VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01466
Package ID: USCOURTS-cofc-1_16-vv-01466
Petitioner: R.G.
Filed: 2016-11-07
Decided: 2023-01-03
Vaccine: DTaP
Vaccination date: 2013-11-15
Condition: epilepsy
Outcome: compensated
Award amount USD: 282086

AI-assisted case summary:
On November 7, 2016, Stacy and Jennifer Ginn, parents of R.G., filed a petition under the National Vaccine Injury Compensation Program alleging that their minor son, R.G., developed epilepsy as a result of receiving multiple vaccines on November 15, 2013. The vaccines administered were diphtheria-tetanus-acellular-pertussis (DTaP), inactivated polio (IPV), haemophilus influenzae type b (Hib), measles-mumps-rubella (MMR), and influenza (flu). R.G. was four years old at the time of vaccination. Petitioners alleged that the vaccines triggered a febrile seizure which caused or contributed to R.G.'s epilepsy. The respondent, the Secretary of Health and Human Services, argued against compensation, stating that the petitioners had not provided preponderant evidence. 

In a Ruling on Entitlement issued on March 26, 2021, Special Master Nora Beth Dorsey found that the petitioners had provided preponderant evidence that the vaccines triggered a febrile seizure which caused or contributed to R.G.'s epilepsy, satisfying the burden of proof under the Althen standard. The Special Master determined that while most febrile seizures are benign, in rare cases, a vaccine-triggered febrile seizure can initiate the process leading to epilepsy, especially if it is a complex or focal seizure. The Special Master found no alternative cause for R.G.'s epilepsy and established a proximate temporal relationship between the vaccinations and the injury. Petitioners' expert, Dr. Mahbubul Huq, a pediatric neurologist, opined that R.G. had epilepsy. Respondent's expert, Dr. Shlomo Shinnar, initially opined that R.G. had a mild seizure disorder but later agreed that R.G. had epilepsy after reviewing additional medical records. The Special Master deferred to the diagnosis of R.G.'s treating physician, Dr. Wilfred Castro-Reyes, who diagnosed epilepsy on February 24, 2014. The Special Master found that the vaccinations likely caused R.G.'s initial seizure, and that this seizure, in turn, caused or contributed to the development of his epilepsy. The public decision does not describe the specific symptoms of the initial seizure beyond R.G. shaking, being unresponsive, and having blue lips, nor does it detail the specific mechanism of epileptogenesis beyond the general role of pro-inflammatory cytokines and potential blood-brain barrier disruption. 

A subsequent Ruling Awarding Damages was issued on January 3, 2023, by Special Master Nora Beth Dorsey. The parties agreed to a total compensation award of $282,086.95. This award was structured as a lump sum payment of $260,014.62 for life care expenses for the first year and pain and suffering, and a lump sum payment of $22,072.33 for past unreimbursable expenses. An additional amount was allocated to purchase an annuity for future life care expenses, with specific growth rates for medical and non-medical items. The total award included $243,258.39 for pain and suffering (past and future, with future pain and suffering converted to net present value) and $22,072.33 for past unreimbursable expenses. The annuity payments were to be made for R.G.'s lifetime, contingent on his survival. Petitioners were represented by Ronald C. Homer of Conway Homer, P.C., and respondent was represented by Terrence K. Mangan and later Felicia Langel of the U.S. Department of Justice.

Theory of causation field:
Petitioners alleged that the DTaP, IPV, Hib, MMR, and flu vaccines administered on November 15, 2013, to four-year-old R.G. caused a febrile seizure which led to epilepsy. The Special Master found that the vaccines triggered a febrile seizure, which caused or contributed to the development of epilepsy. Petitioners' expert, Dr. Mahbubul Huq, and respondent's expert, Dr. Shlomo Shinnar, agreed that the vaccines likely caused the initial seizure. Dr. Huq posited a mechanism involving pro-inflammatory cytokines produced in response to vaccination, leading to brain inflammation, disruption of the blood-brain barrier, and enhanced neuronal excitability, ultimately causing epilepsy. Dr. Shinnar agreed that pro-inflammatory cytokines are produced post-vaccination and contribute to decreased seizure threshold, but initially questioned whether brief febrile seizures could initiate epilepsy, later conceding that in rare cases, they can. The Special Master found that R.G.'s initial seizure, occurring within 24 hours of vaccination, was likely vaccine-related and contributed to his epilepsy, supported by the subsequent abnormal EEG and diagnosis of epilepsy within two months. The Special Master found no alternative cause for R.G.'s epilepsy. The proximate temporal relationship was established, with the initial seizure occurring within 24 hours of vaccination and the diagnosis of epilepsy occurring approximately two months later. The award totaled $282,086.95, including lump sums for life care expenses and pain and suffering, and an annuity for future life care expenses. Special Master Nora Beth Dorsey presided. Petitioners were represented by Ronald C. Homer and respondent by Terrence K. Mangan and Felicia Langel.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-01466-1
Date issued/filed: 2021-04-21
Pages: 13
Docket text: PUBLIC RULING (Originally filed: 3/26/2021) regarding 113 Ruling on Entitlement. Signed by Special Master Nora Beth Dorsey. (mca) Service on parties made.
--------------------------------------------------------------------------------
Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
Filed: March 26, 2021
* * * * * * * * * * * * * * *
STACY GINN and JENNIFER GINN, * PUBLISHED
Parents of R.G., a minor, *
* No. 16-1466V
Petitioners, *
* Special Master Nora Beth Dorsey
v. *
* Entitlement; Diphtheria-Tetanus-Acellular-
SECRETARY OF HEALTH * Pertussis (“DTaP”) Vaccine; Inactivated
AND HUMAN SERVICES, * Polio (“IPV”) Vaccine; Haemophilus
* Influenzae Type B (“Hib”) Vaccine;
Respondent. * Measles-Mumps-Rubella (“MMR”)
* Vaccine; Influenza (“Flu”) Vaccine;
* * * * * * * * * * * * * * * Febrile Seizures; Epilepsy.
Ronald C. Homer, Conway, Homer, P.C., Boston, MA, for petitioners.
Terrence K. Mangan, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
I. INTRODUCTION
On November 7, 2016, Stacy Ginn and Jennifer Ginn (“petitioners”), on behalf of their
minor child, R.G., filed a petition under the National Vaccine Injury Compensation Program
(“Vaccine Act” or “the Program”), 42 U.S.C. § 300aa-10 et seq. (2012).2 Petitioners alleged that
as a result of receiving a diphtheria-tetanus-acellular-pertussis (“DTaP”), inactivated polio
(“IPV”), haemophilus influenzae type b (“Hib”), measles-mumps-rubella (“MMR”), and
1 Because this Ruling contains a reasoned explanation for the action in this case, the undersigned
is required to post it on the United States Court of Federal Claims’ website in accordance with
the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and
Promotion of Electronic Government Services). This means the Ruling will be available to
anyone with access to the Internet. In accordance with Vaccine Rule 18(b), petitioners have
14 days to identify and move to redact medical or other information, the disclosure of which
would constitute an unwarranted invasion of privacy. If, upon review, the undersigned agrees
that the identified material fits within this definition, the undersigned will redact such material
from public access.
2 The National Vaccine Injury Compensation Program is set forth in Part 2 of the National
Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755, codified as amended,
42 U.S.C. §§ 300aa-10 to -34 (2012). All citations in this Ruling to individual sections of the
Vaccine Act are to 42 U.S.C. § 300aa.

