{"package_id":"USCOURTS-cofc-1_17-vv-01109","decision_granule_id":"USCOURTS-cofc-1_17-vv-01109-0","petitioner_identifier":"E.M.","is_minor":1,"age_at_vaccination":12.2,"age_unit_raw":"years","vaccine_type":"HPV/Gardasil; influenza","vaccination_date":"2015-07-20","condition_raw":"optic neuritis and Rasmussen's encephalitis with seizures and severe neurologic sequelae","condition_category":"encephalitis_encephalopathy","autism_spectrum_adjacent":0,"outcome":"entitlement_granted_pending_damages","award_amount_usd":null,"decision_date":"2025-03-05","extraction_version":"manual-supplement-redo-2026-05-normal44","extracted_at":"2026-05-05 00:32:14","number_of_concurrent_vaccines":1,"dose_number":2,"time_to_onset_days":30,"theory_of_causation":"Second HPV/Gardasil vaccine on July 20, 2015, age about 12.2, followed about one month later by optic neuritis; later influenza vaccine on November 10, 2015, alleged as part of a two-hit pathway to Rasmussen's encephalitis, seizures, and severe neurologic sequelae. ENTITLEMENT GRANTED; damages pending in staged public text. Petitioners Leah and Jeremy Marsh relied on Dr. Lawrence Steinman. Respondent's experts Dr. Christine McCusker and Dr. Jenny Linnoila disputed vaccine causation and suggested infection such as HSV. Special Master Horner found the HPV vaccine caused optic neuritis and that the vaccine-induced optic neuritis substantially contributed to Rasmussen's encephalitis.","is_death":0,"date_of_death":null,"petition_filed_date":"2017-08-16","case_summary":"On August 16, 2017, Leah and Jeremy Marsh filed a petition under the National Childhood Vaccine Injury Act on behalf of their minor daughter, E.M. They alleged that the Human Papillomavirus (HPV) vaccine administered on July 20, 2015, caused optic neuritis and Rasmussen's encephalitis. They later amended the petition to include the allegation that E.M.'s influenza (flu) vaccine, received on November 10, 2015, also contributed to the Rasmussen's encephalitis. The respondent opposed entitlement. Special Master Daniel T. Horner found that the HPV vaccine caused E.M.'s optic neuritis and that this vaccine-induced optic neuritis was a substantial contributing factor in the development of her Rasmussen's encephalitis.\n\nE.M., born May 1, 2003, had no significant medical issues before 2015. She received her first HPV vaccine on February 17, 2015, and her second on July 20, 2015. By mid-August 2015, approximately one month after her second HPV vaccine, E.M. began experiencing visual disturbances. An optometrist noted papilledema, and an ophthalmologist diagnosed optic nerve edema. A neuro-ophthalmologist observed left-sided optic neuritis with atypical disk swelling and suggested a possible demyelinating disorder. An MRI showed an enlarged left optic nerve with increased T2 signal and scattered white-matter foci. E.M. was treated with IV Solu-Medrol and underwent a lumbar puncture, which revealed elevated white blood cells and a single oligoclonal band, consistent with a systemic immune reaction.\n\nE.M. reported improvement in her vision by November 10, 2015, though she still experienced intermittent headaches. On that date, she received her seasonal flu vaccine. Dr. Lloyd continued to diagnose left-sided optic neuritis and planned monitoring. On December 9, 2015, E.M. experienced her first seizure. Conflicting reports existed regarding any preceding illness, but an EEG showed left-hemisphere abnormalities consistent with an acute left-hemisphere process. HSV testing was negative in the cerebrospinal fluid (CSF).\n\nE.M.'s condition rapidly escalated. A subsequent MRI showed persistent white-matter abnormalities and a new lesion in the left periatrial region. She developed right-hand numbness and language deficits. Neurologists suspected autoimmune encephalitis. E.M. experienced further seizures and was admitted to the hospital with frequent seizures, fever, and increasing neurologic deficits. She received extensive treatments, including anticonvulsants, steroids, plasmapheresis, and IVIG. Imaging showed progressive left-hemisphere abnormalities. A left frontal lobe biopsy revealed chronic active encephalitis, most consistent with a T-cell mediated immune-mediated or infectious encephalitis. Later MRI evidence of left-hemisphere volume loss supported a diagnosis of Rasmussen's encephalitis.\n\nPetitioners' expert, neuroimmunologist Dr. Lawrence Steinman, proposed a \"two-hit\" model, suggesting the HPV vaccine caused optic neuritis and associated left-sided brain pathology, which then predisposed E.M. to Rasmussen's encephalitis, potentially with the flu vaccine acting as a second hit. Respondent's experts, Dr. Christine McCusker and Dr. Jenny Linnoila, disputed the vaccine connection, arguing that optic neuritis and Rasmussen's encephalitis were distinct and that E.M.'s condition was likely triggered by an infection like HSV.\n\nSpecial Master Horner found that E.M.'s optic neuritis began within a medically acceptable interval after the HPV vaccine and met the Althen prongs for vaccine causation. He further concluded that the vaccine-induced optic neuritis, including left-sided brain pathology, was a but-for cause and substantial contributing factor to E.M.'s Rasmussen's encephalitis. The Special Master found that respondent did not prove that HSV or any other factor unrelated to vaccination was the sole cause. Entitlement was granted, with damages to be determined in a separate proceeding.","is_minor_inferred":0,"is_pediatric_broad":1,"special_master":"Daniel T. Horner","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"Jeffrey S. Pop","petitioner_attorney_firm":"Jeffrey S. Pop & Associates","petitioner_attorney_location":"Beverly Hills, CA","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|jeffrey-pop|","firm_canonical_key":"jeffrey-s-pop-and-associates","package_title":"MARSH, et al v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01109","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01109.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01109.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_17-vv-01109-0","title":"MARSH, et al v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC ORDER/RULING (Originally filed: 3/5/2025) regarding 130 Ruling on Entitlement. Signed by Special Master Daniel T. Horner. (ksb) Service on parties made.","date_issued":"2025-04-04","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_17-vv-01109/granules/USCOURTS-cofc-1_17-vv-01109-0/pdf","pdf_bytes":715180,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'ruling on entitlement'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_17-vv-01109/USCOURTS-cofc-1_17-vv-01109-0"}]}