H.T.R. v. HHS - Tdap, acute transverse myelitis with permanent paraplegia below T10 and bowel/bladder loss (2015)

On October 11, 2011, Kevin and Heather Raymo, as legal representatives for their minor daughter H.T.R., filed a petition under the National Vaccine Injury Compensation Program. They alleged that H.T.R. developed acute transverse myelitis (ATM) with permanent paraplegia and bowel/bladder loss following vaccinations administered on October 13, 2010.

The vaccines received were Hepatitis A, HPV/Gardasil, meningococcal, and Tdap. The petition ultimately focused on the tetanus component of the Tdap vaccine as the causal agent.

H.T.R., born February 2, 1999, was eleven years old at the time of vaccination. She had a history of recurrent ear infections and allergies but no serious health issues.

On October 13, 2010, she presented with a two-week history of headache, sinus drainage, congestion, and cough, diagnosed as allergic rhinitis and an upper respiratory infection. Following this visit, she received the aforementioned vaccines.

Over the next few days, H.T.R. attended school and participated in a church lock-in without apparent ill effects. On the morning of October 17, 2010, she awoke with numbness in her right leg, which progressed to paralysis and loss of bowel and bladder control by the time she was evaluated at Arkansas Children's Hospital.

Despite treatment with steroids and plasma exchange, her condition did not improve, leaving her wheelchair-dependent. The parties disputed the exact timing of symptom onset and the progression to nadir (maximum impairment).

Petitioners argued for an onset while sleeping, leading to a progression longer than four hours, supporting an autoimmune theory. Respondent contended that symptoms began upon waking, with a progression of less than four hours.

Chief Special Master Denise K. Vowell found that onset likely occurred between 9:30 PM on October 16 and 8:00 AM on October 17, 2010, with onset-to-nadir lasting longer than four hours, a timeframe medically acceptable for an autoimmune theory.

Both parties' primary experts faced credibility issues. Petitioners' initial expert, Dr.

Daniel Becker, was discredited due to evidence of plagiarism. Respondent's expert, Dr.

John Sladky, was discredited for failing to disclose prior medical license suspension. Consequently, the causation decision relied heavily on Dr.

Marcel Kinsbourne's opinion for petitioners, supported by a remote second-opinion review by Dr. Farrah Mateen.

Dr. Kinsbourne opined that H.T.R. suffered from immune-mediated ATM, potentially triggered by the tetanus toxoid in the Tdap vaccine through mechanisms like molecular mimicry or bystander activation.

He cited medical literature and case reports linking tetanus-containing vaccines to neurological complications. Chief Special Master Vowell found sufficient evidence that tetanus vaccination could cause ATM and that H.T.R.'s Tdap vaccination caused her condition within a medically appropriate timeframe.

On February 24, 2014, Chief Special Master Vowell granted entitlement. Following this, the parties entered into a damages stipulation.

On November 5, 2015, Chief Special Master Nora Beth Dorsey adopted the stipulation, awarding compensation. The total award included an amount for an annuity for future life care, a lump sum of $754,047.00 for past and future pain and suffering and future wage loss, $26,930.62 for past unreimbursed expenses, and $97,561.00 for first-year future life care expenses.

The total award was $878,538.62, plus an amount sufficient to purchase an additional annuity. Subsequently, the court reviewed the attorneys' fees and costs.

The chief special master awarded $368,953.81 in fees and costs, a figure significantly lower than requested by petitioners but higher than respondent's initial estimate. This award reflected reductions for administrative tasks, duplicative billing, and the use of local rather than forum rates, among other adjustments.

Petitioners sought review of this decision, but the court affirmed the chief special master's award.