VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00501
Package ID: USCOURTS-cofc-1_19-vv-00501
Petitioner: Christopher Lane
Filed: 2019-04-04
Decided: 2024-09-04
Vaccine: influenza; hepatitis A; typhoid
Vaccination date: 2017-11-01
Condition: immune thrombocytopenic purpura (ITP)
Outcome: compensated
Award amount USD: 228921.56

AI-assisted case summary:
On April 4, 2019, Christopher Lane filed a petition alleging that vaccines administered on November 1, 2017, caused immune thrombocytopenic purpura. He was 41 years old and in good health before receiving influenza, hepatitis A, and typhoid vaccines. Because typhoid vaccine is not covered by the Vaccine Act, the entitlement analysis focused on the covered vaccines, especially the influenza vaccine.

Within roughly a week, Mr. Lane developed petechiae and bleeding gums. He was hospitalized in November 2017 with critically low platelets and diagnosed with ITP. He required a second hospitalization later that month, platelet support, and additional treatment. Conservative therapy failed to provide durable control, and he underwent splenectomy in February 2018. His ITP then became a long-lasting condition.

Special Master Moran credited the opinion of petitioner's hematology expert, Dr. Jerry Spivak, over respondent's expert, Dr. Cindy Neunert. The decision relied on epidemiologic literature, including Garbe, and an immune-complex mechanism to find that influenza vaccination can cause ITP. The timing of Mr. Lane's petechiae and bleeding was medically acceptable, and the record did not identify a more likely alternative cause.

Entitlement was granted on June 7, 2024. On September 4, 2024, the Court awarded damages totaling $228,921.56: $115,000.00 for pain and suffering, $3,391.93 for past unreimbursable expenses, and $110,529.63 to satisfy a California Medi-Cal lien. Mr. Lane was represented by Diana Stadelnikas.

Theory of causation field:
Influenza, hepatitis A, and typhoid vaccines, November 1, 2017, age 41, causing immune thrombocytopenic purpura; typhoid is not covered, so the entitlement analysis focused on covered vaccines, especially influenza. ENTITLEMENT GRANTED June 7, 2024; COMPENSATED September 4, 2024. Key evidence: petechiae and bleeding gums within about 7-10 days, critically low platelets, hospitalizations, failed conservative treatment, splenectomy, treating hematology support, petitioner expert Dr. Jerry Spivak, respondent expert Dr. Cindy Neunert, Garbe epidemiology, and immune-complex theory. Award: $115,000 pain/suffering + $3,391.93 expenses to petitioner and $110,529.63 California Medi-Cal lien, total $228,921.56. Attorney Diana Stadelnikas.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-00501-0
Date issued/filed: 2024-07-30
Pages: 12
Docket text: PUBLIC ORDER/RULING (Originally filed: 06/07/2024) regarding 120 Ruling on Entitlement Signed by Special Master Christian J. Moran. (ceo) Service on parties made.
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Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 1 of 12
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * * *
CHRISTOPHER LANE, *
* No. 19-501V
Petitioner, * Special Master Christian J. Moran
*
v. *
* Filed: June 7, 2024
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * * *
Diana L. Stadelnikas, Maglio, Christopher & Toale, Sarasota, FL, for petitioner;
Sarah B. Rifkin and Madelyn Weeks, United States Dep’t of Justice, Washington,
DC, for respondent.
PUBLISHED RULING FINDING ENTITLEMENT TO COMPENSATION1
Christopher Lane alleges that an influenza (“flu”) vaccine caused him to
develop immune thrombocytopenia and seeks compensation through the National
Childhood Vaccine Injury Compensation Program. The Secretary opposes this
claim.
Each party retained an expert. Mr. Lane’s claim was supported by a
hematologist, Jerry Spivak. The Secretary’s opposition was based upon opinions
from a pediatric hematologist, Cindy Neunert. Both parties advocated through
1 Because this ruling contains a reasoned explanation for the action taken in this case, it
must be made publicly accessible and will be posted on the United States Court of Federal
Claims’ website, and/or at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in
accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2018) (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), the
parties have 14 days to identify and move to redact medical or other information, the disclosure
of which would constitute an unwarranted invasion of privacy. Any changes will appear in the
document posted on the website.

