Eliana Cowart v. HHS - Meningococcal, fibromyalgia (2021)

Eliana Cowart, born March 18, 1999, filed a petition for compensation under the National Childhood Vaccine Injury Act of 1986 on April 26, 2016. She alleged that the meningococcal conjugate vaccine she received on March 27, 2015, caused her to develop fibromyalgia.

Initially, Ms. Cowart also claimed an acute allergic reaction to the vaccine, but this claim was later voluntarily dismissed.

Ms. Cowart's medical history prior to vaccination included minimal health issues, primarily asthma and seasonal allergies.

In December 2012, she sought treatment for potential epilepsy due to episodes of upper body quivering, and was referred to a neurologist, though she never saw him. Her pediatrician noted no further epilepsy symptoms in subsequent visits.

Mental health screenings were conducted, but no concerns were noted. A neuropsychologist retained by the Secretary opined that Ms.

Cowart experienced significant life stressors before vaccination, including transitioning to college and potential familial stressors. A psychiatrist retained by Ms.

Cowart countered that her college transition was not sufficiently disruptive to cause a depressive episode. On March 27, 2015, Ms.

Cowart received the Menveo meningococcal vaccine. That night, she presented to the emergency room with back pain shooting down her arms and tingling fingers, with a clinical impression of acute allergic reaction.

Over the following months, her symptoms evolved. She experienced pain, seizure-like and neurological symptoms, fatigue, tremors, dizziness, nausea, headaches, and blurry vision.

She was evaluated by her pediatrician, Dr. Hilliard, and neurologist Dr.

Linda Leary. Tests including an MRI and EEG were normal, and a diagnosis of epilepsy was not made.

Ms. Cowart also saw rheumatologist Dr.

Jorge C. Zamora-Quezada, but no records were obtained.

On July 2, 2015, Ms. Cowart saw rheumatologist Dr.

Mark Nelson, reporting chronic fatigue, vertigo, nausea, polyarthralgias, and myalgias since vaccination. His physical examination was normal.

He initially diagnosed "serum sickness" and ordered labs. On August 4, 2015, Dr.

Nelson diagnosed Ms. Cowart with fibromyalgia, polyarthralgia, chronic fatigue syndrome, and bilateral headaches, noting tenderness at fibromyalgia trigger points in her spine.

On September 15, 2015, Dr. Nelson again diagnosed fibromyalgia, noting an onset date of August 4, 2015.

Ms. Cowart's causation theory, developed through experts Michael McCabe (Ph.D. in immunology) and Dr.

Eric Gershwin (rheumatologist), proposed a two-step process: first, the vaccine caused an initial reaction, and second, overtreatment of these initial symptoms by doctors led to stress, which in turn caused fibromyalgia. Dr.

Gershwin stated that Ms. Cowart was suffering from fibromyalgia as of July 2, 2015, and that overtreatment was the "lynchpin" of her condition.

The Secretary argued that Ms. Cowart failed to establish a persuasive medical theory connecting the vaccine to fibromyalgia, citing that the standard is not mere "biologic plausibility" but requires a persuasive theory, as per cases like Althen, LaLonde, and Boatmon.

The Secretary also contended that Ms. Cowart failed to demonstrate overtreatment during the critical period between vaccination and diagnosis, and that her pre-vaccination medical records indicated pre-existing conditions and stressors.

The Secretary's experts, Dr. Carlos Rose (pediatric rheumatologist) and Ms.

Deborah Anderson (licensed psychologist and neuropsychologist), opined that Ms. Cowart's fibromyalgia originated before vaccination, possibly due to Major Depressive Disorder and other stressors.

Special Master Christian J. Moran found that Ms.

Cowart failed to meet her burden of proof. The court determined that her experts' theories were "plausible" but not "persuasive," failing to meet the standard set by Federal Circuit precedent.

Furthermore, the court found no clear evidence of overtreatment during the critical period between vaccination and diagnosis, which was essential to Ms. Cowart's theory.

The court also noted inconsistencies in the timing of the fibromyalgia diagnosis as presented by her experts, particularly Dr. Gershwin's assertion of a July 2, 2015 diagnosis, which conflicted with other medical records.

The court concluded that Ms. Cowart did not establish a logical sequence of cause and effect or a proximate temporal relationship that would support her claim.

On January 26, 2021, Special Master Christian J. Moran issued a decision denying entitlement because Ms.

Cowart did not meet her burden of proof on causation. Ms.

Cowart's claim for an immediate reaction was withdrawn. The public decision does not describe the specific dollar amount of any award, as entitlement was denied.

Petitioner's counsel was Sean F. Greenwood, and respondent's counsel was Voris E.

Johnson.