{"package_id":"USCOURTS-cofc-1_14-vv-00741","decision_granule_id":"USCOURTS-cofc-1_14-vv-00741-0","petitioner_identifier":"B.B.T.","is_minor":1,"age_at_vaccination":0.002,"age_unit_raw":"years","vaccine_type":"hepatitis B","vaccination_date":"2013-03-28","condition_raw":"hemophagocytic lymphohistiocytosis (HLH)","condition_category":"death","autism_spectrum_adjacent":0,"outcome":"compensated","award_amount_usd":628837,"decision_date":"2017-03-31","extraction_version":"gemini-v2","extracted_at":"2026-04-30T03:09:05.734898+00:00","number_of_concurrent_vaccines":1,"dose_number":1,"time_to_onset_days":3,"theory_of_causation":"Petitioner Sara Elizabeth Sajbel filed on behalf of her deceased son, B.B.T., alleging that the hepatitis B vaccine administered on March 28, 2013, caused acquired hemophagocytic lymphohistiocytosis (HLH), leading to his death on June 26, 2013. Petitioner's expert, Dr. Vera Byers, posited that the vaccine triggered HLH through immune activation, antigen-antibody complexes, and a cytokine storm, supported by a post-vaccination rash, maternal antibodies, normal prenatal findings, and absence of other triggers. Respondent's expert, Dr. Kenneth McClain, argued HLH began in utero and the vaccine was not a trigger, citing polyhydramnios and jaundice. Special Master Mindy Michaels Roth found petitioner met the Althen prongs, crediting gestational diabetes over in utero HLH for polyhydramnios, the rash as an immune response, kidney failure over liver failure for low albumin, and concluding the vaccine likely triggered HLH. Respondent failed to prove an alternative cause. Entitlement was granted on March 31, 2017, and damages totaling $628,837.34 were awarded on July 5, 2017 ($250,000 death benefit, $250,000 pain and suffering, $3,156 expenses, and $125,681.34 for Colorado Medicaid lien). Petitioner's counsel was Richard Gage. Respondent's counsel was Lisa Watts.","is_death":1,"date_of_death":"2013-06-26","petition_filed_date":"2014-08-15","case_summary":"On August 15, 2014, Sara Elizabeth Sajbel, as representative of the estate of her deceased son, B.B.T., filed a petition alleging that the hepatitis B vaccine administered to B.B.T. 32 minutes after birth on March 28, 2013, caused him to develop hemophagocytic lymphohistiocytosis (HLH), which led to his death on June 26, 2013. B.B.T. was born at 37 weeks and 4 days gestation. His birth was complicated by polyhydramnios, suspected gestational diabetes, and excessive fetal growth. Prenatal ultrasounds and amniocentesis showed normal fetal anatomy, and placental pathology was normal. At birth, B.B.T. weighed 9 pounds, 3 ounces, had Apgar scores of 8 and 9, and was discharged as a healthy baby after phototherapy for jaundice. Hospital nurses described him as \"rashy\" after the hepatitis B vaccine and through discharge. On March 31, 2013, B.B.T. appeared lethargic and fed poorly. He was found limp and apneic after a brief car ride and taken to St. Mary-Corwin Hospital. He was intubated, treated with oxygen, IV fluids, and antibiotics, and transferred to The Children's Hospital in Denver. At The Children's Hospital, B.B.T. was diagnosed with severe metabolic acidosis, encephalopathy, respiratory failure/apnea, hypoglycemia, and hypocalcemia. By early April, physicians suspected primary or secondary HLH. He developed liver failure, kidney failure, cardiomyopathy, pulmonary hypertension, and spontaneous intestinal perforation. Genetic testing for known familial HLH and X-linked lymphoproliferative disease mutations was negative. A treating physician, Dr. Tom Garrington, concluded that the hepatitis B vaccine was the most likely trigger, as no infection, malignancy, or known HLH gene mutation was found. B.B.T. deteriorated despite treatment, and a do-not-resuscitate order was entered on June 25, 2013. He died after ventilator support was withdrawn on June 26, 2013. Petitioner's expert, Dr. Vera Byers, an immunologist, argued that the hepatitis B vaccine triggered acquired HLH through immune activation, antigen-antibody complexes, cytokine production, and a cytokine storm, relying on the post-vaccination rash, maternal hepatitis B antibodies, normal prenatal and placental findings, negative genetic testing, and absence of another trigger. Respondent's expert, Dr. Kenneth McClain, a pediatric hematologist-oncologist and HLH specialist, argued that HLH likely began in utero and that the hepatitis B vaccine was not shown to trigger HLH, pointing to polyhydramnios, low albumin, and jaundice, and the lack of literature directly linking the vaccine to HLH. Special Master Mindy Michaels Roth found that petitioner satisfied all three Althen prongs. She credited gestational diabetes as the more likely cause of polyhydramnios, found the rash likely reflected an immune response after vaccination, credited kidney failure rather than prenatal liver failure as the more plausible explanation for low albumin, and found no convincing evidence that B.B.T. had HLH in utero. She concluded that the hepatitis B vaccine could activate the innate immune system and trigger HLH, that it more likely than not did so in B.B.T.'s case, and that the timing was medically appropriate. Respondent did not prove an unrelated alternative cause. On March 31, 2017, Special Master Roth granted entitlement. On July 5, 2017, she awarded damages by proffer totaling $628,837.34: $250,000.00 for the statutory death benefit, $250,000.00 for past pain and suffering, $3,156.00 for past unreimbursed expenses, and $125,681.34 to satisfy a Colorado Medicaid lien. Petitioner was represented by Richard Gage of Richard Gage, P.C.","is_minor_inferred":null,"is_pediatric_broad":1,"special_master":"Mindy Michaels Roth","petitioner_identifier_original":null,"caption_petitioner_name":"B.B.T.","petitioner_attorney_name":"Richard Gage","petitioner_attorney_firm":"Richard Gage, P.C.","petitioner_attorney_location":"Cheyenne, WY","adjudicator_name":null,"caption_people_backfilled_at":"2026-05-05 23:45:50","attorney_canonical_keys":"|richard-gage|","firm_canonical_key":"richard-gage","package_title":"SAJBEL v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_14-vv-00741","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_14-vv-00741.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_14-vv-00741.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_14-vv-00741-0","title":"SAJBEL v. 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(mw) Copy to parties.","date_issued":"2017-07-31","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_14-vv-00741/granules/USCOURTS-cofc-1_14-vv-00741-1/pdf","pdf_bytes":198736,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'stipulation'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_14-vv-00741/USCOURTS-cofc-1_14-vv-00741-1"},{"granule_id":"USCOURTS-cofc-1_14-vv-00741-2","title":"SAJBEL v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 8/30/2017) regarding 89 DECISION of Special Master - Fees. Signed by Special Master Mindy Michaels Roth. (mw) Copy to parties.","date_issued":"2017-09-25","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"fees-only decision (attorney compensation)","download_status":"skipped"}]}