This case was reported by a lawyer and described the occurrence of neurological damage in a male subject who was vaccinated with 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 follow info was received via medical records: The subject was vaccinated with hepatitis B vaccine on 12/10/93 and 1/26/94. The subject was also vaccinated with combination DTP and Haemophilus influenza type b conjugate vaccine (Tetramune), live attenuated oral poliomyelitis vaccine (OPV), MMR for prophylaxis. During pregnancy, there was essentially no fetal movement with only occasional hic-upping, and the subject had polyhydromnios. During infancy, he experienced delayed acquisition of head control. At 15 months of age, on 4/10/95, the subject was described as a "thriving" toddler. However, a language delay was noted at that time. An ear abnormality (CMS) was also noted. Surgery was scheduled with a note to "watch language development after surgery", and he underwent PE tube placement in 4/95. A hearing test in 7/95 showed normal findings. He was evaluated by a pediatric neurologist on 8/24/95 for developmental and language delay, with specific concerns of failure to progress in language and understanding, solitariness, and lack of interest in his surroundings. The subject's walking skills had not progressed in the preceding 5 months and he experienced frequent falls. The neurologist expressed the opinion of a probable "extensive static process" possibly falling into the category of pervasive developmental delay. On 11/16/95, the subject underwent a developmental assessment due to chief concerns of inability to listen and understand language, inability to communicate, manifestation of stereotypes including fascination with wheels and vacuum cleaners and upset as a result of any disruptions in his routine. Neurological exam revealed minor diminished tone in the extremities. The subject was dx'd with pervasive developmental disorder, mild nonspecific dysmorphisms with macrocephaly and minor neuro-motor hypotonia. The subject was dx'd with autism. A psychological exam on 11/27/95 showed self stimulation with hands, social withdrawal and social skill deficits, lack of appropriate play skills and poor eye contact. Upon re-evaluation by the neurologist on 2/15/96, the subject had made "substantial progress relative to his diagnosis", including improved walking with motor progress and small improvement in expressive language characterized by polysyllable babbling. He exhibited occasional temper tantrums. In 10/96, the subject continued to have features of autism, although his family noted "considerable" improvement particularly in his areas of behavior. The subject was treated by a speech therapist and by 3 years of age recognized approx. 30 words. A neuropsychological exam was conducted on 9/27/99 at five years ten months of age, with results including a number of attentional and behavioral peculiarities and idiosyncrasies. Verbal language understanding and processing was equivalent to a 2 year old child. The School Readiness Composite of the Bracken Basic Concept Scale was administered and placed the subject at a 4 year 10 month level. At 6 years of age, concerns included school avoidance, aggression, separation difficulties and bedwetting. By 2004, the subject continued to exhibit behavioral problems. This case was assessed to be medically significant by mfr.