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 2 of 12
memoranda. A review of this material shows that Mr. Lane has established that he
is entitled to compensation.
I. Events in Mr. Lane’s Life2
Mr. Lane was born in 1976. Exhibit 14 at ¶ 1. Before the vaccination, his
health was fine. Id. at ¶ 3.3
When he was 41 years old, he received a flu vaccine on November 1, 2017.
Exhibit 1 at 2, 4, 6. Mr. Lane also received two other vaccines, a hepatitis A
vaccine and a typhoid vaccine. Id. The focus of Mr. Lane’s claim is on the flu
vaccine. Pet’r’s Br. at 2 (Mr. Lane “seeks compensation for injuries sustained as a
result of the covered influenza vaccination administered on November 1, 2017”);
see also Exhibit 37 at 5-7.
Mr. Lane had a dental appointment on November 6, 2017. The sparse notes
do not mention any problem with his gums. Exhibit 24 at 4-5.
Mr. Lane sought medical attention from an urgent care center on November
11, 2017. He reported a petechiae rash had started “a couple of days ago.” Exhibit
8 at 10. He also reported that his “gums ha[d] begun bleeding easily.” Id. He was
sent to an emergency room.
2 The parties generally agree that the medical records accurately memorialize events
happening contemporaneously with the creation of the medical records. Based upon this general
agreement, the recitation of Mr. Lane’s medical history is presented summarily. For a more
complete description, see Pet’r’s Br., filed Dec. 30, 2022, at 3-5; Resp’t’s Br., filed Apr. 24,
2023, at 2-5.
3 Although as mentioned in the previous footnote, the parties generally agree about Mr.
Lane’s health, the parties may have a dispute about the accuracy of one medical record. When
Mr. Lane was hospitalized, he informed a doctor that he was feeling weak for three-to-four
months. Exhibit 5 at 570. Based at least in part on this history, the Secretary argues that Mr.
Lane had thrombocytopenia before the vaccination. Resp’t’s Br. at 11.
The Secretary’s contention regarding pre-existing thrombocytopenia is rejected for two
reasons. Foundationally, the Secretary’s apparent acceptance of a report about weakness existing
for three months is inconsistent with the Secretary’s practice of only crediting information
conveyed to a medical professional contemporaneously with the event’s occurrence. In
numerous cases in which a petitioner has claimed a shoulder injury, the Secretary has not
accepted similar histories. More importantly, Dr. Neunert did not opine that Mr. Lane’s
thrombocytopenia started before the vaccination. See Exhibit A at 9. This leaves the Secretary’s
argument without expert support.
2

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 3 of 12
In the emergency room, Mr. Lane told a triage nurse that he had “developed
red spots all over [his] body on 11/6/17.” Exhibit 2 at 9. When a physician’s
assistant examined him, Mr. Lane stated that his rash appeared “3 days ago after
vaccines.” Id. at 2. A laboratory test revealed that his platelet count was critically
low. Exhibit 2 at 5. He was admitted to the hospital.
This stay at the hospital lasted until November 14, 2017. Exhibit 5 at 579
(discharge report).4 During this hospitalization, he was diagnosed with immune
thrombocytopenia (“ITP”). Id. at 570. In this litigation, Dr. Spivak and Dr.
Neunert agree with the diagnosis of ITP. Exhibit 37 at 3, Exhibit A at 5.
As Mr. Lane was being treated for his ITP, he told different medical
personnel about the beginning of his problems. For example, Mr. Lane informed a
nurse practitioner that “He had no problems and was completely asymptomatic
until yesterday [November 10, 2017] when he noticed some rash and bruising of
his lower legs and feet. The rash got progressively worse.” Exhibit 5 at 568. He
told a hematologist, Dyanesh Ravindran, that he had received vaccinations and had
been well “until 4 days ago [November 7] when he started noticing bruising.” Id.
at 572.
Dr. Ravindran did not comment upon a possible causal relationship between
the vaccinations and Mr. Lane’s ITP. Exhibit 5 at 572; see also id. at 580 (note
from November 13, 2017, stating that “We do not have any results of workup
yet”). However, another doctor treating Mr. Lane, Samantha Mason, wrote that his
ITP was “likely secondary to vaccinations.” Id. at 578.
After Mr. Lane was discharged from the hospital, he continued to have
problems. He was hospitalized again from November 29, 2017 to December 5,
2017, during which he received an infusion of platelets. Exhibit 5 at 5-8.
Conservative treatments did not fully remedy Mr. Lane’s problems. Thus,
he underwent a splenectomy. Exhibit 7 at 79 (Feb. 9, 2018).5
4 The pages of Exhibit 5 are not labeled consistently. Any citations refer to the PDF page
number.
5 Some petitioners with ITP have difficulty establishing that their ITP met the Vaccine
Act’s severity requirement. See, e.g., Wright v. Sec'y of Health & Hum. Servs., 22 F.4th 999
(Fed. Cir. 2022); Michie v. Sec'y of Health & Hum. Servs., No. 19-453V, 2023 WL 10410004
(Fed. Cl. Spec. Mstr. Dec. 4, 2023). Mr. Lane’s ITP, unfortunately, was long-lasting. The
Secretary did not argue that Mr. Lane failed to meet the severity requirement. See Resp’t’s Rep.,
filed July 24, 2020.
3