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 2 of 13
influenza (“flu”) vaccines on November 15, 2013, R.G. suffered a neurological injury,
specifically epilepsy. Petition at 1 (ECF No. 1). Respondent argued against compensation,
stating that “petitioners have not provided preponderant evidence in support of their petition.”
Respondent’s Report (“Resp. Rept.”), filed May 24, 2017, at 7 (ECF No. 19).
After carefully analyzing and weighing the evidence presented in this case in accordance
with the applicable legal standards, the undersigned finds that petitioners have provided
preponderant evidence that the vaccines that R.G. received on November 15, 2013, triggered a
febrile seizure which caused or contributed to the development of a seizure disorder and
epilepsy, which satisfies their burden of proof under Althen v. Secretary of Health and Human
Services, 418 F.3d 1274, 1280 (Fed. Cir. 2005). Accordingly, petitioners are entitled to
compensation.
II. BACKGROUND
A. Summary of Relevant Facts
The facts have been covered in the parties’ pre- and post-hearing submissions and the
expert reports, and will not be repeated here in detail.3 A very brief chronology is helpful for
context.
R.G. was born on November 11, 2009, and was healthy prior to the vaccinations at issue.
At his four-year-old well child visit on November 15, 2013, he received MMR, DTaP, IPV, Hib,
and flu vaccinations. Petitioners’ Exhibit (“Pet. Ex.”) 1 at 1. Later that night R.G.’s parents
heard a strange noise and found R.G. shaking, unresponsive, and not breathing. Pet. Ex. 10 at 2.
His lips were blue. Id. They called 911, and R.G. was transported by ambulance to the hospital.
Id. He was seen by a physician in the emergency department (“ED”) who noted that R.G. likely
had a febrile seizure. Pet. Ex. 7 at 5. The ED physician noted that R.G. had received
vaccinations less than 24 hours before the seizure. Id. at 4-5.
On January 23, 2014, R.G. had a second seizure. Pet. Ex. 7 at 23. Again, he was seen in
the ED, where the physician noted that he had a seizure two months before, thought to be related
to fever and/or vaccinations. Id. R.G. was referred for an electroencephalogram (“EEG”). Id. at
24.
R.G. had the EEG on January 29, 2014. Pet. Ex. 5 at 389. The EEG was abnormal. Id.
It showed an “independent foci of spike activity in the right parieto posterior temporal occipital
and left occipital regions.” Id. The findings “indicate[d] the presence of a focal potentially
epileptogenic process in these regions.” Id. at 389-90.
Subsequently, on February 25, 2014, R.G. saw pediatric neurologist, Dr. Wilfred Castro-
Reyes, who noted that R.G.’s first seizure occurred in November with fever after receiving
3 See Petitioners’ (“Pet.”) Pre-Hearing Brief (“Br.”), filed July 21, 2020 (ECF No. 81); Resp.
Pre-Hearing Br., filed Aug. 20, 2020 (ECF No. 100); Pet. Post-Hearing Br., filed Nov. 30, 2020
(ECF No. 106); Resp. Post-Hearing Br., filed Jan. 4, 2021 (ECF No. 111).
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Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 3 of 13
vaccinations. Pet. Ex. 5 at 418. Dr. Castro-Reyes diagnosed R.G. with “[e]pilepsy with an
abnormal EEG that showed multifocal spikes.” Id. at 419. She prescribed anticonvulsant
therapy, Trileptal. Id.
Since then, R.G. has had more seizures and he continues to see his neurologist every six
months and remains on medication for treatment of his epilepsy. See generally Pet. Ex. 5. His
current neurologist, Dr. Garrett Burris, has opined that R.G. will require medication and
neurological follow-up until the age of twenty-two. Id.
B. Febrile Seizures and Epilepsy
Febrile seizures occur in 2-5% of children under the age of five. Resp. Ex. E at 3.4 A
febrile seizure is defined as “an epileptic seizure . . . occurring in childhood after age 1 month,
associated with a febrile illness not caused by an infection of the [central nervous system].”
Resp. Ex. D at 3.5 “In the past, it was believed that most febrile seizures represented a form of
epilepsy and that the prognosis was not favorable,” but over the last several decades, and with
the benefit of more research and data, “[t]he prognosis for febrile seizures usually has been found
to be good.” Resp. Ex. E at 3.
There are two types of febrile seizures: simple and complex. Resp. Ex. E at 3. A febrile
seizure is complex, “if it is focal, prolonged (lasting more than either 10 . . . or 15 minutes), or
multiple.” Id. Most febrile seizures are simple, and only approximately 20-30% are complex.
Id. A complex seizure is defined as a focal seizure, one or more seizures occurring within 24
hours, or a seizure lasting longer than 15 minutes. Transcript (“Tr.”) 72. The causes of febrile
seizures are multifactorial and include inflammation, brain pH, and genetic factors. See
generally Resp. Ex. M.6
Epilepsy is defined as two or more seizures, “unprovoked by any immediate identified
case.” Resp. Ex. D at 3. Evidence shows febrile seizures are associated with an increased risk of
subsequent epilepsy, and that epilepsy develops in 2-4% of children with a history of febrile
seizures. Resp. Ex. F at 2.7 The risk for development of epilepsy after a simple febrile seizure is
two times higher than the general population, and for a complex febrile seizure, the risk is
higher. Tr. 22. If a “febrile seizure is focal, that makes it complex. And the risk of subsequent
epilepsy is higher. It’s 5 to 10 percent.” Tr. 123.
4 Shlomo Shinnar, Febrile Seizures, in 1 Swaiman’s Pediatric Neurology: Principles and
Practice, 790 (Kenneth F. Swaiman et al. eds., 5th ed. 2018).
5 Comm’n on Epidemiology & Prognosis, Int’l League Against Epilepsy, Guidelines for
Epidemiologic Studies on Epilepsy, 34 Epilepsia 592 (1993).
6 S. Gatti et al., Mechanisms of Fever and Febrile Seizures: Putative Role of the Interleukin-1
System, in Febrile Seizures, 169 (Tallie Z. Baram & Shlomo Shinnar eds., 2002).
7 Anne T. Berg et al., A Prospective Study of Recurrent Febrile Seizures, 327 New Eng. J. Med.
1122 (1992).
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“There seems to be a consensus that seizures affect brain function.” Pet. Ex. 13, Tab HH
at 7.8 “The vulnerability of the brain to seizure-induced injury is age-specific . . . . Experimental
studies show that immature brains are highly prone to develop seizures . . . but are more resistant
to seizure . . . induced damage than adult brains.” Id. at 8. Recent animal data suggest that
seizures “may produce age-specific changes that are not confined to cell loss.” Id. “Structural,
functional, and neurochemical changes have been reported after brief and prolonged seizures in
human beings. However, the significance of these changes is unclear.” Id.
Epileptogenesis “refers to [the] process in which an initial brain damaging insult triggers
a cascade of molecular and cellular changes that eventually lead to the occurrence of
spontaneous seizures.” Pet. Ex. 13, Tab TT at 1.9 In other words, “epileptogenesis is a process
determined by conversion of the healthy brain into the epileptic brain. In epileptic seizure
development . . . abnormal and excessive electronic discharges” occur. Pet. Ex. 13, Tab E at 3.10
The immune system is suggested to play a role in seizure development. Id.
C. Experts Qualifications
Both experts are well qualified to opine on the causation issues presented by the facts and
circumstances presented in this case.
1. Petitioners – Dr. Mahbubul Huq
Dr. Huq is a clinical geneticist and a board certified pediatric neurologist at Children’s
Hospital of Michigan. Pet. Ex. 13 at 1. He completed pediatrics and neurology residencies at
Wayne State University, as well as clinical and postdoctoral fellowships in genetics at Baylor
College of Medicine and the University of British Columbia. Pet. Ex. 14 at 1. Dr. Huq is a
Professor of Pediatrics and Neurology at Wayne State University in the “Clinician Educator
track.” Pet. Ex. 13 at 1. He has an active clinical practice and has authored or co-authored over
75 publications including published peer reviewed articles on the genetics of epilepsy and
neurodevelopmental disorders. Id.; Pet. Ex. 14 at 14-21.
2. Respondent – Dr. Shlomo Shinnar
Dr. Shinnar is board certified in Pediatrics and Neurology with an added Qualification in
Epilepsy. Resp. Ex. A at 2. He completed residencies in Pediatrics and Neurology at Johns
Hopkins Hospital. Id. Dr. Shinnar is a Professor of Neurology, Pediatrics and Epidemiology,
8 Sheryl R. Haut et al., Susceptibility of Immature and Adult Brains to Seizure Effects, 3 Lancet
Neurology 608 (2004).
9 Asla Pitkanen A & Katarzyna Lukasiuk, Molecular and Cellular Basis of Epileptogenesis in
Symptomatic Epilepsy, 14 Epilepsy & Behavior 16 (2009).
10 Feyza Alyu & Miriş Dikmen, Inflammatory Aspects of Epileptogenesis: Contribution of
Molecular Inflammatory Mechanisms, 29 Acta Neuropsychiatrica 1 (2017).
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and Population Health, and the Hyman Climenko Professor of Neuroscience Research and the
Director of the Comprehensive Epilepsy Management Center at Montefiore Medical Center and
the Albert Einstein College of Medicine. Resp. Ex. A at 2. He has authored or co-authored more
than 200 publications, a majority which relate to seizure disorders. Id.
III. DISCUSSION
A. Standards for Adjudication
The Vaccine Act was established to compensate vaccine-related injuries and deaths. §
10(a). “Congress designed the Vaccine Program to supplement the state law civil tort system as
a simple, fair and expeditious means for compensating vaccine-related injured persons. The
Program was established to award ‘vaccine-injured persons quickly, easily, and with certainty
and generosity.’” Rooks v. Sec’y of Health & Hum. Servs., 35 Fed. Cl. 1, 7 (1996) (quoting
H.R. Rep. No. 908 at 3, reprinted in 1986 U.S.C.C.A.N. at 6287, 6344).
Petitioners burden of proof is by a preponderance of the evidence. § 13(a)(1). The
preponderance standard requires petitioners to demonstrate that it is more likely than not that the
vaccine at issue caused the injury. Moberly v. Sec’y of Health & Hum. Servs., 592 F.3d 1315,
1322 n.2 (Fed. Cir. 2010). Proof of medical certainty is not required. Bunting v. Sec’y of Health
& Hum. Servs., 931 F.2d 867, 873 (Fed. Cir. 1991). In particular, petitioners must prove that the
vaccine was “not only [the] but-for cause of the injury but also a substantial factor in bringing
about the injury.” Moberly, 592 F.3d at 1321 (quoting Shyface v. Sec’y of Health & Hum.
Servs., 165 F.3d 1344, 1352-53 (Fed. Cir. 1999)); see also Pafford v. Sec’y of Health & Hum.
Servs., 451 F.3d 1352, 1355 (Fed. Cir. 2006). A petitioner who satisfies this burden is entitled to
compensation unless respondent can prove, by a preponderance of the evidence, that the
vaccinee’s injury is “due to factors unrelated to the administration of the vaccine.” §
13(a)(1)(B).
B. Causation
To receive compensation through the Program, petitioners must prove either (1) that R.G.
suffered a “Table Injury”—i.e., an injury listed on the Vaccine Injury Table—corresponding to a
vaccine that he received, or (2) that R.G. suffered an injury that was actually caused by a
vaccination. See §§ 13(a)(1)(A), 11(c)(1); Capizzano v. Sec’y of Health & Hum. Servs., 440
F.3d 1317, 1319-20 (Fed. Cir. 2006). Because petitioners do not allege that R.G. suffered a
Table Injury, they must prove that the vaccinations R.G. received caused his injury. To do so,
they must establish, by preponderant evidence: (1) a medical theory causally connecting the
vaccines and R.G.’s injury (“Althen Prong One”); (2) a logical sequence of cause and effect
showing that the vaccines were the reason for R.G.’s injury (“Althen Prong Two”); and (3) a
showing of a proximate temporal relationship between the vaccine and R.G.’s injury (“Althen
Prong Three”). § 13(a)(1); Althen, 418 F.3d at 1278.
The causation theory must relate to the injury alleged. Petitioners must provide a sound
and reliable medical or scientific explanation that pertains specifically to this case, although the
explanation need only be “legally probable, not medically or scientifically certain.” Boatmon v.
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Sec’y of Health & Hum. Servs., 941 F.3d 1351, 1359 (Fed. Cir. 2019); see also Knudsen v.
Sec’y of Health & Hum Servs., 35 F.3d 543, 548-49 (Fed. Cir. 1994). Petitioners cannot
establish entitlement to compensation based solely on their assertions; rather, a vaccine claim
must be supported either by medical records or by the opinion of a medical doctor. § 13(a)(1).
In determining whether petitioners are entitled to compensation, the special master shall consider
all material in the record, including “any . . . conclusion, [or] medical judgment . . . which is
contained in the record regarding . . . causation.” § 13(b)(1)(A). The undersigned must weigh
the submitted evidence and the testimony of the parties’ proffered experts and rule in petitioners’
favor when the evidence weighs in their favor. See Moberly, 592 F.3d at 1325-26 (“Finders of
fact are entitled—indeed, expected—to make determinations as to the reliability of the evidence
presented to them and, if appropriate, as to the credibility of the persons presenting that
evidence.”); Althen, 418 F.3d at 1280 (noting that “close calls” are resolved in petitioners’
favor).
C. Diagnosis
As Federal Circuit precedent establishes, in certain cases it is appropriate to determine the
nature of an injury before engaging in the Althen analysis. Broekelschen v. Sec’y of Health &
Hum. Servs., 618 F.3d 1339, 1346 (Fed. Cir. 2010). Since “each prong of the Althen test is
decided relative to the injury[,]” determining facts relating to the claimed injury can be
significant in a case like this, where R.G. has an evolving course of symptoms, resulting in a
diagnosis of epilepsy. Id. Thus, before determining if petitioners have met each prong of
Althen, the undersigned addresses whether they have established, by a preponderance of the
evidence, that R.G. suffered from epilepsy.
Prior to the hearing, there was a question as to whether R.G. had epilepsy. Petitioners’
expert, Dr. Huq, opined that R.G. did have epilepsy; however, respondent’s expert, Dr. Shinnar,
did not agree. Instead, Dr. Shinnar opined that R.G. had a mild seizure disorder. At the hearing
however, after Dr. Shinnar had the opportunity to review R.G.’s medical records from August
10, 2018, he agreed that R.G. does have epilepsy. Tr. 101. Dr. Shinnar changed his opinion
based on the August 2018 records that showed that R.G. had an unprovoked seizure.
However, Dr. Shinnar disagreed that R.G.’s diagnosis of epilepsy was appropriate before
2018. He disagreed with the diagnosis of epilepsy made by R.G.’s treating physician, Dr.
Castro-Reyes. Tr. 106. Specifically, Dr. Shinnar disagreed with Dr. Castro-Reyes’ diagnosis of
epilepsy on February 24, 2014, based on R.G.’s clinical course and his initial EEG done January
29, 2014. Id.; see Pet. Ex. 5 at 416-19.
A treating physician’s opinions are considered “quite probative,” and are entitled to some
weight. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1326 (Fed. Cir. 2009);
Capizzano, 440 F.3d at 1326 (“[M]edical records and medical opinion testimony are favored in
vaccine cases, as treating physicians are likely to be in the best position to determine whether a
‘logical sequence of cause and effect show[s] that the vaccination was the reason for the injury.’”
(quoting Althen, 418 F.3d at 1280)). Medical records are generally viewed as trustworthy
evidence since they are created contemporaneously with the treatment of the vaccinee. Cucuras
v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
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The undersigned defers to the diagnosis of R.G.’s treating physician, Dr. Castro-Reyes,
and finds that Dr. Castro-Reyes’ diagnosis of epilepsy was appropriate and correct at the time
that she made the diagnosis on February 24, 2014.
D. Causation Analysis
The petitioners assert that the vaccinations R.G. received on November 15, 2013,
caused a febrile seizure which triggered the process by which he developed epilepsy. Both Dr.
Huq and Dr. Shinnar agree that the vaccinations R.G. received on November 15, 2013, likely
caused his initial seizure. Tr. 85, 120. They disagree, however, as to whether that initial
seizure caused or contributed to the development of his epilepsy. Dr. Shinnar testified that
whether a febrile seizure is the “starting point” of epilepsy is a much debated issue. Tr. 114.
However, he does agree that in rare cases, patients with febrile seizures can develop epilepsy.
Tr. 115.
1. Althen Prong One
Under Althen Prong One, petitioners must set forth a medical theory explaining how the
received vaccine could have caused the sustained injury. Andreu, 569 F.3d at 1375; Pafford, 451
F.3d at 1355-56. Petitioners’ theory of causation need not be medically or scientifically certain,
but it must be informed by a “sound and reliable medical or scientific explanation.” Knudsen, 35
F.3d at 548; Boatmon, 941 F.3d at 1359; see also Veryzer v. Sec’y of Health & Hum. Servs., 98
Fed. Cl. 214, 223 (2011) (noting that special masters are bound by both § 13(b)(1) and Vaccine
Rule 8(b)(1) to consider only evidence that is both “relevant” and “reliable”). If petitioners rely
upon a medical opinion to support their theory, the basis for the opinion and the reliability of that
basis must be considered in the determination of how much weight to afford the offered opinion.
See Broekelschen, 618 F.3d at 1347 (“The special master’s decision often times is based on the
credibility of the experts and the relative persuasiveness of their competing theories.”); Perreira
v. Sec’y of Health & Hum. Servs., 33 F.3d 1375, 1377 n.6 (Fed. Cir. 1994) (stating that an
“expert opinion is no better than the soundness of the reasons supporting it” (citing Fehrs v.
United States, 620 F.2d 255, 265 (Ct. Cl. 1980))).
From a chapter authored by Dr. Shinnar, he quotes data showing that in “children with
febrile seizures[,] . . . epilepsy subsequently develops in 2-10 percent.” Resp. Ex. E at 6. There
is a “slightly but statistically significant increased risk of subsequent epilepsy” after febrile
seizures. Id. at 7. This risk is increased to 5-10% where the febrile seizure is a complex or focal
seizure. Tr. 123.
Dr. Huq explained the mechanism by which epilepsy is thought to occur following an
initial vaccine-induced febrile seizure. See Pet. Ex. 13 at 5-9. Pro-inflammatory cytokines are
produced in response to vaccinations. Id. at 5. These cytokines lead to an inflammatory state in
the brain, which causes enhanced neuronal excitability and contributes to a disruption of the
blood brain barrier. Id. Some of the pro-inflammatory cytokines are involved in the
“precipitation of seizures,” while others are implicated in the process by which the brain
becomes predisposed to recurrent seizures. Id. at 2. While the exact cause of epilepsy is not
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clear, genetic factors are also thought to be at play. Pet. Ex. 15 at 1. “A genetic predisposition to
develop sustained inflammatory reactions” has been suggested in children with febrile seizures.
Id. at 2. It is thought that genetic factors play a role in decreasing the seizure threshold by either
activating excitatory pathways or by disturbing inhibitory systems. See Resp. Ex. J at 2.11
“[B]rain inflammation is associated with the breakdown in the [blood brain barrier], and [blood
brain barrier] leakages ha[ve] been implicated both in the induction of seizures and in the
progression to epilepsy.” Pet. Ex. 13 at 6. A seizure can cause blood brain barrier (“BBB”)
leakage. See Tr. 52-53, 75-77.
Dr. Shinnar explained the mechanism of the development of epilepsy in a manner similar
to Dr. Huq. Dr. Shinnar agreed that pro-inflammatory cytokines are produced in response to
vaccination and that the cytokine profile IL-beta affects neuronal excitability. Tr. 108. He also
agreed that brain inflammatory processes contribute to a decrease in the seizure threshold. Tr.
109.
The central question for Dr. Shinnar is whether febrile seizures cause or contribute to the
development of epilepsy or whether they are simply markers for epilepsy. Tr. 111-12.
According to Dr. Shinnar, only prolonged seizures can initiate or contribute to the development
of epilepsy. Tr. 110-11. The undersigned finds that based on the opinions of Dr. Huq, along
with the medical literature filed by both parties, in rare cases, a brief febrile seizure triggered by
vaccinations can be the starting point for the development of epilepsy.
For example, in the Doose article, the authors state that, in rare cases, febrile seizures
form the starting point of epilepsy by activation of excitatory pathways or disturbance of
inhibitory systems. Resp. Ex. J at 7. Other factors, such as genetics, may also play a role. See
Tr. 45, 114. In the Pitkanen article, the authors explain that “[i]n animals, it has been shown that
even brief induced or spontaneous seizures, in addition to [status epilepticus], can trigger
neurogenesis.” Pet. Ex. 13, Tab TT at 3. And in the Virta article, the authors opine that
“[c]hildren with febrile seizures may therefore have an increased pro-inflammatory reaction
during fever,” which “may predispose some children to the development of epilepsy.” Pet. Ex.
13, Tab LLL at 1.12
11 H. Doose et al., EEG Longitudinal Studies in Febrile Convulsions, 14 Neuropediatrics 81
(1982).
12 Miia Virtua et al., Increased Frequency of Interleukin-1Beta (-511) Allele 2 in Febrile
Seizures, 26 Pediatric Neurology 192 (2002).
8

