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 diphtheria and tetanus toxoids and acellular pertussis vaccine DTap manufacturer unspecified on 6/19/90/, 8/7/90, 10/3/91, and 11/3/92. The subject received hepatitis B vaccination manufacturer unk 4/11/98, 5/9/98. 10/3/98. The subject had previously received Recombivax hepatitis B vaccination 4/11/97 and 6/13/97. A progress note dated 10/3/91 indicated that the subject was behind on immunizations and questioned the possibility of a developmental delay. The subject began walking at fourteen months of age. As of Feb 92, the subject was not speaking at all, but screams a lot and dose not seem to be getting any smarter. An evaluation in Aug 1992 was performed for behavioral problems including hyperactivity, distractibility, impulsivity, temper tantrums, rocking, head banging, and self injurious behavior. Evaluation also revealed disorder receptive and expressive language. Prior to Sept 1992 the subject was diagnosed with pervasive developmental disorder, autism, mental retardation accompanied by behavior problems and speech delay. Re evaluation on 9/20/93 confirmed developmental delay with moderate to severe mental retardation. on an unknown date, the subject was diagnosed with ADHD. Treatment with Ritalin initially resulted in minor improvements in behavior. However, Ritalin was subsequently discontinued with no significant change in the pts behavioral problems. The pt was re evaluated on a regular basis between 1992 and 1997, and progress notes repeatedly referenced aggressive and self injurious behavior, pervasive developmental delay, autism, communication disorders, hyperactivity, behavioral problems (fecal smearing, elopement), enuresis, encopresis, and destructiveness. In April 1997, the subject was admitted to a neurobehavioral unit for treatment of disruption, self injury, aggression, and elopement. The subject received functional communication training and was provided with a communication aid (Alpha Talker) to assist with communication for attention and food, speech and language evaluations between April 1997 and Oct 1997 showed profound receptive expressive delay with respect to chronological age consistent with the profile of autistic disorder, and phonological impairment commensurate with language skills. He was discharged from inpatient care in Oct 97. Treatment while hospitalised included Tenex, with good response. In 2000, the subject was evaluated for increasingly violent behavior, head banging, screaming, and hyperactivity. On 5/18/00 the subject was evaluated in the ER for escalating misbehavior, destruction of property at school and home, and violence. Notes indicated that the pts mother fears that he has outgrown his Tenex dosing. The subject was observed to be mute, with mother acknowledging rare monosyllabic utterances. Attempted treatment included Zyprexa and Risperdal. As of 7/10/01, the subject was noted to have an IQ of approx 30 associated with autism. The subject used no useful speech at all, and was physically abusive toward his mother and himself. He exhibited mild aggression at school, and required assistance with personal hygiene. At the time of examination, the subject received only Benadryl to assist in sleep. In Feb 2002, the subject continued to demonstrate combative and destructive behavior. His mother noted that attempted treatment with Haldol did nothing for his combativeness. His dose of Risperdal was increased, and clonodine was added to his treatment regimen. A note dated 8/11/02 indicated that the pt had regressed back to two years of age according to his school. On11/26/02 the subject returned to the ER for increasing combative behavior. Medications at that time included Remeron, Risperdal, clonidine and chloral hydrate.