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 4 of 12
The degree to which Mr. Lane is continuing to experience sequela to his ITP
appears uncertain. Compare Pet’r’s Br. at 5 with Resp’t’s Br. at 5.
II. Procedural History
This case’s course during litigation has been straightforward. Mr. Lane
started the case by filing his petition on April 4, 2019. He periodically submitted
medical records.
When the medical records were complete, the Secretary examined the
evidence. The Secretary recommended that compensation be denied. Resp’t’s
Rep., filed July 24, 2020. The key deficiency, in the Secretary’s view, was that
Mr. Lane lacked an expert report. Id. at 9. In addition, the Secretary found the
causal statement of Dr. Mason insufficient. Id. at 10.
A status conference was held during which Mr. Lane expressed an interest in
obtaining a report from an expert. To facilitate this process, a draft set of
instructions were proposed. Order, issued July 30, 2020. After neither party
commented upon the instructions, they became final. Order, issued Aug. 14, 2020.
Roughly one year later, Mr. Lane filed the first report of Dr. Spivak.6
Beginning in 1972, Dr. Spivak served at the Johns Hopkins University School of
Medicine in various roles, ascending to the title of professor before becoming a
professor emeritus in 2019. Exhibit 38 (curriculum vitae). He directed the
division of hematology from 1980 to 1992. Id. He is board-certified in internal
medicine and hematology. Id.; see also Exhibit 37 (report) at 1. When Dr. Spivak
submitted his first report, he had treated three patients with immune
thrombocytopenia in the last five years. Exhibit 37 at 1.
The Secretary responded by presenting the first report of Dr. Neunert.
Exhibit A (filed Dec. 20, 2021). Dr. Neunert graduated from medical school in
2001. Exhibit B (curriculum vitae) at 2. When she submitted her curriculum vitae,
she was serving as an associate professor of pediatrics in the division of
hematology / oncology / bone marrow transplant at Columbia University. Id. at 1.
“The focus of [her] career has been to understand patient-related outcomes in ITP.”
Exhibit A (report) at 1. She has led various groups investigating ITP. She reported
that she has “taken care of more than one hundred patients with ITP, and [she]
6 Some of the delay was attributable to hematologists responding to the coronavirus
pandemic. See Pet’r’s Status Rep., filed Nov. 13, 2020.
4