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 9 of 13
The mechanism is illustrated below:
Pet. Ex. 13, Tab JJJ at 2 fig.1.13 In the schematic illustration above, Vezzani and her co-authors
defined the phrase “inciting event” as an event with “epileptogenic properties.” Id. Examples of
inciting events were listed and specifically included “febrile seizures.” Id.
During the hearing there was discussion about whether a brief febrile seizure could
disrupt the BBB and contribute to the development of epilepsy. Van Vliet et al. describe that in
an animal model, “it has been shown that a single bicuculline-induced14 seizure is sufficient to
compromise the BBB.” Pet. Ex. 13, Tab FFF at 6.15 In another article by Van Vliet et al., the
authors opine that there is “ample evidence from experimental animal studies that BBB
dysfunction can be caused by seizure activity . . . [and] that BBB disruption can also lead to
epilepsy.” Pet. Ex. 13, Tab GGG at 1.16 They were able to show that a “long lasting increase in
BBB permeability [occurred] after a single seizure.” Id. at 2. Further, they state that although
BBB leakage gradually decreases, it can persist even weeks or months after the initial insult. Id.
at 4.
13 Annamaria Vezzani et al., The Role of Inflammation in Epileptogenesis, 69
Neuropharmacology 16 (2013).
14 Bicuculline is a neurotoxin that is a convulsant. Bicuculline, Dorland’s Med. Dictionary
Online, https://www.dorlandsonline.com/dorland/definition?id=6028&searchterm=bicuculline
(last visited Mar. 15, 2021).
15 E.A. Van Vliet et al., Role of Blood-Brain Barrier in Temporal Lobe Epilepsy and
Pharmacoresistance, 277 Neuroscience 455 (2014).
16 E.A. Van Vliet et al., Blood-Brain Barrier Dysfunction, Seizures and Epilepsy, 38 Seminars
Cell & Developmental Biology 26 (2015).
9

