Savannah Smithson v. HHS - HPV, adrenal deficiency and dysautonomia, which presented as postural orthostatic tachycardia syndrome (POTS) (2019)

Savannah Smithson, through her parents initially, filed a claim for compensation on September 25, 2013, alleging that the HPV vaccines she received on November 5, 2012, and February 4, 2013, caused her to develop adrenal deficiency and dysautonomia, specifically postural orthostatic tachycardia syndrome (POTS). Ms.

Smithson was substituted as the petitioner after reaching the age of majority. Over several years, Ms.

Smithson submitted expert and treating physician reports to support her claim. The respondent, the Secretary of Health and Human Services, opposed eligibility, arguing that the evidence did not support the diagnosis or causation.

Petitioner's initial expert reports from Dr. Ramesh Adiraju were found to be incomplete and deficient.

Subsequent reports from Dr. David Axelrod and Dr.

Patrick Nemechek also raised concerns. Respondent's experts, Dr.

Kenneth Mack and Dr. Arnold Levinson, noted that a gold-standard tilt-table test for POTS had not been performed.

Treating physicians Dr. Michael Gerber and Dr.

Stewart Tatem provided letters regarding the POTS diagnosis, but without detailing diagnostic criteria or first-hand accounts. Dr.

Nemechek's reports and autonomic testing results were also found to have deficiencies and failed to address respondent's expert concerns. Petitioner then obtained a report from Dr.

Mitchell Miglis, but concerns remained regarding the diagnostic testing and the association between the HPV vaccine and dysautonomia. The Special Master noted that without evidence associating the HPV vaccination to POTS, compensation could not be awarded, citing Hibbard v.

Sec'y of Health & Human Servs. On April 2, 2019, Ms.

Smithson moved to dismiss her petition, stating her conclusion that she would likely be unable to meet her burden of proof. Special Master Christian J.

Moran granted the motion, dismissing the petition for insufficient proof, finding that Ms. Smithson had been provided a full and fair opportunity to present her case but failed to meet the preponderance of the evidence standard required for a compensable vaccine injury.

The decision was issued on April 9, 2019, and posted on May 6, 2019.