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 5 of 12
see[s] patients from across the United States in consultation for a second opinion
with respect to diagnosis and management of ITP.” Id.
Each party submitted a second report from his expert. Exhibit 76 (Dr.
Spivak’s report, filed May 10, 2022); Exhibit C (Dr. Neunert’s report, filed July
11, 2022).
When the parties completed the disclosure of expert opinions, they were
directed to file briefs. Order, issued Aug. 31, 2022. Mr. Lane argued his case via a
primary brief, filed Dec. 30, 2022, and a reply brief, filed May 24, 2023. In
between, the Secretary presented his arguments. Resp’t’s Br., filed Apr. 24, 2023.
Neither party requested an opportunity to present oral testimony. With the
submission of the reply brief, the case is ready for adjudication.
III. Standards for Adjudication
A petitioner is required to establish his case by a preponderance of the
evidence. 42 U.S.C. § 300aa–13(1)(a). The preponderance of the evidence standard
requires a “trier of fact to believe that the existence of a fact is more probable than
its nonexistence before [he] may find in favor of the party who has the burden to
persuade the judge of the fact's existence.” Moberly v. Sec’y of Health & Hum.
Servs., 592 F.3d 1315, 1322 n.2 (Fed. Cir. 2010) (citations omitted). Proof of
medical certainty is not required. Bunting v. Sec’y of Health & Hum. Servs., 931
F.2d 867, 873 (Fed. Cir. 1991).
Distinguishing between “preponderant evidence” and “medical certainty” is
important because a special master should not impose an evidentiary burden that is
too high. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379-80 (Fed.
Cir. 2009) (reversing special master's decision that petitioners were not entitled to
compensation); see also Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357
(Fed. Cir. 2000); Hodges v. Sec’y of Health & Hum. Servs., 9 F.3d 958, 961 (Fed.
Cir. 1993) (disagreeing with dissenting judge's contention that the special master
confused preponderance of the evidence with medical certainty).
For causation-in-fact claims, petitioners bear a burden “to show by
preponderant evidence that the vaccination brought about [the vaccinee’s] injury
by providing: (1) a medical theory causally connecting the vaccination and the
injury; (2) a logical sequence of cause and effect showing that the vaccination was
the reason for the injury; and (3) a showing of a proximate temporal relationship
between vaccination and injury.” Althen v. Sec’y of Health & Hum. Servs., 418
F.3d 1274, 1278 (Fed. Cir. 2005).
5

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 6 of 12
IV. Analysis
The analysis is contained in five sections. The heart of the analysis concerns
the three Althen prongs, which are found in sections IV.B. through IV.D.
Following these sections, there is a short section addressing the lack of alternative
cause. Section IV.E. The analysis begins with an assessment of Dr. Spivak’s and
Dr. Neunert’s credentials.
A. Qualifications of Experts
As a preliminary matter, the parties dispute the relative qualifications of Dr.
Spivak and Dr. Neunert. Mr. Lane argues that Dr. Neunert’s career of treating
pediatric cases of ITP diminishes her ability to opine in Mr. Lane’s case because he
was an adult (41 years old) when he developed the disease. Pet’r’s Br. at 12-13;
Pet’r’s Reply at 3-6. The Secretary defends Dr. Neunert’s knowledge of ITP
without critiquing Dr. Spivak’s qualifications. Resp’t’s Br. at 15-16.
The differences between Dr. Spivak’s qualifications and Dr. Neunert’s
qualifications are differences in degree, not in kind. Although Dr. Neunert treats
children, Mr. Lane has not persuasively shown that the causal mechanisms for ITP
differ for children and adults. Although Dr. Spivak’s treatment of adults makes his
specialization a tighter fit to the circumstances of Mr. Lane’s case, Dr. Spivak has
also seen significantly fewer cases of ITP (three cases in the last five years versus
more than a hundred over a career). Under these circumstances, the undersigned
declines to favor Dr. Spivak or Dr. Neunert solely due to his or her qualifications.
B. Althen Prong One
According to Mr. Lane, the “dispute in the instant case centers primarily on
prong one.” Pet’r’s Reply at 1. Mr. Lane meets his burden of proof largely due to
a supporting epidemiologic study. For a lengthy discussion of the value of
epidemiologic studies in the Vaccine Program, see Tullio v. Sec’y of Health &
Hum. Servs., No. 15-51V, 2019 WL 7580149, at *5-8 (Fed. Cl. Spec. Mstr. Dec.
19, 2019), mot. for rev. denied, 149 Fed. Cl. 448, 475 (2020).
A group of German researchers investigated whether various drugs could
induce thrombocytopenia. They meticulously searched for adults with
thrombocytopenia around Berlin from October 2000 to March 2009. Garbe at
6