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 10 of 13
These articles support Dr. Huq’s theory of why and how a febrile seizure caused by
vaccinations can cause changes in the brain that contribute to the development of epilepsy.
Accordingly, the undersigned finds that petitioners have set forth a sound and reliable medical
theory, satisfying Althen Prong One.
2. Althen Prong Two
Under Althen Prong Two, petitioners must prove by a preponderance of the evidence that
there is a “logical sequence of cause and effect showing that the vaccination was the reason for
the injury.” Capizzano, 440 F.3d at 1324 (quoting Althen, 418 F.3d at 1278). “Petitioner[s]
must show that the vaccine was the ‘but for’ cause of the harm . . . or in other words, that the
vaccine was the ‘reason for the injury.’” Pafford, 451 F.3d at 1356 (internal citations omitted).
The petitioners need not make a specific type of evidentiary showing, i.e., “epidemiologic
studies, rechallenge, the presence of pathological markers or genetic predisposition, or general
acceptance in the scientific or medical communities to establish a logical sequence of cause and
effect.” Capizzano, 440 F.3d at 1325. Instead, petitioners may satisfy their burden by presenting
circumstantial evidence and reliable medical opinions. Id. at 1325-26.
Here, both experts agree that the vaccinations likely caused R.G.’s initial seizure. The
undersigned has found that petitioners presented a sound and reliable theory as to how, in rare
cases, a febrile seizure can trigger changes in the brain that can lead to epilepsy. Here, the
undersigned extends that finding to R.G., and holds that R.G.’s vaccinations caused his initial
febrile seizure which caused or contributed to changes in the brain that caused his epilepsy.
R.G. had his first seizure on November 15, 2013, within 24 hours of his vaccinations.
Pro-inflammatory cytokines were released after these vaccinations, causing fever, and the initial
seizure. Of note, R.G. received the flu vaccine in addition to the nine childhood vaccines he was
scheduled to receive. R.G. had his next seizure nine weeks later. After the second seizure, his
EEG was abnormal and consistent with epilepsy. R.G. was diagnosed with epilepsy and put on
anticonvulsants. This chronology suggests that R.G. had changes in the brain after his initial
seizure, which caused or contributed to his second seizure, as well as the abnormalities seen on
his initial EEG. Specifically, the EEG showed a focal epileptogenic process in the “right parieto
posterior temporal occipital and left occipital regions.” Pet. Ex. 5 at 389-90. As described by
Dr. Huq, the time frame from seizure onset to the diagnosis of epilepsy was just over two
months. This clinical course is consistent with the effect of the pro-inflammatory cytokines
released after vaccination, affecting neuronal excitability, and creating changes in the brain that
caused epilepsy. The fact that R.G. received the flu vaccine along with the other vaccines
increased the risk of his initial febrile seizure. Tr. 30-32.
Dr. Shinnar agreed that R.G.’s initial seizure “may well have been related” to the
vaccines administered to him on November 15, 2013. Tr. 84. However, Dr. Shinnar
characterized it as a “benign febrile seizure.” Tr. 85. While the literature states that most febrile
seizures are benign, it is also clear that not all febrile seizures are harmless.
10

