{"package_id":"USCOURTS-cofc-1_16-vv-01083","decision_granule_id":"USCOURTS-cofc-1_16-vv-01083-2","petitioner_identifier":"J.S.","is_minor":0,"age_at_vaccination":18.0,"age_unit_raw":"years","vaccine_type":"Hepatitis A","vaccination_date":"2015-08-04","condition_raw":"inappropriate tachycardia and autonomic dysfunction, manifesting in a wide variety of conditions and symptoms (including joint pain, dizziness, nausea, and postural orthostatic tachycardia syndrome (“POTS”))","condition_category":"dysautonomia","autism_spectrum_adjacent":0,"outcome":"denied","award_amount_usd":null,"decision_date":"2023-02-13","extraction_version":"gemini-v2","extracted_at":"2026-04-30T00:44:50.210184+00:00","number_of_concurrent_vaccines":1,"dose_number":null,"time_to_onset_days":1,"theory_of_causation":"Petitioner J.S. alleged that the Hepatitis A and HPV vaccines administered on August 4 and August 19, 2015, respectively, caused her to develop inappropriate tachycardia, autonomic dysfunction, and POTS. Petitioner's theory of causation, primarily advanced by her expert Dr. Lawrence Steinman, posited molecular mimicry, where vaccine components share amino acid sequences with adrenergic receptors, triggering an autoimmune response leading to dysautonomia. Dr. Steinman cited BLAST searches showing homology between vaccine components and adrenergic receptors, and Petitioner's positive antibody test results for anti-adrenergic antibodies as evidence. Petitioner's medical records documented symptoms like tachycardia, dizziness, and jerking movements, with some physicians noting a temporal association with vaccination. Respondent's experts, Dr. Andrew MacGinnitie and Dr. Peter Bingham, argued against this theory, stating POTS is not typically autoimmune, that Petitioner's antibody results were inconclusive or not timely, and that the molecular mimicry theory lacked sufficient scientific support and epidemiological evidence. The Chief Special Master denied the claim, finding no cognizable injury was established, as Petitioner's symptoms were more likely due to somatization or anxiety, and her causation theory was unreliable and unpersuasive, lacking sufficient scientific backing. The Court of Federal Claims affirmed the Chief Special Master's decision, finding it was not arbitrary or capricious, as the Special Master had reasonably weighed the evidence and found Petitioner failed to meet her burden of proof under the Althen standard for causation.","is_death":0,"date_of_death":null,"petition_filed_date":"2016-08-30","case_summary":"J.S., an 18-year-old, filed a petition for compensation under the National Childhood Vaccine Injury Act on August 30, 2016. She alleged that the Hepatitis A vaccine received on August 4, 2015, and the human papillomavirus (HPV) vaccine received on August 19, 2015, caused her to develop inappropriate tachycardia, autonomic dysfunction, and postural orthostatic tachycardia syndrome (POTS). Petitioner claimed symptoms including convulsions, shortness of breath, rapid heartbeat, loss of feeling in her left leg, joint pain, hyperventilation, heart palpitations, dizziness, and nausea, with onset approximately one day after the HPV vaccine and 16 days after the Hepatitis A vaccine.\n\nRespondent argued that Petitioner had not met her burden to show causation-in-fact. The parties filed ten expert reports offering competing theories on whether the vaccines could cause autoimmune reactions leading to autonomic dysfunction and orthostatic intolerance. Petitioner's medical records showed multiple emergency room visits and hospitalizations following the vaccinations, with symptoms often attributed by treating physicians to anxiety reactions or pseudoseizures, and no clear physiological cause identified. While some physicians noted a temporal association with the vaccinations and one suggested a possible autoimmune reaction, extensive testing, including a tilt table test and antibody testing, did not confirm a diagnosis of POTS or other vaccine-related injury. Petitioner's expert, Dr. Lawrence Steinman, theorized molecular mimicry, suggesting the vaccines could trigger cross-reactive autoimmune responses to adrenergic receptors, leading to her symptoms. Respondent's experts, Dr. Andrew MacGinnitie and Dr. Peter Bingham, countered that POTS is not typically autoimmune, that Petitioner's antibody test results were not conclusive or timely, and that the molecular mimicry theory was not well-supported by the evidence or applicable to human disease.