  He was described as "hyperactive" and exhibited play skills by "lining things up".  He was assessed with developmental delay with autistic features.  Upon follow up on 08 February 2002, autistic features included absence of speech, and the subject was note to require constant care.  He  subsequently exhibited additional problems including short attention span, distractibility, unintelligible speech, poor eye contact, infrequent peer interaction, aggression,a nd was described as uncooperative and in need of constant supervision.  In October 2002 the subject was enrolled in a school program, and exhibited agitation with howling and self stimulation (rocking), hitting and biting the teacher's arm, hitting a student, banging his head, and his receptive language was "virtually nonexistent".  He was noted to have a "longstanding" history of attention deficit hyperactivity disorder.  Diagnostic impressions included pervasive developmental disorder, phonological disorder, ADHD (combined type by history), mixed receptive expressive language disorder, speech and language delay, mild mental retardation, and occupational and physical therapy evaluation in September 2004 and October 2004, and progress in developing fine motor, visual motor,  and perceptual skills was noted, although he continued to demonstrate delays compared to other children.  On 03 August 2006, the subject was examined for hyperkinosis and autism.  Medications at that time included RITALIN and Focalin.  It was noted that the patient was able to "say many words; can say sentences and ask for wants".  A note from his speech and language therapist dated 17 February 2006 indicated that the subject had made "much progress".  This case was assessed to be medically significant. (OMIC)