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 11 of 13
Dr. Shinnar agreed that fever after vaccination is caused by cytokines. In particular, Il-
1beta is responsible for producing fever. It is also known to be a pro-convulsive that lowers
seizure threshold. Tr. 88-89. The cytokine profile is what leads to a seizure. With fever, the
profile is primarily IL-1beta cytokine. Tr. 90-91. Cytokines stay in the system after seizure. Dr.
Shinnar explained that after prolonged febrile seizures, a sequence of events involving cytokines,
which cause chronic inflammation, can contribute to the development of epilepsy.17 Tr. 91-92.
Dr. Shinnar does not believe these changes can occur after a brief febrile seizure. Instead, he
argued that they only occur after prolonged seizures or status epilepticus. However, as briefly
discussed above, relative to Althen Prong One, medical literature specifically identifies febrile
seizures as potential triggers for epilepsy. These articles support Dr. Huq’s position that in rare
cases, a febrile seizure can lead to changes in the brain, as happened here.
The second reason for the undersigned’s finding as to Prong Two, is that R.G.’s initial
seizure had characteristics of a complex seizure, which increased his risk of developing epilepsy.
Dr. Huq explained that the “initial seizure was characterized by unusual vocalization, stiffening
of the trunk and extremities, slow breathing, cyanosis, and unresponsiveness.” Pet. Ex. 15 at 1;
see also Tr. 13. Dr. Huq testified that based on the fact that R.G.’s subsequent seizure was
similar in character to the initial one, and the fact that his EEG showed focal abnormalities, it is
more likely than not that R.G.’s initial vaccine related seizure was also a focal (complex) seizure.
Tr. 73. This increased the risk that R.G. would develop epilepsy. Tr. 74.
Dr. Shinnar testified that there was no way to know whether R.G.’s initial seizure was
focal, and thus, complex. Tr. 129. Even if R.G.’s first seizure was focal, that did not change Dr.
Shinnar’s opinion as to causation. Tr. 133. However, Dr. Shinnar agreed with Dr. Huq that a
focal seizure increases the risk of epilepsy. Id. Thus, there is evidence that R.G.’s initial vaccine
related seizure was focal and thus complex, and as such, his risk of epilepsy was higher.
The third reason for the undersigned’s finding as to Prong Two, is that there was no
alternative cause identified for R.G.’s epilepsy. As explained by Dr. Huq:
The pregnancy and delivery were uncomplicated. [R.G.] did not have any trauma
or any genetic syndromes or past medical problems that would predispose him to
develop epilepsy. Family history was negative on both paternal and maternal
sides with regards to epilepsy or any neurodevelopmental disorders. His brain
MRI did not show any developmental anomaly, cortical dysplasia or brain
malformation. Sodium channel mutation (SCN1A gene mutations) have been
identified in some individuals as a cause of epilepsy after vaccination. The
treating physicians of [R.G.] did not think SCN1A gene mutation as a likely cause
of [R.G.’s] epilepsy and chose not to perform the genetic testing for SCN1A.
Seizures associated with SCN1A mutations are aggravated by sodium channel
blockers like Trileptal (Wirrell, 2016). However, [R.G.’s] seizures were
17 Dr. Shinnar further opined, however, that the cytokines present at the time of a febrile seizure
would not be present nine weeks later. Tr. 91. He further stated that the cytokine IL-1beta was
not involved in chronic inflammation. Tr. 92.
11

