{"package_id":"USCOURTS-cofc-1_20-vv-00503","decision_granule_id":"USCOURTS-cofc-1_20-vv-00503-1","petitioner_identifier":"M.R.","is_minor":1,"age_at_vaccination":1.0,"age_unit_raw":"years","vaccine_type":"MMR","vaccination_date":"2017-11-07","condition_raw":"immune thrombocytopenic purpura (ITP)","condition_category":"other","autism_spectrum_adjacent":0,"outcome":"entitlement_granted_pending_damages","award_amount_usd":null,"decision_date":"2025-08-25","extraction_version":"gemini-v2","extracted_at":"2026-04-30T01:14:14.416025+00:00","number_of_concurrent_vaccines":1,"dose_number":null,"time_to_onset_days":31,"theory_of_causation":"Petitioner M.R., a minor, received an MMR vaccine on November 7, 2017. The petition alleged Immune Thrombocytopenic Purpura (ITP) caused-in-fact by the vaccine. The Special Master previously found ITP onset between 31-42 days post-vaccination, precluding a Table presumption. The case turned on the \"causation-in-fact\" standard (Althen analysis). Respondent conceded Althen prongs one (medical theory) and three (proximate temporal relationship) based on expert Dr. Strouse's acknowledgment that MMR can cause ITP and elevated risk persists up to 42 days. The dispute focused on Althen prong two (logical sequence of cause and effect). Respondent argued M.R.'s ITP was atypical due to insidious/gradual onset, chronicity, and a concurrent pharyngitis diagnosis on December 8, 2017, suggesting viral infection as a more likely cause. Petitioner countered with expert Dr. Ghose, who opined the MMR vaccine caused M.R.'s ITP and no other trigger was documented. The Special Master found respondent's arguments regarding gradual onset and chronicity unpersuasive, noting fluctuations in platelet counts and that chronicity does not preclude vaccine causation. The Special Master found the pharyngitis diagnosis insufficient to establish it as the sole cause, rejecting statistical likelihood alone and noting no treating physician linked it to the ITP. The Special Master concluded petitioner proved by a preponderance of the evidence that the MMR vaccine caused M.R.'s ITP. Entitlement was granted pending damages. Attorneys: David John Carney (Petitioner), Benjamin Patrick Warder (Respondent). Special Master: Daniel T. Horner. Decision Date: August 25, 2025.","is_death":0,"date_of_death":null,"petition_filed_date":"2020-07-29","case_summary":"On April 27, 2020, Mayra Del Bosque, as the parent and natural guardian of M.R., a minor, filed a petition under the National Childhood Vaccine Injury Act. The petition alleged that M.R. suffered immune thrombocytopenic purpura (ITP) caused-in-fact by vaccinations received on November 7, 2017, including the measles, mumps, and rubella (MMR) vaccine. Petitioner counsel was David John Carney of Green & Schafle LLC, and respondent counsel was Benjamin Patrick Warder of the U.S. Department of Justice. Special Master Daniel T. Horner presided over the case. The parties did not dispute that M.R. suffered ITP, but they disagreed on the timing of symptom onset. In a prior ruling on October 12, 2023, the Special Master found that abnormal bruising was the first symptom of M.R.'s ITP, with onset occurring no earlier than 31 days and within 42 days post-vaccination. This timing meant the case did not qualify for the Vaccine Injury Table's presumption for ITP, which requires onset between 7-30 days post-vaccination for the MMR vaccine. Consequently, the case proceeded under the \"causation-in-fact\" standard, requiring petitioner to prove a medical theory connecting the vaccine and injury, a logical sequence of cause and effect, and a proximate temporal relationship (the Althen analysis). Respondent conceded that the MMR vaccine can cause ITP and that the elevated risk persists for up to 42 days, satisfying the first and third Althen prongs. The dispute centered on the second prong: whether there was a logical sequence of cause and effect implicating the MMR vaccine. Respondent argued that M.R.'s ITP was atypical for vaccine-caused ITP, citing an insidious and gradual decrease in platelet levels, chronicity, and the presence of pharyngitis diagnosed on December 8, 2017, as a more likely cause. Respondent's expert, Dr. Strouse, suggested that vaccine-caused ITP typically involves a sudden decrease in platelets and is usually self-limiting, resolving within weeks to months. Dr. Strouse also pointed to the pharyngitis as a potential cause, noting that short-term decreases in neutrophils and platelets can be seen with viral suppression. Petitioner argued that M.R.'s clinical course supported a logical sequence of cause and effect, supported by her expert, Dr. Ghose, who opined that the MMR vaccine caused M.R.'s ITP and that no other triggering event was documented. Petitioner contended that respondent's arguments regarding gradual onset and chronicity were not persuasive, noting that respondent acknowledged that 10% of ITP patients have chronic disease and that the six-month severity requirement for compensation does not preclude chronic cases. Petitioner also argued that the pharyngitis diagnosis was vaguely described and not attributed to M.R.'s ITP by treating physicians. The Special Master found that respondent's arguments regarding the onset and chronicity of M.R.'s ITP were not persuasive. The Special Master noted that the medical records did not clearly indicate the speed of M.R.'s platelet drop and that the Rajantie study cited by respondent had limitations. The Special Master also found that the chronicity of M.R.'s ITP did not distinguish it from vaccine-related ITP, citing respondent's own expert's acknowledgment of chronic ITP after MMR vaccination in some cases. Regarding the pharyngitis, the Special Master found that it was not sufficiently established as a sole cause, noting that \"pharyngitis\" simply indicates a sore throat and that respondent's expert relied on a syllogism that viral infections often cause ITP. The Special Master concluded that petitioner proved by a preponderance of the evidence that M.R.'s ITP was caused-in-fact by the MMR vaccination. A separate order for damages will be issued.","is_minor_inferred":null,"is_pediatric_broad":1,"special_master":"Daniel T. Horner","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"David John Carney","petitioner_attorney_firm":"Green & Schafle, LLC","petitioner_attorney_location":"Philadelphia, PA","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|david-carney|","firm_canonical_key":"green-and-schafle","package_title":"DEL BOSQUE v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00503","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00503.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00503.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_20-vv-00503-0","title":"DEL BOSQUE v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC ORDER/RULING (Originally filed: 10/12/2023) regarding 47 Findings of Fact & Conclusions of Law. Signed by Special Master Daniel T. Horner. (sh) Service on parties made.","date_issued":"2023-11-06","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_20-vv-00503/granules/USCOURTS-cofc-1_20-vv-00503-0/pdf","pdf_bytes":348313,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'findings of fact'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_20-vv-00503/USCOURTS-cofc-1_20-vv-00503-0"},{"granule_id":"USCOURTS-cofc-1_20-vv-00503-1","title":"DEL BOSQUE v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC ORDER/RULING (Originally filed: 7/29/2025) regarding 67 Ruling on Entitlement. Signed by Special Master Daniel T. Horner. (ksb) Service on parties made.","date_issued":"2025-08-25","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_20-vv-00503/granules/USCOURTS-cofc-1_20-vv-00503-1/pdf","pdf_bytes":288700,"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_20-vv-00503/USCOURTS-cofc-1_20-vv-00503-1"}]}