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 7 of 12
823.7 Upon identifying this population, the researchers determined whether they
had “drug exposures during 1 week before the index date.” Id. at 830. “Index
date” corresponds to the earlier of either the drop in platelet levels or the clinical
manifestation of thrombocytopenia. Id. at 823. The researchers matched these
participants with controls in a “case-control approach.” Id.
Garbe and colleagues identified the influenza vaccine as a drug with a
“definite or probable causal relationship in suspected drug-induced immune
thrombocytopenia.” Id. at 825 (table 1). “In the case-control analysis, influenza
vaccination was associated with a statistically significant 4-fold risk.” Id. at 829.
The authors advised that in evaluating the causes of thrombocytopenia, “particular
attention should be paid to vaccines.” Id. at 830.
As an epidemiologic study, Garbe weighs heavily in favor of finding that an
influenza vaccine can cause thrombocytopenia. Against this evidence, the
Secretary raises two points. Resp’t’s Br. at 10.
Based upon an opinion from Dr. Neunert, the Secretary argues that because
the Garbe researchers had identified only three cases of ITP following flu
vaccination, “a true association could not be determined.” Resp’t’s Br. at 10; see
also Exhibit C at 6. However, the article contradicts the Secretary’s assertion. The
Garbe researchers, who included one person who worked at an institute for
epidemiology, found their results “statistically significant.” Exhibit 42 at 829. The
Secretary has not demonstrated that Dr. Neunert is qualified to call into question
the results of an epidemiologic study.
The Secretary’s second challenge to Garbe appears to be the presentation of
a different epidemiologic study. See Resp’t’s Br. at 8-9, citing Lafaurie.8 In that
study, a group of French researchers used databases to find patients, aged 65 and
older, who developed thrombocytopenia. Exhibit D at 444. These researchers did
not find an increased adjusted incident rate ratio. Id. at 445 (table 2).
The presence of Lafaurie does, indeed, weaken the value of Garbe, but only
by a bit. Due to contradictory results, it probably cannot be said that the
proposition that the flu vaccine can cause thrombocytopenia has been established
7 Garbe et al., Drug-induced immune thrombocytopaenia: results from the Berlin Case-
Control Surveillance Study, 68 EUR J. CLIN PHARMACOL 821 (2012); filed as Exhibit 42.
8 Lafaurie et al., Research Letter: Risk of Immune Thrombocytopenia After Influenza
Vaccine, 182 JAMA INTERNAL MEDICINE 444 (2022); filed as Exhibit D.
7

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 8 of 12
with scientific certainty. Reasonable people, such as Dr. Spivak and Dr. Neunert,
might come to different conclusions in good faith. But, Mr. Lane’s burden is
neither scientific certainty nor general consensus. Rather he must establish that the
flu vaccine “can cause” thrombocytopenia. See Pafford v. Sec’y of Health &
Hum. Servs., 451 F.3d 1352, 1356 (Fed. Cir. 2006) (accepting the question “can
[the] vaccine(s) at issue cause the type of injury alleged” as “identical to the first
prong of the Althen test”). The Garbe study suffices.
Dr. Spivak proposed various theories by which the flu vaccine can cause
thrombocytopenia, such as immune complex formation. Exhibit 37 at 6; see also
Pet’r’s Br. at 37-38. Dr. Neunert appears not to have addressed these theories in
detail and did not specifically address immune complex formation. See Exhibit A
at 8, Exhibit C at 4. Likewise, the Secretary has not challenged the sufficiency of
immune complexes as a theory. See Resp’t’s Br. at 14.
Under the circumstances in which an epidemiologic study supports a finding
that a vaccine can cause an injury and in which the Secretary has not meaningfully
contested a proposed theory, an in-depth exploration of the theory is not required.
The epidemiologic study persuasively shows that the flu vaccine can cause
thrombocytopenia. How that occurs---whether by immune complex formation or
some other means---is much less important than the showing that it does occur.
For these reasons, Mr. Lane has met his burden of proof regarding prong
one. Thus, the remaining Althen elements are considered.
C. Althen Prong Two
A petitioner must present preponderant evidence showing “a logical
sequence of cause and effect showing that the vaccination was the reason for the
injury.” Althen, 418 F.3d at 1278. The opinions of treating doctors can be quite
probative. Cappizano v. Sec’y of Health & Hum. Servs., 440 F.3d 1317, 1326
(Fed. Cir. 2006).
Here, Mr. Lane has support from a doctor who treated him, Dr. Mason. She
stated that Mr. Lane’s ITP was “likely secondary to vaccinations.” Exhibit 5 at
578. This statement weighs strongly in favor of Mr. Lane’s claim.
To oppose Dr. Mason, the Secretary emphasizes that Dr. Ravindran, a
hematologist, did not affirmatively agree with Dr. Mason’s opinion. Resp’t’s Br.
at 12, citing Exhibit 5 at 580. The Secretary’s characterization is accurate.
However, it is also equally true that Dr. Ravindran did not negate or contradict Dr.
8

