George Swaiss v. HHS - Tdap, small fiber neuropathy which constitutes a variant of Guillain-Barré syndrome (2019)

On March 19, 2015, George Swaiss filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that a Tdap vaccination received on June 1, 2012, caused him to develop a small fiber neuropathy, which he contended was a variant of Guillain-Barré syndrome (GBS). Mr.

Swaiss, born May 12, 1966, was a mechanical engineer for NASA and managed rental properties. His medical history prior to the vaccination included hypertension, migraines, neck pain, and a noted episode of muscle ache and neuropathic pain after taking ciprofloxacin in 2008.

He also had physical therapy for myofascial pain in 2009. On June 1, 2012, during a routine physical, he received the Tdap vaccine.

Seven days later, on June 8, 2012, he reported severe pain in his left shoulder, weakness in his left forearm and palm, a bitter taste, and flu-like symptoms. By June 11, 2012, he experienced facial numbness, numbness on the soles of his feet, and pain and fatigue in his legs, making walking difficult.

Neurological examinations noted decreased sensation in a stocking-glove pattern, consistent with peripheral nervous system involvement, though reflexes and strength were largely normal. His initial treating physicians, Dr.

Messner and Dr. Cho, considered a possible GBS variant, though Dr.

Cho noted that the symptoms were primarily sensory and did not strictly follow the typical ascending pattern of GBS. Further workup, including MRIs and a lumbar puncture, yielded normal results.

Despite ongoing symptoms, including pain, weakness, blurred vision, and balance issues, Dr. Cho believed his condition was plateauing and cleared him to travel to Jordan in August 2012.

Over the following years, Mr. Swaiss continued to experience fluctuating pain, fatigue, and sensory issues.

He was diagnosed by some providers with myofascial pain syndrome, while others continued to consider neuropathic pain and possible GBS variants. In 2016, a skin biopsy confirmed small fiber neuropathy.

The respondent's expert, Dr. Peter Donofrio, argued that Mr.

Swaiss's condition did not fit the typical GBS profile and that the Tdap vaccine was not a recognized cause of small fiber neuropathy. The petitioner's expert, Dr.

Nizar Souayah, opined that GBS is an umbrella term for immune-mediated peripheral neuropathies, including variants that affect small nerve fibers, and that the Tdap vaccine could cause such a variant through molecular mimicry. Special Master Thomas L.

Gowen found that Mr. Swaiss had established a medically acceptable temporal relationship between the Tdap vaccine and the onset of his symptoms.

He concluded that the Tdap vaccine can cause a small fiber GBS variant through molecular mimicry, and that the vaccine was the cause-in-fact of Mr. Swaiss's injury.

The Special Master found that the respondent did not establish an alternative cause for the injury. Mr.

Swaiss was found entitled to compensation, with damages to be determined in a separate order. Attorneys for the petitioner were Ronald C.

Homer and Joseph M. Pepper.

Attorneys for the respondent were Adriana R. Teitel and Lynn E.

Ricciardella. The decision was issued on December 4, 2019.