A.H. v. HHS - DTaP, basal ganglia bleed and seizure disorder (2012)

On November 14, 2012, Megan Vaughan filed a petition for review on behalf of her minor daughter, A.H., challenging the Special Master's May 3, 2012 decision that denied compensation under the National Childhood Vaccine Injury Act. A.H. was born in the fall of 2005.

Prior to December 1, 2005, A.H. experienced frequent and prolonged crying spells, leading her mother to repeatedly contact her pediatrician. On December 1, 2005, at her two-month well-child visit, A.H. received vaccinations including Pediarix (DTaP, IPV polio, hepatitis B), Hib, and pneumococcal conjugate.

That evening, A.H. became increasingly irritable after sleeping for four hours post-vaccination. The following day, December 2, 2005, while in her car seat, A.H. made a strange face and shook her head slightly; this episode resolved when her mother touched her face.

The pediatrician noted this appeared to be a "catching breath from crying so hard look." Over the next few weeks, A.H. continued to cry excessively, and on December 12, her mother reported her left eye was wandering and sticking. On December 19, A.H. was seen by the pediatrician for constant crying but was found to be "fussy, engaging and active" with no signs of illness.

On December 28, 2005, A.H. was admitted to Porter Hospital with vomiting, stiffness, and lethargy. She was transferred to Fletcher Allen Health Care (FAHC), where she began screaming loudly, vomited, choked, and turned white.

On December 30, 2005, A.H. experienced a witnessed seizure characterized by cessation of crying, head and eye deviation, drooling, staring, and rhythmic shaking. An EEG confirmed seizure activity, and a diagnosis of a right basal ganglia hemorrhage and hemorrhage in the deep white matter of the right frontal lobe was made.

A.H. was treated in the PICU and discharged on January 10, 2006, with a recommendation to avoid pertussis vaccination. Two neurologists agreed that A.H. had a pre-existing arteriovenous malformation (AVM) that had bled, an event unrelated to vaccination.

The disagreement centered on whether the vaccines triggered the bleed. Petitioner's expert, Dr.

Ronald Jacobson, theorized that intense post-vaccination crying increased intracranial and blood pressure, precipitating the hemorrhage from the AVM and causing seizures. He described the events as a "stuttering presentation." Respondent's expert, Dr.

Max Wiznitzer, testified that the December 2 event was drowsiness or a breath-holding spell, that alleged subsequent seizures were not documented, and that AVMs do not present with a "stuttering presentation." The Special Master denied compensation, finding that the December 2 event was not a seizure, which was critical to Dr. Jacobson's theory.

He also found that AVMs do not present with a "stuttering presentation." The Special Master found Dr. Wiznitzer's testimony more persuasive and rejected Petitioner's Exhibit 9 (a typed narrative) and Exhibit 30 (an affidavit) as inconsistent with contemporaneous medical records and influenced by hindsight.

The Court of Federal Claims, per Judge Damich, affirmed the Special Master's decision on June 4, 2012, rejecting all six of Petitioner's arguments. The court found the Special Master's factual findings were supported by substantial evidence and that legal standards were correctly applied.

The court noted that the Special Master properly considered evidence, drew plausible inferences, and provided a rational basis for his decision, including the credibility determinations of expert witnesses.