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 9 of 12
Mason’s opinion. Dr. Ravindran could be described as neutral or unopinionated on
the topic of what caused Mr. Lane’s ITP.
In sum, the affirmative evidence favoring vaccination as a cause for Mr.
Lane’s thrombocytopenia outweighs the neutral evidence. Mr. Lane has met his
burden of proof regarding prong two.9
D. Althen Prong Three
The timing prong actually contains two parts. A petitioner must show the
“timeframe for which it is medically acceptable to infer causation” and the onset of
the disease occurred in this period. Shapiro v. Secʼy of Health & Hum. Servs., 101
Fed. Cl. 532, 542-43 (2011), recons. denied after remand on other grounds, 105
Fed. Cl. 353 (2012), aff’d without op., 503 F. App’x 952 (Fed. Cir. 2013).
As to the expected temporal interval, the parties may or may not agree about
the minimum amount of time for which an inference of causation is appropriate.
Dr. Spivak’s analysis of the expected temporal relationship begins by pointing out
that the Secretary has recognized that a different vaccine, the mumps-measles-
rubella (“MMR”) vaccine, can cause thrombocytopenia that appears at least seven
days and not more than 30 days after the vaccination. Exhibit 37 at 7; see also 42
C.F.R. § 100.3 ¶ V.A. Dr. Spivak also cites four case reports about a total of ten
adults developing thrombocytopenia one to 17 days after receiving flu vaccine.
Id.; see also Pet’r’s Br. at 49. The Garbe group “look[ed] at drug exposures during
1 week before the index date.” Exhibit 41 at 830.
Dr. Neunert appears to accept that the pathogenesis of thrombocytopenia
induced by the MMR vaccine would resemble the pathogenesis of
thrombocytopenia induced by the flu vaccine. Exhibit A at 9. In her second
report, Dr. Neunert opines that an onset more rapid than seven days is unlikely to
happen in adults, compared to children who frequently receive the MMR vaccine.
Exhibit C at 7. She did not address the case reports Dr. Spivak cited.
9 To an extent, the Secretary may be suggesting that Mr. Lane was burdened with
showing that the typhoid vaccine did not cause his ITP. Resp’t’s Br. at 11. However, the
Secretary has not identified any evidence that the typhoid vaccine can cause ITP. Thus, Mr.
Lane was not required to knock down a straw man that the Secretary did not erect.
9

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 10 of 12
As to the onset of Mr. Lane’s thrombocytopenia, the parties and their experts
again have some disagreement. Some of the disagreement is probably attributable
to inconsistencies in the histories that Mr. Lane provided in November 2017.
Medical Records about the Onset of Mr. Lane’s Thrombocytopenia
# Cite Date Given Context History Implied
Onset
Ex. 1 11/1/2017 Date of
at 2, vaccination
4, 6.
Ex. 11/6/2017 Dental No bleeding in gums
24 at appointment noted.
4-5
1 Ex. 8 11/11/2017 Urgent Care a petechiae rash had 11/9/2017
at 10. started “a couple of days
ago.”
2 Ex. 2 11/11/2017 Triage nurse “developed red spots all 11/6/2017
at 9. in emergency over [his] body on
room 11/6/17.”
3 Ex. 2 11/11/2017 Physician’s A rash appeared “3 days 11/8/2017
at 2 assistant in ago after vaccines.”
emergency
room
4 Ex. 5 11/11/2017 “He had no problems 11/10/2017
at and was completely
568 asymptomatic until
yesterday [November
10, 2017] when he
noticed some rash and
bruising of his lower
legs and feet. The rash
got progressively
worse."
10

