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 neurological damage which was attributed to cumulative mercury toxicity. The following information was received via medical records, The subject was vaccinated with hep B vaccine (Engerix B) on 7/17/98. The subject was vaccinated with hepatitis B vaccine (manufacturer unspecified) on 7/16/1999m 12/17/1999, and 7/21/2000. The subject was vaccinated with DTap on 12/17/99. The subject was also vaccinated with Polio vaccine, MMR, Hib and varicella for prophylaxis. On 12/30/1999, the subject was evaluated for concerns of saying only da da and not walking, It was noted that he had been saying more at 12 months of age. On 10/26/1999 a gross functional assessment showed increased muscle tone and rigidity, increased tremor of the upper extremities, inability to perform thumb opposition, and reduced proximal stability, postural control and balance. Upon evaluation on 11/2/99, the subject had expressive communication skills at the 7 months range, and receptive and expressive language skills at the 6 to 9 month range. By April 200 he had been diagnosed with developmental delay. Physical exam was grossly unremarkable, and impression included pervasive developmental disorder. Behavior included hand flapping, and treatment included occupational therapy. Audiology exam on 6/6/00 were suggestive of mild hearing loss, however, findings were considered to be inconclusive. ON 10/19/00, the subject was evaluated for suspected autism, and achieved an age equivalent score of 11 months, indicating a 25 percent delay in development. Clinical impressions included moderate to severe receptive and expressive language delay, mild gross motor delay, oral motor dysfunction, atypical behavior, and moderate fine motor problems solving delays. On follow up in May 2001, he scored 16 months in cognitive skills and 14 to 16 months in social and emotional skills. A progress note dated 7/26/01 noted that the subject was diagnosed with autism at three years of age better on B12. The subjects fourth DTap vaccination was not administered due to suspicion of problems from the vaccine. On 6/27/01, the subject was diagnosed with a developmental language disorder. On 2/8/02, two units of Secretin were administered IV, which reportedly improved the pts speech. Taurine amino acid was added. On 9/6/02, Dtap and MMR vaccines were deferred. The subjects expressive language was described as limited unless he takes Secretin, with receptive language skills enabling him to understand and follow. Concerns included variable attention and distractibility. A note dated 10/31/02 showed that the subject was receiving TMB, SuperNuthera, Taurine, Nystatin, Cod liver oil, B 12 injections and was eating a mild and wheat free diet. On 12/29/2003, physicians notes indicated that the pt was trying to talk more on methylcobamide, and on mercury coming out in urine. In future,consider restarting chelation. Additional attempted treatment included Risperdal, Abilify, and Strattera. Hair analysis on 12/2/04 revealed a mercury level of 0.62 (normal 0 to 0.6) This case was assessed to be medically significant by manufacturer (OMIC).