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 12 of 13
controlled with Trileptal which makes it unlikely that he has a SCN1A gene
mutation.
Pet. Ex. 13 at 9.
R.G. had had two MRI studies. The first one was done March 10, 2014. Pet. Ex. 5 at
348. The report mentioned a possible T2 flare change that could represent an artifact, however
Dr. Huq testified that he would have considered the study normal. Tr. 49. Dr. Shinnar testified
that it was possible that the MRI was abnormal, but his opinion did not rise to the level of more
likely than not. Tr. 95.
The second MRI was performed on May 28, 2019, and it was also interpreted as normal.
Tr. 49. Dr. Huq testified that it did not show cortical dysplasia, stroke, mass lesion, or vascular
lesions. He testified that these two normal MRIs ruled out a host of causes of epilepsy. Id. Dr.
Shinnar testified that if R.G.’s second MRI was normal, the cause of R.G.’s epilepsy was
unknown, which he opined was true for the majority of cases of epilepsy. Tr. 102. Therefore,
the diagnostic work-up and MRIs did not provide any evidence of an alternative cause.
The last reason for the undersigned’s finding is based on the appropriate temporal
association between R.G.’s vaccinations and his initial seizure, as well as the time frame from his
initial seizure to his diagnosis of epilepsy, discussed below.
For these reasons, the undersigned finds that petitioners, by preponderant evidence, have
shown that the vaccinations were the cause for R.G.’s initial seizure and epilepsy. Accordingly,
petitioners have satisfied Althen Prong Two.
3. Althen Prong Three
Althen Prong Three requires petitioners to establish a “proximate temporal relationship”
between the vaccination and the injury alleged. Althen, 418 F.3d at 1281. That term has been
equated to mean a “medically acceptable temporal relationship.” Id. The petitioners must offer
“preponderant proof that the onset of symptoms occurred within a timeframe which, given the
medical understanding of the disease’s etiology, it is medically acceptable to infer causation-in-
fact.” De Bazan v. Sec’y of Health & Hum. Servs., 539 F.3d 1347, 1352 (Fed. Cir. 2008). The
explanation for what is a medically acceptable time frame must also coincide with the theory of
how the relevant vaccine can cause the injury alleged (under Althen Prong One). Id.; Koehn v.
Sec’y of Health & Hum. Servs., 773 F.3d 1239, 1243 (Fed. Cir. 2014); Shapiro v. Sec’y of
Health & Hum. Servs., 101 Fed. Cl. 532, 542 (2011), recons. den’d after remand, 105 Fed. Cl.
353 (2012), aff’d mem., 503 F. App’x 952 (Fed. Cir. 2013).
Dr. Huq opined that for the DTaP and flu vaccinations, the onset of R.G.’s initial seizure
was appropriate. Tr. 50-51. Dr. Shinnar agreed that a seizure occurring within 24 hours of
vaccinations was a medical appropriate time frame to infer a causal relationship. Tr. 120.
Thus, there is expert agreement that there was a proximately temporal relationship between
R.G.’s vaccinations and his initial seizure.
12

Case 1:16-vv-01466-UNJ Document 115 Filed 04/21/21 Page 13 of 13
The next question is whether the time frame between R.G.’s initial seizure and the
development of his epilepsy was appropriate. Dr. Huq opined that R.G.’s initial seizure began
the process of epileptogenesis—the process by which R.G. developed epilepsy. Tr. 18. When
R.G. was seen by Dr. Castro-Reyes after his first EEG, she diagnosed him with epilepsy based
on his clinical course and abnormal EEG. Tr. 20. Dr. Huq testified that this time frame of nine
weeks was appropriate in terms of epileptogenesis. Tr. 51.
Dr. Huq cited the 2015 Van Vliet article to support his opinion. In that article, the
authors concluded that BBB leakage may continue for weeks to months after an initial insult
such as a seizure. Pet. Ex. 13, Tab GGG at 1. This sustained dysfunction of the BBB leads to
an altered micro-environment of neurons with increased excitability and lowered firing
threshold that contribute to the emergence of seizures. Tr. 52-53 (citing Pet. Ex. 13, Tab GGG
at 1.)
Further, the undersigned notes that R.G.’s treating neurologist routinely documented
that the onset of his seizure disorder was the date of his vaccinations and initial seizure,
November 15, 2013. See Tr. 118.
For the above reasons, the undersigned finds that petitioners have provided
preponderant evidence of a proximate temporal relationship between R.G.’s November 15,
2013 vaccinations and his initial seizure, as well as his epilepsy.
E. Alternative Causation
Because the undersigned concludes that petitioners have established a prima facie case,
petitioners are entitled to compensation unless respondent can put forth preponderant evidence
“that [R.G.’s ] injury was in fact caused by factors unrelated to the vaccine[s].” Whitecotton v.
Sec’y of Health & Hum. Servs., 17 F.3d 374 (Fed. Cir. 1994), rev’d on other grounds sub nom.,
Shalala v. Whitecotton, 514 U.S. 268 (1995); see also Walther v. Sec’y of Health & Hum. Servs.,
485 F.3d 1146, 1151 (Fed. Cir. 2007). As discussed above, respondent did not prove by a
preponderance of evidence that R.G.’s injury was “due to factors unrelated to the administration
of the vaccine[s].” § 13(a)(1)(B).
IV. CONCLUSION
For the reasons discussed above, the undersigned finds that petitioners have established
by preponderant evidence that they are entitled to compensation. A separate damages order will
issue.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Special Master
13

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_16-vv-01466-3
Date issued/filed: 2023-01-03
Pages: 10
Docket text: PUBLIC DECISION (Originally filed: 12/6/2022) regarding 163 DECISION of Special Master. Signed by Special Master Nora Beth Dorsey. (kis) Service on parties made.
--------------------------------------------------------------------------------
Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
Filed: December 6, 2022
* * * * * * * * * * * * * * * * * * * * * * * * *
STACY GINN and JENNIFER GINN, * PUBLISHED
parents of R.G., a minor, *
*
Petitioners, * No. 16-1466V
*
v. * Special Master Nora Beth Dorsey
*
SECRETARY OF HEALTH * Damages Decision; Pain and Suffering
AND HUMAN SERVICES, * Damages; Health Insurance; Diphtheria-
* Tetanus-Acellular-Pertussis (“DTaP”)
Respondent. * Vaccine; Inactivated Polio (“IPV”) Vaccine;
* Haemophilus Influenzae Type B (“Hib”)
* Vaccine; Measles-Mumps-Rubella
* (“MMR”) Vaccine; Influenza (“Flu”)
* Vaccine; Epilepsy; Febrile Seizures.
* * * * * * * * * * * * * * * * * * * * * * * * *
Ronald Craig Homer, Conway Homer, P.C., Boston, MA, for Petitioners.
Felicia Langel, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On November 7, 2016, Stacy Ginn and Jennifer Ginn (“Petitioners”), as parents of R.G.,
a minor, filed a petition for compensation under the National Vaccine Injury Compensation
1 Because this Ruling contains a reasoned explanation for the action in this case, the undersigned
is required to post it on the United States Court of Federal Claims’ website in accordance with
the E-Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and
Promotion of Electronic Government Services). This means the Ruling will be available to
anyone with access to the Internet. In accordance with Vaccine Rule 18(b), Petitioners have
14 days to identify and move to redact medical or other information, the disclosure of which
would constitute an unwarranted invasion of privacy. If, upon review, the undersigned agrees
that the identified material fits within this definition, the undersigned will redact such material
from public access.