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 11 of 12
Medical Records about the Onset of Mr. Lane’s Thrombocytopenia
5 Ex. 5 11/11/2017 Hematologist, Doing well “until 4 days 11/7/2017
at Dyanesh ago [November 7] when
572 Ravindran he started noticing
bruising.”
These histories, which were given around the same day, do not line up with
precision. Do these inconsistencies mean that Mr. Lane did not suffer from
thrombocytopenia? No; objective evidence establishes that his platelet counts
were low. Exhibit 5 at 570; see also Exhibit 37 at 3, Exhibit A at 5. Thus, the
question for the second part of the third Althen prong is determining when, among
these range of options, Mr. Lane first displayed a symptom of his
thrombocytopenia. A reasonable inferential answer is that Mr. Lane first
manifested symptoms of his thrombocytopenia on November 8, 2017.
November 8, 2017 is seven days after November 1, 2017, the date of
vaccination. Thus, Mr. Lane’s onset falls within the seven-day period the experts
accepted based upon the Vaccine Injury Table for MMR vaccine.
Moreover, the Federal Circuit has cautioned that special masters should not
set “hard and fast deadlines” for the appropriate temporal relationship. Paluck v.
Sec’y of Health & Hum. Servs., 786 F.3d 1373, 1383 (Fed. Cir. 2015). This
admonition carries force in Mr. Lane’s case with respect to both parts of the third
Althen prong. Based upon case reports and Garbe, a more in-depth analysis could
find that the minimum amount of time for an influenza vaccine to cause
thrombocytopenia is six days. Alternatively, there is evidence that Mr. Lane’s
thrombocytopenia did not manifest until November 10, 2017. Exhibit 5 at 563.
This date is unquestionably within the period Dr. Spivak and Dr. Neunert accept as
one for which an inference of causation is appropriate.
Accordingly, for these reasons, Mr. Lane has satisfied the third Althen
prong.
E. Alternative Cause
As explained in the preceding sections, Mr. Lane satisfied each Althen
prong, demonstrating that the flu vaccine was the cause-in-fact of his
thrombocytopenia. In this situation, the Secretary has an opportunity to identify an
11

Case 1:19-vv-00501-UNJ Document 125 Filed 07/30/24 Page 12 of 12
alternative cause. However, the Secretary has not. See Resp’t’s Br. Thus, Mr.
Lane is entitled to compensation.
V. Conclusion
With preponderant evidence, Mr. Lane showed that he is one of the rare
people who experienced a serious adverse reaction to a vaccine. His injury is
unfortunate. Congress created the Vaccine Program to compensate people like Mr.
Lane. A status conference to discuss compensation remains set for June 18, 2024
at 11:00 A.M.
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
12

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-00501-1
Date issued/filed: 2025-10-14
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 09/04/2024) regarding 128 DECISION Stipulation/Proffer. Signed by Special Master Christian J. Moran. (jjb) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * * *
CHRISTOPHER LANE, *
* No. 19-501V
Petitioner, * Special Master Christian J. Moran
*
v. *
* Filed: September 4, 2024
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * * *
Diana L. Stadelnikas, Maglio, Christopher & Toale, Sarasota, FL, for petitioner;
Sarah B. Rifkin and Madelyn Weeks, United States Dep’t of Justice, Washington,
DC, for respondent.
UNPUBLISHED DECISION AWARDING DAMAGES1
On April 4, 2019, Christopher Lane filed a petitioner seeking compensation
under the National Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-1
et seq., alleging that an influenza (“flu”) vaccine he received on November 1,
2017, caused him to develop immune thrombocytopenia. The parties submitted
1 Because this Decision contains a reasoned explanation for the action taken
in this case, it must be made publicly accessible and will be posted on the United
States Court of Federal Claims’ website, and/or at
https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with
the E-Government Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal
Management and Promotion of Electronic Government Services). This means the
Decision will be available to anyone with access to the internet. In accordance with
Vaccine Rule 18(b), the parties have 14 days to identify and move to redact
medical or other information, the disclosure of which would constitute an
unwarranted invasion of privacy. Any changes will appear in the document posted
on the website.

