Shabnam Kouchak v. HHS - Influenza, transverse myelitis (2023)

Shabnam Kouchak, a 41-year-old adult, filed a petition for compensation under the National Vaccine Injury Compensation Program on August 23, 2018. She alleged that she suffered transverse myelitis (TM) as a result of receiving an influenza vaccine on November 12, 2015.

Sixteen days later, on November 28, 2015, Ms. Kouchak presented to the emergency department with bilateral leg numbness and chest and abdominal pain, experiencing leg weakness.

She was admitted to the hospital, where initial assessments included "new onset paraparesis." A lumbar puncture was performed to rule out Guillain-Barré syndrome, but the results were unremarkable. An MRI of the thoracolumbar spine did not reveal acute spinal cord signal abnormalities.

A subsequent MRI on November 30, 2015, of the cervical and thoracic spine revealed "pathologic T2 high signal intensity in bilateral anterior upper thoracic spinal cord, at T3 visualized T6 levels." On December 4, 2015, a thoracic spine MRI showed that the T2 hyperintensity within the anterior spinal cord gray matter at the T3-T6 levels demonstrated restricted diffusion consistent with spinal cord infarct. Petitioner was discharged on December 9, 2015, with records noting her symptoms were determined to be from a spinal cord infarct of undetermined etiology.

Later follow-up appointments with neurologists, including Dr. Shaneela Malik, Dr.

Daniel Miller, Dr. Mirjon Bishja, Dr.

Suheb Hasan, and Dr. Frederick Frost, generally supported the diagnosis of spinal cord infarction, though some, including Dr.

Miller and Dr. Hasan, initially considered or could not exclude TM.

In May 2018, Dr. Nancy Cao opined that the etiology was likely TM, suggested by history versus spinal cord stroke.

Petitioner's expert, Dr. Cao, submitted reports opining that Petitioner suffered from TM provoked by the vaccine, leading to cord inflammation based on timing and clinical history.

She noted that Petitioner's third MRI from early 2016 showed cord signal abnormality from T3-T6, which she stated is typical for myelitis. Respondent's expert, Dr.

Steven Messé, a neurologist, opined that it was highly unlikely the flu vaccine was causal of Petitioner's spinal injury, stating it was more likely due to a stroke/infarction. Dr.

Messé argued that Petitioner's symptom progression, unremarkable cerebrospinal fluid studies, and radiographic findings were highly suggestive of stroke. He also presented literature suggesting influenza vaccination is protective against stroke.

Chief Special Master Brian H. Corcoran reviewed the evidence and arguments.

Petitioner argued she demonstrated TM and a causal link to the vaccine, citing medical literature and the temporal proximity of symptoms. Respondent argued the records favored spinal cord infarct and that Petitioner failed to provide a medical expert report supporting her claim.

The Special Master found that the medical record preponderantly favored a diagnosis of spinal cord infarction over TM. He noted that while Dr.

Cao opined TM was vaccine-provoked, her opinion was found to be conclusory and not adequately supported by the evidence, failing to outweigh contrary evidence supporting infarct. The Special Master also noted that Petitioner did not propose a theory linking the flu vaccine to spinal cord infarction, and literature suggested the flu vaccine is more likely preventative of infarct.

Consequently, the Special Master dismissed the claim, finding Petitioner failed to establish by a preponderance of the evidence that she suffered from TM or that the flu vaccine caused her injury. The case was dismissed.