Jeffrey Prepejchal v. HHS - Influenza, deep vein thrombosis (2018)

Jeffrey Prepejchal, a 44-year-old medical charter pilot, filed a petition alleging that the influenza vaccine he received on November 7, 2012, caused deep vein thrombosis (DVT) in his left arm. He claimed to have experienced soreness and mild pain an hour after the vaccination, with swelling developing later.

Nine days post-vaccination, an ultrasound confirmed DVT in his left arm. Mr.

Prepejchal's medical records showed a history of left shoulder pain and his father had a history of upper extremity DVT, but he had no prior personal DVT. His treating physicians offered conflicting opinions on whether the DVT was vaccine-related, with one being unsure and another, after research, concluding it was unlikely.

Petitioner's expert, Dr. M.

Eric Gershwin, proposed a "mechanical injury" theory, analogizing the DVT to Nicolau Syndrome (NS), but conceded there was no immunological link between the flu vaccine and DVT. Respondent's expert, Dr.

Megha Tollefson, a pediatric dermatologist, disputed the analogy to NS, noting Mr. Prepejchal's lack of immediate pain and skin lesions, and highlighted Mr.

Prepejchal's risk factors including family history and his profession. The Special Master dismissed the claim, finding that Mr.

Prepejchal failed to establish a plausible medical theory of causation (Althen prong one) and a logical sequence of cause and effect (Althen prong two). The court affirmed, agreeing that the causation theory was not sufficiently supported and that the analogy to NS was faulty.

The court also noted that the claim failed the six-month residual effects requirement, as the DVT appeared to have resolved within three months. The decision was made on the record without a hearing.