This case was reported by a lawyer and described the occurrence of nerve damage in a female subject of unspecified age who was vaccinated with Engerix B, Hepatitis B vaccine, combined DTaP/HIb and IPV for prophylaxis. On 2/20/1997 the subject received 3rd dose of Engerix B, on 7/12/96 and 6/15/96 the subject received 2nd and 1st dose of Hep B vaccine (UNK). On 2/20/1997 the subject received 3rd dose of DTaP/Hib (unk). On an unspecified date the subject received 3rd dose of IPV unk. At an unspecified time after vaccination with Dtap/Hib, Engerix B, Hepatitis B and IPV, the subject experienced nerve damage, toxic effect of mercury and it compounds. delayed motor skills, disturbance of fine motor skills, encephalopathy, developmental delay, tremor, hand flapping tremor, hand wringing, toe walking gait, seizures, oppositional behavior, Syndactyly, lumbar lordosis, cognitive deficit and mixed receptive expressive language disorder. 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 11/19/1996 MRI of the brain revealed mildly enlarged CSF spaces and mild enlargement of the third and lateral ventricles consistent with benign macrocephaly of infancy. 9/28/98, 2 year old subject evaluated by a physician for pediatric neurodevelopment due to lack of fine and gross motor skills. It was reported that there was concern for the subjects development since she was about 1 year of age. The subject was born to a Gravida 1 para 0 mother. Mother was induced at term due to hypertension. Mother had a vaginal delivery and the infant weighed 5 pounds and 3oz. Apgar were 8 and 8. Tobacco and alcohol were not consumed and there was no exposure to known teratogens. Jaundice was present at birth. No history of serious illnesses, major injuries, seizures, fainting or unconscious spells. Macrocephaly was noted. Head cir was 50-50.5 (90percentile). She had marked strabismus early on and is being treated with patching for amblyopia. She has had a heart murmur since birth with a small ventricular septal defect. Father was diagnosed with mild Tourette syndrome which is no longer an issue. The physician concluded that the subject had a significant problem with neurodevelopment which is giving her a major developmental delay with many skills at 12 months and lower. Dysmorphic features noted. The physician noted that she is clearly not autistic. She was diagnosed with encephalopathy, delayed milestones and rule out genetic syndrome. Subject was evaluated on 4/1/99 for developmental delay and multiple congenital anomalies. The physician concluded that the subject had global developmental delays particularly walking and speech. It was noted that the subject had multiple congenital anomalies, including VSD, macroencephaly, familial resolved (maternal), too walking, tremulousness and hand flapping and hand wringing. The physician noted I do not recognize a specific syndrome to account of this girls problems. Evaluated on 11/10/99 in the neurology clinic for seizures. First seizure occurred in April 1999 and the second seizure occurred in 10/22/99. EEG revealed presence of left posterior temporal spike slow wave discharges seen during sleep. No treatment was ordered. 2/28/2000, blood lead level was less than 3. On 3/28/03, the 6 year, 9 month old subject was seen. At the time of this visit, she could not speak except for nonsense jabbering. She was able to walk. Diagnostic impressions were delayed development and oppositional behavior with some questionable features of OCD. It was reported that a karotye done in Sept 1998 that was 45 XX and a negative Fragile X. Evaluation on 4/7/03 by a biochemical geneticist who noted that developmental issues were identified at about 21 months of age. Parents were concerned about the mercury in the immunizations. They deny that she had any acute reactions to any immunization. It was noted that the parents feel that the subject was never normal in her development. She is making slow consistent progress. He reported that he thought the most likely etiology was chromosomal. He also considered the possibility of Smith Magens syndrome or atypical Rett presentation. Fish study revealed normal subtelomere loci. Evaluated on 9/30/03 and the subject was 7 years of age. It was noted that all her skills hover just above or slightly below 12 months. 1/24/05 the subject was evaluated and it was noted that no genetic etiology has been established. She has developed a few single words. It was noted that she had some unusual features including a wide forehead, wide spaced eyes (as dose her mother) and a bowed upper lip. Her feet appeared very long and narrow with very short great toes and Syndactyly of the second and third toes. Lumbar lordosis was also noted. Continued to have developmental delay with notable cognitive deficits as well as expressive and receptive communication skills delays and neuromotor deficits. Slow progress was made. It was noted that her facial and other features 9 holding arms close to body, may potentially be suggestive of an unidentified genetic syndrome. This case was considered medically serious by manufacturer (OMIC). At the time of reporting the outcome of the events was unspecified.