T.A. v. HHS - MMR, systemic inflammatory response syndrome (SIRS), shock, multiorgan dysfunction syndrome, renal and respiratory failure, and bilateral above-knee amputations (2020)

On November 9, 2012, Doug and Kari Ahlum filed a petition under the National Childhood Vaccine Injury Act on behalf of their minor son, T.A., alleging that the measles, mumps, rubella (MMR) vaccine administered on August 11, 2011, caused a severe inflammatory illness. The petition was initially filed as a Table encephalopathy claim and later amended to include thrombocytopenic purpura leading to systemic inflammatory response syndrome (SIRS).

Following a three-day entitlement hearing, Special Master Laura D. Millman ruled in favor of the petitioners on entitlement, finding that the MMR vaccine caused T.A.'s SIRS, shock, multiorgan dysfunction syndrome, and bilateral leg amputations.

The Special Master rejected the Table-injury theories for encephalopathy and thrombocytopenic purpura. T.A. was born on March 10, 2008.

His medical history included prior neck abscesses, a Staphylococcus aureus infection, and intermittent anemia. On August 11, 2011, at age three, he received the MMR vaccine during a well-child visit.

Twelve days later, on August 23, 2011, T.A. developed a fever and a petechial and macular rash. His platelet count was low at 97,000.

The following day, August 25, 2011, T.A. presented with increased lethargy, dehydration, a higher fever, a worsening rash, an elevated white blood cell count, and a further decreased platelet count. He was hospitalized, where his condition rapidly deteriorated into shock, acute renal failure, respiratory failure, thrombocytopenia, coagulopathy, diffuse capillary leak, and multiorgan dysfunction.

Extensive testing for infectious causes, including bacterial and tick-borne etiologies, yielded negative results. Due to progressive ischemia and gangrene in his lower extremities, T.A. underwent bilateral guillotine below-knee amputations on September 6, 2011, which were later revised to bilateral above-knee amputations.

Petitioners' treating pediatrician, Dr. L.

Barry Allen, testified that the timing of T.A.'s illness, coupled with negative cultures, led him to believe the MMR vaccine was the cause. Petitioners also presented expert testimony from pediatric neurologist Dr.

David Siegler and immunologists Dr. Alan S.

Levin and Dr. David Axelrod, who opined that the vaccine triggered an immune response leading to SIRS and subsequent organ dysfunction.

Respondent's experts, including pediatric neurologist Dr. Lawrence Brown, pediatric infectious-disease expert Dr.

Jerome Klein, and virologist/pathologist Dr. J.

Lindsay Whitton, argued that T.A.'s presentation was most consistent with septic shock, likely bacterial, despite the negative cultures, and that the MMR vaccine could not biologically cause such a severe reaction. Special Master Millman found that T.A. did not meet the criteria for a Table encephalopathy or thrombocytopenic purpura.

However, she credited petitioners' evidence regarding causation in fact for SIRS, relying on the timing of onset, the failure to identify an infectious organism, the treating physician's opinion, and expert testimony. She found that respondent had not proven a known unrelated factor caused the illness.

On January 27, 2020, Special Master Daniel T. Horner awarded damages based on a stipulation and proffer agreed upon by the parties.

The award included a lump sum of $319,976.01 for pain and suffering and first-year life-care expenses, $15,551.47 for past unreimbursable expenses, and $311,507.41 to satisfy the Arkansas Medicaid lien. Additionally, an amount sufficient to purchase a life-contingent annuity for future life-care items was awarded, with a 4% annual growth rate for non-medical items and a 5% growth rate for medical items.

Lost future earnings were not awarded as the parties agreed T.A. would likely be gainfully employed in the future. Petitioners' counsel was Andrew D.

Downing. Respondent's counsel was Debra Filteau Begley.