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 2 of 7
written evidence, including medical records, expert reports, and briefs. On June 7,
2024, the undersigned determined that Mr. Lane is entitled to compensation.
On August 29, 2024, respondent filed a Proffer on Award of Compensation,
to which petitioner agrees. Based upon the record as a whole, the special master
finds the Proffer reasonable and that petitioner is entitled to an award as stated in
the Proffer. Pursuant to the attached Proffer, the court awards petitioner the
following:2
A. A lump sum payment of $118,391.93 in the form of a check
payable to petitioner; and,
B. A lump sum payment of $110,529.63, representing
compensation for satisfaction of a Medicaid lien, in the form of a
check payable jointly to petitioner and:
MediCal Program
Department of Health Care Services
Personal Injury Program, MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Ref.: Christopher Lane, DHCS Acct. No. C95079315F-001T
Petitioner agrees to endorse the check to the State of California MediCal
Program for satisfaction of the Medicaid lien.
In the absence of a motion for review filed pursuant to RCFC, Appendix B,
the clerk is directed to enter judgment in case 19-501V according to this decision
and the attached proffer.3
2 Should petitioner 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, future pain and suffering, and
future lost wages.
3 Pursuant to Vaccine Rule 11(a), the parties can expedite entry of judgment
by each party filing a notice renouncing the right to seek review by a United States
Court of Federal Claims judge.
2

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 3 of 7
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
3

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 4 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
CHRISTOPHER LANE,
Petitioner, No. 19-501V
Special Master Moran
v. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On April 4, 2019, Christopher Lane (“petitioner”) filed a petition for compensation under
the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act”
or “Act”), alleging that he suffered immune thrombocytopenic purpura (“ITP”), as the result of
“a vaccination or vaccinations” administered on November 1, 2017.1 Petition at 1.
On December 30, 2022, petitioner filed a Memorandum in Support of Entitlement. ECF
No. 105. See also Petitioner’s Reply in Support of Motion For Entitlement, ECF No. 113.
Respondent filed his Response on April 24, 2023, recommending that entitlement to
compensation be denied. ECF No. 110. On June 7, 2024, the Court issued a Ruling on
Entitlement, finding petitioner entitled to compensation for ITP that was caused-in-fact by the flu
vaccine.2 ECF No. 120.
1 Petitioner received influenza (“flu”) and Hepatitis A vaccines on November 1, 2017. Petitioner
also received a typhoid vaccine, but that vaccine is not covered by the Act.
2 Respondent has no objection to the amount of the proffered award of damages set forth herein.
Assuming the Court issues a damages decision in conformity with this proffer, respondent
waives his right to seek review of such damages decision. However, respondent reserves his
right, pursuant to 42 U.S.C. § 300aa-12(e), to seek review of the June 7, 2024 entitlement
decision.

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 5 of 7
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $115,000.00 in pain and suffering
damages. See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.
B. Past Unreimbursable Expenses
Evidence supplied by petitioner documents that he incurred past unreimbursable expenses
related to his vaccine-related injury. Respondent proffers that petitioner should be awarded past
unreimbursable expenses in the amount of $3,391.93. See 42 U.S.C. § 300aa-15(a)(1)(B).
Petitioner agrees.
C. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy a Medicaid lien in
the amount of $110,529.63, which represents full satisfaction of any right of subrogation,
assignment, claim, lien, or cause of action the State of California may have against any
individual as a result of any Medicaid payments made to or on behalf of petitioner from the date
of his eligibility for benefits through the date of judgment in this case as a result of his alleged
vaccine-related injury suffered on or about November 1, 2017 under Title XIX of the Social
Security Act.
The above amounts represent all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
The parties recommend that compensation provided to petitioner should be made through two
2

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 6 of 7
lump sum payments described below, and request that the Special Master’s decision and the
Court’s judgment award the following: 3
A. A lump sum payment of $118,391.93 in the form of a check payable to petitioner;
and,
B. A lump sum payment of $110,529.63, representing compensation for satisfaction of a
Medicaid lien, in the form of a check payable jointly to petitioner and:
MediCal Program
Department of Health Care Services
Personal Injury Program, MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
Ref.: Christopher Lane, DHCS Acct. No. C95079315F-001T
Petitioner agrees to endorse the check to the State of California MediCal Program for satisfaction
of the Medicaid lien.
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.
Assistant Director
Torts Branch, Civil Division
3 Should petitioner 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, future pain and suffering, and future lost wages.
3

Case 1:19-vv-00501-UNJ Document 136 Filed 10/14/25 Page 7 of 7
s/Sarah B. Rifkin
SARAH B. RIFKIN
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) 305-5997
Sarah.Rifkin@usdoj.gov
Dated: August 29, 2024
4