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 2 of 10
Program (“Vaccine Act” or “the Program”), 42 U.S.C. § 300aa-10 et seq. (2012).2 Petitioners
alleged that R.G. suffered from epilepsy as the result of diphtheria-tetanus-acellular-pertussis
(“DTaP”), inactivated polio (“IPV”), haemophilus influenzae type b (“Hib”), measles-mumps-
rubella (“MMR”), and influenza (“flu”) vaccines administered on November 15, 2013. Petition
at 1 (ECF No. 1). On March 26, 2021, a Ruling on Entitlement issued, finding Petitioners
entitled to compensation. Ruling on Entitlement dated Mar. 26, 2021 (ECF No. 113).
On November 4, 2022, the undersigned issued a Ruling on Damages, awarding
Petitioners the cost of health insurance until R.G. reaches the age of 22; actual pain and suffering
in the amount of $200,000.00 for R.G.; and for future pain and suffering, $5,000.00 per year,
reduced to net present value, until R.G. reaches the age of 22. Ruling Awarding Damages dated
Nov. 4, 2022 (ECF No. 160). That Ruling is incorporated herein as if fully set forth. The
undersigned also ordered the parties to file a joint status report (1) converting the undersigned’s
award of future pain and suffering to its net present value, (2) providing an updated Life Care
Plan reflecting all items of damages agreed to as well as those awarded consistent with the
Ruling, and (3) a list of all other items of damages agreed to by the parties. Id. at 13.
On December 5, 2022, Respondent filed a joint status report (attached hereto as
Appendix A), in which the parties agreed that the net present value of R.G.’s future pain and
suffering award is $43,258.39. Joint Status Report, filed Nov. 5, 2022, at 2-3 (ECF No. 162).
The parties provided a chart illustrating all life care items awarded by the undersigned in her
Ruling. Id. at Appendix A. The parties also confirmed the previously agreed upon amount of
$22,072.33 for past unreimbursable expenses and that there is no claim for loss of earnings. Id.
at 3. Additionally, the parties requested that compensation be provided to Petitioners through a
combination of lump sum payments and future annuity payments. Id. at 3-5.
Therefore, based on the record as a whole, and pursuant to the undersigned’s damages
Ruling, the undersigned finds that Petitioners are entitled to an award as ordered below:
(1) A lump sum payment of $260,014.62, representing compensation for life care
expenses expected to be incurred during the first year after judgment
($16,756.23), and pain and suffering ($243,258.39) in the form of a check payable
to Petitioners as guardian(s)/conservator(s) of the estate of R.G., for the benefit
of R.G.
(2) A lump sum payment of $22,072.33, representing compensation for past
unreimbursable expenses, in the form of a check payable to Petitioners, Stacy
Ginn and Jennifer Ginn.
2 The National Vaccine Injury Compensation Program is set forth in Part 2 of the National
Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755, codified as amended,
42 U.S.C. §§ 300aa-10 to -34 (2012). All citations in this Ruling to individual sections of the
Vaccine Act are to 42 U.S.C. § 300aa.
2

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 3 of 10
(3) An amount sufficient to purchase an annuity contract described in Section II.C.
of the Joint Status Report.
Joint Status Report at 3-6. These amounts represent compensation for all damages that
would be available under § 300aa-15(a). The Clerk of Court is directed to enter judgment in
accordance with this decision.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Special Master
3

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 4 of 10
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
STACY GINN and JENNIFER GINN, )
parents of R.G., a minor, )
)
Petitioners, ) No. 16-1466V
) Special Master Dorsey
v. ) ECF
)
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
)
JOINT STATUS REPORT IN RESPONSE
TO RULING AWARDING DAMAGES
In the Special Master’s November 4, 2022 Ruling Awarding Damages (“Ruling”), the
Court directed the parties “to file a joint status report by Monday, December 5, 2022, (1)
converting the undersigned’s award of future pain and suffering to its net present value, (2)
providing an updated LCP reflecting all items of damages agreed to as well as those awarded
consistent with this Ruling, and (3) a list of all other items of damages agreed to by the parties.
Thereafter, a damages decision will issue.” ECF No. 160 at 13.
Respondent submits this joint status report providing the Court with a statement of all
damages, including those that the parties have agreed upon as well as those decided by the
Special Master, in the manner that the parties agree contains the information needed for the
Special Master’s damages decision.
While preserving his right, pursuant to 42 U.S.C. § 300aa-12(3), to seek review of the
Special Master’s March 26, 2021 Ruling on Entitlement (ECF No. 113) and November 4, 2022
Ruling (ECF No. 160), respondent submits the following joint status report regarding damages.

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 5 of 10
Petitioners’ counsel has reviewed this joint status report and does not object to the
representations made herein.
I. Items of Compensation
A. Life Care Items
Respondent engaged life care planner Laura E. Fox, MSN, BSN, RN, CNLCP, and
petitioners engaged Maureen Clancy, RN, BSN, CLCP, to provide an estimation of R.G.’s future
vaccine injury related needs. Life care plans were filed in this case. The parties did not agree on
any life care items. All life care items awarded by the Special Master are illustrated by the chart
entitled “Appendix A: Items of Compensation for R.G.,” attached to this joint status report as
Tab A.1
B. Lost Future Earnings
No loss of earnings was requested or awarded.
C. Pain and Suffering
The parties agreed that, based upon the evidence of record, R.G. is entitled to an award
for pain and suffering under the Vaccine Act, 42 U.S.C. § 300aa-15(a)(4). However, the parties
did not agree on an overall award or the allocation to actual versus projected pain and suffering.
On November 4, 2022, the Special Master awarded R.G. $200,000.00 for actual pain and
suffering and “$5,000.00 per year until R.G. reaches the age of 22, reduced to net present value.”
ECF No. 160 at 13. Applying the Court’s guidance on the award for projected pain and
suffering, the parties agree that the amount to be awarded for R.G.’s projected pain and suffering
1 The chart at Tab A illustrates all life care items awarded by the Special Master in her
November 4, 2022 Ruling. Annual benefit years run from the date of judgment up to the first
anniversary of the date of judgment, and every subsequent year indicated up to the anniversary of
the date of judgment.
2

