{"package_id":"USCOURTS-cofc-1_19-vv-00746","decision_granule_id":"USCOURTS-cofc-1_19-vv-00746-0","petitioner_identifier":"Virginia Van Zandt","is_minor":null,"age_at_vaccination":null,"age_unit_raw":null,"vaccine_type":"influenza","vaccination_date":"2017-11-06","condition_raw":"Guillain-Barré syndrome","condition_category":"GBS","autism_spectrum_adjacent":0,"outcome":"denied","award_amount_usd":null,"decision_date":"2022-06-06","extraction_version":"gemini-v2","extracted_at":"2026-04-30T05:14:04.275204+00:00","number_of_concurrent_vaccines":1,"dose_number":null,"time_to_onset_days":null,"theory_of_causation":"Petitioner Virginia Van Zandt alleged that an influenza vaccine administered on November 6, 2017, caused Guillain-Barré syndrome (GBS), an on-Table injury. The core dispute was the onset date of GBS symptoms. Petitioner proposed November 13, 2017, relying on neurologist Frederick Nahm. Respondent argued onset was November 4, 2017, two days prior to vaccination, based on neurologist Thomas Leist. Special Master Christian J. Moran found that Ms. Van Zandt's back pain, experienced on November 4, 2017, was the initial manifestation of GBS. This finding meant the symptoms predated the vaccination, failing the \"on-Table\" requirement for compensation. Key evidence included medical records, testimony from Ms. Van Zandt, Dr. Melody Lee (PCP), Dr. Nahm, and Dr. Leist. The Special Master found Dr. Leist's explanation that the back pain was not solely due to a congenital spinal abnormality more persuasive than Dr. Nahm's musculoskeletal theory, noting the timing, spread, and response to treatment (lack of relief from trigger point injection, improvement with IVIG) were more consistent with GBS. Petitioner was denied compensation.","is_death":0,"date_of_death":null,"petition_filed_date":"2019-05-20","case_summary":"Virginia Van Zandt filed a petition on May 20, 2019, alleging that she received an influenza vaccine on November 6, 2017, which caused her to develop Guillain-Barré syndrome (GBS). GBS is an injury listed on the Vaccine Injury Table. The primary issue in this case was the timing of the onset of Ms. Van Zandt's symptoms. Ms. Van Zandt proposed an onset date of November 13, 2017, and relied on the opinion of neurologist Frederick Nahm. The respondent, the Secretary of Health and Human Services, argued that Ms. Van Zandt's symptoms began two days before her vaccination, based on the opinion of neurologist Thomas Leist. A hearing was held on February 23, 2022, where Ms. Van Zandt, her primary care physician Melody Lee, Dr. Nahm, and Dr. Leist testified. Oral argument was held on May 12, 2022. Special Master Christian J. Moran issued an oral bench ruling denying compensation, which is memorialized in this document. The Special Master found that a preponderance of the evidence indicated that Ms. Van Zandt developed a symptom of her GBS before the vaccination. The Special Master considered medical records, witness testimony, expert reports, and medical literature. The evidence regarding numbness and tingling onset was close, with some records suggesting it began after vaccination and others suggesting it began at the same time as back pain. However, the Special Master found it unnecessary to definitively resolve the onset of numbness and tingling because the case could be resolved based on the finding that her back pain was a manifestation of her GBS. Both Dr. Nahm and Dr. Leist agreed that back pain can be a symptom of GBS, and Dr. Lee acknowledged this possibility. While some literature suggests GBS diagnosis focuses on sensory and motor changes, and Dr. Nahm stated focal, non-radiating back pain would not be the top GBS diagnosis, other articles discussed GBS patients with preceding pain. The parties agreed Ms. Van Zandt experienced back pain two days before her vaccination. Dr. Nahm opined the back pain was due to a congenital spinal abnormality, a view shared by ER doctor Vivian Reyes. However, Dr. Leist persuasively explained that the congenital abnormality at the T6 level did not explain pain throughout other areas of her back, noting tenderness at the T10 level. Dr. Nahm's theory that the pain was musculoskeletal was undermined by the timing, as Ms. Van Zandt had not experienced this type of back pain before or after November 2017, despite her congenital abnormality being lifelong. Dr. Leist noted that significant congenital problems typically cause recurring issues. The spread of pain throughout Ms. Van Zandt's spine, noted by Dr. Reutter, and the lack of relief from a trigger point injection, also pointed away from a purely structural abnormality, according to Dr. Leist. Dr. Nahm could not explain the extensive spread of pain or definitively state the lack of improvement from the injection indicated a neurologic issue. Furthermore, Ms. Van Zandt's back pain improved after IVIG therapy, which Dr. Leist suggested was consistent with a gradual decline in pain over time for GBS patients, indicating an inflammatory cause. Dr. Nahm's assertion that an inflammatory or neurological condition would have resolved with IVIG was countered by Dr. Leist's expectation of gradual decline. Statements from treating physicians recommending against future flu shots due to a \"severe complication\" were noted but did not resolve the onset issue. Ultimately, the Special Master found that the evidence preponderated in favor of the finding that Ms. Van Zandt's back pain on November 4, 2017, two days prior to vaccination, was the initial manifestation of her GBS. Because her symptoms predated the vaccination, she failed to establish that the flu vaccine caused her GBS within the Table's timeframe. Therefore, Ms. Van Zandt was denied compensation.","is_minor_inferred":0,"is_pediatric_broad":0,"special_master":"Christian J. Moran","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"Bridget McCullough","petitioner_attorney_firm":"Muller Brazil, LLP","petitioner_attorney_location":"Dresher, PA","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|bridget-mccullough|","firm_canonical_key":"muller-brazil","package_title":"VAN ZANDT v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00746","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00746.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00746.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_19-vv-00746-0","title":"VAN ZANDT v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 5/13/2022) regarding 67 DECISION of Special Master. Signed by Special Master Christian J. Moran. (amb) Service on parties made.","date_issued":"2022-06-06","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_19-vv-00746/granules/USCOURTS-cofc-1_19-vv-00746-0/pdf","pdf_bytes":259667,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'decision of special master'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_19-vv-00746/USCOURTS-cofc-1_19-vv-00746-0"},{"granule_id":"USCOURTS-cofc-1_19-vv-00746-1","title":"VAN ZANDT v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 9/27/23) regarding 76 DECISION of Special Master - Fees Signed by Special Master Christian J. Moran. (jm) Service on parties made.","date_issued":"2023-11-02","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"fees-only decision (attorney compensation)","download_status":"skipped"}]}