Raymond Markarian v. HHS - Tdap, brachial neuritis (2023)

Raymond Markarian, an adult, received a Tdap vaccine on November 11, 2016. Within approximately 15.5 hours, he experienced severe pain, numbness, tingling, and weakness in his left arm, consistent with brachial neuritis (BN).

He sought medical attention, and treating physicians noted possible SIRVA or BN as a result of the vaccination. Although BN is listed on the Vaccine Injury Table with an onset window of 2-28 days after a tetanus toxoid vaccine, Mr.

Markarian's symptoms began sooner, classifying his claim as 'off-Table.' He had to prove causation-in-fact. Petitioner presented expert testimony and medical literature suggesting that BN can, in rare cases, manifest with onset sooner than the Table's timeframe.

Respondent argued that the early onset was too soon to be causally linked to the vaccine and suggested a coincidental gastrointestinal virus as the cause. However, the medical records did not support a gastrointestinal illness or a prescription for Cipro on the vaccination date, and indicated petitioner's stomach issues were stress-related.

The court found that Mr. Markarian provided preponderant evidence of a logical sequence of cause and effect and a proximate temporal relationship between the Tdap vaccine and his brachial neuritis, supported by expert opinion, literature, his clinical course, and treating physician opinions.

The court ruled that the Tdap vaccine was the cause-in-fact of his BN and granted entitlement to compensation, with damages to be determined in a separate order.