Stephanie Kuhn v. HHS - DTaP, suspected intussusception ruled out; salmonella gastroenteritis; off-Table causation dismissed (2015)

On July 24, 2014, Stephanie Kuhn filed a petition under the National Vaccine Injury Compensation Program on behalf of her minor child, L.K. The petition alleged that the DTaP, IPV, Hib, hepatitis B, PCV, and rotavirus vaccines administered on August 4, 2011, caused L.K. to develop intussusception and continue to have medical issues requiring future care.

The respondent is the Secretary of Health and Human Services. The case was assigned to the Special Processing Unit.

Petitioner was represented by Randall Knutson of Knutson and Casey Law Firm, and respondent was represented by Justine Walters of the Department of Justice. Chief Special Master Nora Beth Dorsey presided over the case.

L.K. was born on June 1, 2011. His newborn examination was normal, though he had jaundice and a benign rash.

At his one-month visit, he was noted to be gassy and congested, and was prescribed Mylicon with instructions to switch to soy formula. On July 18, 2011, L.K. was taken to the emergency room due to inconsolability for 24 hours, lack of bowel movement since the previous morning, vomiting, and back arching.

He was diagnosed with reflux and a corneal abrasion, and later prescribed Zantac. At his two-month well-child visit on August 1, 2011, his gastroesophageal reflux disease was much improved, and he received the vaccinations at issue.

On August 11, 2011, L.K. returned to the pediatrician for a rash diagnosed as eczema. The record also noted a temperature of 100.1 degrees the prior day and soft bowel movements every three to four days.

He was referred to pediatric surgery. On August 25, 2011, pediatric surgeon Dr.

Walter Pipkin diagnosed L.K. with anal sphincter spasm and instructed his mother to perform anal dilations. A follow-up on September 15, 2011, indicated L.K. was without abdominal pain, constipation, vomiting, nausea, or diarrhea.

On September 17, 2011, L.K. was admitted to the hospital with fever, diarrhea, and intermittent abdominal pain, and observed to have bloody, currant-jelly stools. X-rays and a sonogram showed evidence of intussusception, but a barium enema ruled it out.

He was discharged the next day, with the discharge diagnosis amended to indicate intussusception was ruled out by barium enema and no acute surgical intervention was needed. Two days later, on September 20, 2011, L.K. returned to the emergency room with increased irritability and recurrent bloody stools.

A second x-ray and barium enema again showed no evidence of intussusception. The discharge diagnosis for this hospitalization was formula intolerance.

On October 5, 2011, Dr. Pipkin reported that stool cultures were positive for salmonella and described L.K.'s condition as resolved salmonella gastroenteritis.

At his four-month visit, his history was described as possible intussusception, reduced if present, and recent salmonella. Later records described ear infections and common childhood illnesses, with bowel movement issues described as resolved.

Petitioner was unable to obtain a supporting expert report. She initially sought an opinion from Dr.

Pipkin, who verbally indicated he believed the vaccination caused L.K.'s intussusception and continuing issues, but later stated he could not definitively relate the vaccination to the intussusception. Petitioner was unable to obtain a causation opinion from another specialist and moved for a ruling on the written record.

Chief Special Master Nora Beth Dorsey dismissed the petition for insufficient proof. She found that petitioner had not proven by a preponderance of the evidence that L.K. actually suffered intussusception, as it was ruled out by barium enema on two occasions.

The Special Master noted that entries suggesting intussusception were for billing purposes or differential diagnoses, and that salmonella gastroenteritis was a more likely explanation for L.K.'s symptoms. The Special Master also found that causation was not proven.

Because the petition was filed before the 2015 Vaccine Table amendment adding intussusception after rotavirus vaccination, petitioner had to prove an off-Table causation claim. No treating physician attributed L.K.'s condition to vaccination, and petitioner had no expert opinion.

The onset of the alleged intussusception was more than 40 days after vaccination, which was considered too late for a proximate temporal relationship. Furthermore, petitioner had not proven residual effects for more than six months or inpatient hospitalization with surgical intervention for the alleged intussusception.

On September 29, 2015, the petition was dismissed. Subsequently, on December 11, 2015, the parties filed a stipulation for attorney's fees and costs.

Chief Special Master Dorsey awarded $11,726.77 as a lump sum, jointly payable to petitioner and her counsel, Randall G. Knutson.

No injury compensation was awarded.