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 6 of 10
is $43,258.39. This results in a total award for pain and suffering of $243,258.39. See 42 U.S.C.
§ 300aa-15(a)(4).
D. Past Unreimbursable Expenses
Evidence supplied by petitioners documents their expenditure of past unreimbursable
expenses related to R.G.’s vaccine-related injury. On October 19, 2022, respondent filed a status
report updating the Court on the parties’ agreement as to petitioners’ unreimbursable expenses of
$22,072.33.00. ECF No. 159.
II. Form of the Award
The parties request that the compensation provided to petitioners be made through a
combination of lump sum payments and future annuity payments as described below.2
A. A lump sum payment of $260,014.62, representing compensation for life care
expenses expected to be incurred during the first year after judgment ($16,756.23), and pain and
suffering ($243,258.39), in the form of a check payable to petitioners as guardian(s)/
conservator(s) of the estate of R.G., for the benefit of R.G. If petitioners are not authorized by a
court of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate of R.G., any
such payment shall be made to the party or parties appointed by a court of competent jurisdiction
to serve as guardian(s)/conservator(s) of the estate of R.G. upon submission of written
documentation of such appointment to the Secretary.
2 Should R.G. die prior to entry of judgment, the parties reserve the right to move the Court for
appropriate relief. In particular, respondent would oppose any award for future medical
expenses and future pain and suffering.
3

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 7 of 10
B. A lump sum payment of $22,072.33, representing compensation for past
unreimbursable expenses, in the form of a check payable to petitioners, Stacy Ginn and Jennifer
Ginn.
C. An amount sufficient to purchase an annuity contract,3 subject to the conditions
described below, that will provide payments for the life care items contained in the life care plan,
as illustrated by the chart at Tab A, attached hereto, paid to the life insurance company4 from
which the annuity will be purchased.5 Compensation for Year Two (beginning on the first
anniversary of the date of judgment) and all subsequent years shall be provided through
respondent’s purchase of an annuity, which annuity shall make payments directly to petitioners,6
as guardian(s)/conservator(s) of R.G., only so long as R.G. is alive at the time a particular
payment is due. At the Secretary’s sole discretion, the periodic payments may be provided to
petitioners in monthly, quarterly, annual, or other installments. The “annual amounts” set forth
3 In respondent’s discretion, respondent may purchase one or more annuity contracts from one
or more life insurance companies.
4 The Life Insurance Company must have a minimum of $250,000,000 capital and surplus,
exclusive of any mandatory security valuation reserve. The Life Insurance Company must have
one of the following ratings from two of the following rating organizations:
a. A.M. Best Company: A++, A+, A+g, A+p, A+r, or A+s;
b. Moody’s Investor Service Claims Paying Rating: Aa3, Aa2, Aa1, or Aaa;
c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-,
AA, AA+, or AAA;
d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability
Rating: AA-, AA, AA+, or AAA.
5 Petitioners authorize the disclosure of certain documents filed by the petitioners in this case
consistent with the Privacy Act and the routine uses described in the National Vaccine Injury
Compensation Program System of Records, No. 09-15-0056.
6 Once R.G. reaches the age of majority, future payments will be made directly to him.
4

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 8 of 10
in the chart at Tab A describe only the total yearly sum to be paid to petitioners and do not
require that the payment be made in one annual installment.
1. Growth Rate
The parties agree that a four percent (4%) growth rate should be applied to all non-
medical life care items, and a five percent (5%) growth rate should be applied to all medical life
care items. Thus, the benefits illustrated in the chart at Tab A that are to be paid through annuity
payments should grow as follows: four percent (4%) compounded annually from the date of
judgment for non-medical items, and five percent (5%) compounded annually from the date of
judgment for medical items.
2. Life-contingent annuity
Petitioners will continue to receive the annuity payments from the Life Insurance
Company only so long as R.G. is alive at the time that a particular payment is due. Written
notice shall be provided to the Secretary of Health and Human Services and the Life Insurance
Company within twenty (20) days of R.G.’s death.
3. Guardianship
No payments shall be made until petitioners provide respondent with documentation
establishing that they have been appointed as the guardian(s)/conservator(s) of R.G.’s estate.7 If
petitioners are not authorized by a court of competent jurisdiction to serve as guardian(s)/
conservator(s) of the estate of R.G., any such payment shall be made to the party or parties
appointed by a court of competent jurisdiction to serve as guardian(s)/conservator(s) of the estate
of R.G. upon submission of written documentation of such appointment to the Secretary.
7 Petitioners filed with the Court a co-guardianship order and letter on February 18, 2022. ECF
No. 144.
5

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 9 of 10
III. Summary of Recommended Payments Following Judgment
A. Lump Sum paid to the court-appointed guardian(s)/
conservator(s) of the estate of R.G. for the benefit of R.G.: $260,014.62
B. Past Unreimbursable Expenses: $ 22,072.33
C. An amount sufficient to purchase the annuity contract
described above in section II. C.
Respectfully submitted,
BRIAN M. BOYNTON
Principal Deputy Assistant Attorney General
C. SALVATORE D’ALESSIO
Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
VORIS E. JOHNSON, JR.
Senior Trial Attorney
Torts Branch, Civil Division
s/Felicia D. Langel
FELICIA D. LANGEL
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel: (202) 451-7659
felicia.d.langel@usdoj.gov
DATED: December 5, 2022
6

Case 1:16-vv-01466-UNJ Document 164 Filed 01/03/23 Page 10 of 10
Appendix A: Items of Compensation for R.G. Page 1 of 1
Lump Sum
Compensation Compensation Compensation Compensation Compensation Compensation Compensation
ITEMS OF COMPENSATION G.R. M Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Years 7-9
2022 2023 2024 2025 2026 2027 2028-2030
BCBS PPO Premium 5% M 8,410.32 8,410.32 8,410.32 8,410.32 8,410.32 8,410.32 8,410.32
BCBS Maximum out of Pocket 5% 7,800.00 7,800.00 7,800.00 7,800.00 7,800.00 7,800.00 7,800.00
Ibuprofen 4% 4.79 4.79 4.79 4.79 4.79 4.79 4.79
Embrace 2 Smartwatch 4% 249.00 249.00
Smartwatch Monitoring 4% 199.20 199.20 199.20 199.20 199.20 199.20 199.20
Mileage: Pediatric Neurologist 4% 43.82 43.82 43.82 43.82 43.82 43.82 43.82
Mileage: EEG 4% 21.91 8.76 8.76 8.76 8.76 8.76 8.76
Mileage: MRI 4% 21.91 4.38 4.38 4.38 4.38 4.38
Mileage: Counselor 4% 5.28 1.06 1.06 1.06 1.06 1.06
Pain and Suffering 243,258.39
Past Unreimbursable Expenses 22,072.33
Annual Totals 282,086.95 16,472.33 16,472.33 16,472.33 16,472.33 16,721.33 16,466.89
Note: Compensation Year 1 consists of the 12 month period following the date of judgment.
Compensation Year 2 consists of the 12 month period commencing on the first anniversary of the date of judgment.
As soon as practicable after entry of judgment, respondent shall make the following payment to the court-appointed guardian(s)/conservator(s)
of the estate of R.G. for the benefit of R.G., for pain and suffering ($243,258.39) and Year 1 life care expenses ($16,756.23): $260,014.62.
As soon as practicable after entry of judgment, respondent shall make the following payment to petitioners, Stacy Ginn and Jennifer Ginn,
for past un-reimbursable expenses: $22,072.33.
Annual amounts payable through an annuity for future Compensation Years follow the anniversary of the date of judgment.
Annual amounts shall increase at the rates indicated in column "G.R." above, compounded annually from the date of judgment.
Items denoted with an "M" payable in 12 monthly installments at the discretion of respondent.