\n\nThe Chief Special Master denied entitlement, finding that Petitioner failed to establish a cognizable vaccine-caused injury by a preponderance of the evidence. The Chief Special Master concluded that Petitioner's symptoms were more likely related to somatization or anxiety, citing numerous instances where physicians noted psychological components to her condition and the lack of objective findings confirming a physiological injury. The Chief Special Master also found Petitioner's causation theory, particularly regarding molecular mimicry and autoimmune dysautonomia, to be unreliable and unsupported by the scientific evidence, noting that POTS is generally not considered autoimmune and that the temporal association alone was insufficient. The Chief Special Master also determined that a hearing was not necessary as the record was sufficiently developed.\n\nPetitioner sought review of the Chief Special Master's decision, raising several objections, including that the findings were arbitrary and capricious, that tachycardia could be a primary condition, that the denial of a hearing was an abuse of discretion, and that the Chief Special Master improperly preemptively denied attorney's fees for the review. The Court of Federal Claims reviewed the decision under the arbitrary and capricious standard. The Court upheld the Chief Special Master's findings, concluding that he had considered the relevant evidence, articulated a reasoned basis for his decision, and that his conclusions were not arbitrary, capricious, or otherwise not in accordance with the law. The Court found that the Chief Special Master appropriately weighed the evidence, including the conflicting expert opinions and medical records, and that his determination that Petitioner failed to establish a cognizable injury or a reliable theory of causation was supported by the record. The Court also found that the Chief Special Master did not abuse his discretion in deciding the case on the record without a hearing, and that the issue of attorney's fees for the review was not ripe.\n\nConsequently, the Court denied Petitioner's motion for review and sustained the Chief Special Master's decision, resulting in the denial of the claim.","is_minor_inferred":0,"is_pediatric_broad":0,"special_master":"Brian H. Corcoran","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"Robert J. Krakow","petitioner_attorney_firm":"Law Office of Robert J. Krakow","petitioner_attorney_location":"New York, NY","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|robert-krakow|","firm_canonical_key":"law-office-of-robert-j-krakow","package_title":"S. v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01083","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01083.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01083.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_16-vv-01083-0","title":"S. v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 01/19/2023) regarding 122 Order on Motion to Redact Decision. Signed by Chief Special Master Brian H. Corcoran. (saj) Service on parties made.","date_issued":"2023-02-13","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"docketText matches skip keyword 'motion'","download_status":"skipped"},{"granule_id":"USCOURTS-cofc-1_16-vv-01083-1","title":"S. v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"JUDGE VACCINE REPORTED OPINION re: 120 Order on Motion for Review, Judge Vaccine Order/Opinion (Reissuance of January 12, 2023 Opinion for Publication). Signed by Judge Edward H. Meyers. (skw) Service on parties made.","date_issued":"2023-02-13","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_16-vv-01083/granules/USCOURTS-cofc-1_16-vv-01083-1/pdf","pdf_bytes":501837,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'opinion'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_16-vv-01083/USCOURTS-cofc-1_16-vv-01083-1"},{"granule_id":"USCOURTS-cofc-1_16-vv-01083-2","title":"S. v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 07/15/2022) regarding 109 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (saj) Service on parties made.","date_issued":"2023-06-27","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_16-vv-01083/granules/USCOURTS-cofc-1_16-vv-01083-2/pdf","pdf_bytes":560960,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'decision of special master'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_16-vv-01083/USCOURTS-cofc-1_16-vv-01083-2"},{"granule_id":"USCOURTS-cofc-1_16-vv-01083-3","title":"S. v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 07/30/2025) regarding 138 DECISION of Special Master - Fees. Signed by Chief Special Master Brian H. Corcoran. (mva) Service on parties made.","date_issued":"2025-08-26","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"fees-only decision (attorney compensation)","download_status":"skipped"}]}