{"package_id":"USCOURTS-cofc-1_20-vv-01067","decision_granule_id":"USCOURTS-cofc-1_20-vv-01067-2","petitioner_identifier":"Kristen Coons","is_minor":0,"age_at_vaccination":36.0,"age_unit_raw":"years","vaccine_type":"Td","vaccination_date":"2019-06-23","condition_raw":"small fiber neuropathy","condition_category":"small_fiber_neuropathy","autism_spectrum_adjacent":0,"outcome":"compensated","award_amount_usd":144627,"decision_date":"2024-10-15","extraction_version":"gemini-v2","extracted_at":"2026-04-30T01:16:28.994926+00:00","number_of_concurrent_vaccines":1,"dose_number":4,"time_to_onset_days":3,"theory_of_causation":"Petitioner Kristen Coons, age 36, received a Td vaccine on June 23, 2019. She alleged developing small fiber neuropathy. Petitioner's experts, Dr. David Axelrod (immunologist) and Dr. Mitchell Miglis (neurologist), opined that the Td vaccine caused her small fiber neuropathy through molecular mimicry. They theorized that similarities between amino acid sequences in the tetanus and diphtheria toxoids and small nerve fiber receptors (such as TRPV1, CASPR2, sodium channels, and nicotinic receptors) triggered an autoimmune response targeting Petitioner's small nerve fibers. They cited literature suggesting small fiber neuropathy can be a variant of Guillain-Barré Syndrome (GBS), for which molecular mimicry is a known mechanism, and that Td vaccines have been associated with GBS. They also noted Petitioner had a prior Tdap vaccine in 2013, suggesting a secondary immune response to the 2019 Td vaccine, with symptom onset three days post-vaccination, which they deemed a medically acceptable timeframe for such a response. Respondent's expert, Dr. Thomas Leist (neurologist), argued against causation, stating there was no literature linking Td vaccine to small fiber neuropathy, that the three-day onset was too short, and that Petitioner had alternative causes such as vitamin B12 deficiency and rabies vaccinations. Special Master Nora Beth Dorsey found Petitioner established a sound and reliable medical theory of causation (molecular mimicry), a logical sequence of cause and effect, and a proximate temporal relationship (onset within three days), satisfying the Althen standard. The Special Master found the theory of molecular mimicry analogous to GBS and supported by the evidence of homology and literature. The Special Master determined the three-day onset was medically acceptable for a secondary immune response. Petitioner was awarded $144,627.10, including $130,000.00 for pain and suffering, $14,055.08 for lost earnings, and $572.02 for expenses.2 for expenses.2 for expenses.2 for expenses.2 for unreimbursable expenses.","is_death":0,"date_of_death":null,"petition_filed_date":"2020-08-25","case_summary":"On August 25, 2020, Kristen Coons filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging a severe neurological injury following a tetanus diphtheria toxoid (Td) vaccination administered on June 23, 2019. The respondent, the Secretary of Health and Human Services, argued against compensation. The parties stipulated to resolve entitlement through a ruling on the record. Petitioner presented medical records and expert reports from Dr. David Axelrod and Dr. Mitchell Miglis, who opined that the Td vaccine caused her condition through molecular mimicry, an autoimmune response triggered by similarities between vaccine components and nerve fibers. Respondent's expert, Dr. Thomas Leist, contended that the Td vaccine is not known to cause small fiber neuropathy, that the three-day onset was too short, and that Petitioner had other pre-existing conditions that could explain her symptoms. Special Master Nora Beth Dorsey, in a ruling dated March 29, 2024, found that Petitioner had provided preponderant evidence that her Td vaccine caused her neurological condition, small fiber neuropathy, satisfying the Althen standard for causation. The Special Master determined that Petitioner established a sound and reliable medical theory of causation (molecular mimicry), a logical sequence of cause and effect, and a proximate temporal relationship between the vaccination and the onset of symptoms. On October 15, 2024, the parties submitted a proffer on damages, agreeing to a total award. Special Master Dorsey issued a decision on October 15, 2024, awarding Kristen Coons a total of $144,627.10. This amount included $130,000.00 for pain and suffering, $14,055.08 for past and future lost earnings, and $572.02 for past unreimbursable expenses. The award was to be paid as a lump sum.","is_minor_inferred":0,"is_pediatric_broad":0,"special_master":"Nora Beth Dorsey","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"Andrew Donald Downing","petitioner_attorney_firm":"Downing, Allison & Jorgenson","petitioner_attorney_location":"Phoenix, AZ","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|andrew-downing|","firm_canonical_key":"downing-allison-and-jorgenson","package_title":"COONS v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01067","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01067.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01067.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_20-vv-01067-0","title":"COONS v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 5/19/2022) regarding 55 DECISION of Special Master - Interim Attorney's Fees. Signed by Special Master Nora Beth Dorsey. (mca) Service on parties made.","date_issued":"2022-06-24","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"fees-only decision (attorney compensation)","download_status":"skipped"},{"granule_id":"USCOURTS-cofc-1_20-vv-01067-1","title":"COONS v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC ORDER/RULING (Originally filed: 3/29/2024) regarding 98 Ruling on Entitlement. Signed by Special Master Nora Beth Dorsey. (kis) Service on parties made. Modified on 4/23/2024 to update docket text (ypb).","date_issued":"2024-04-23","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_20-vv-01067/granules/USCOURTS-cofc-1_20-vv-01067-1/pdf","pdf_bytes":497013,"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-01067/USCOURTS-cofc-1_20-vv-01067-1"},{"granule_id":"USCOURTS-cofc-1_20-vv-01067-2","title":"COONS v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 10/16/2024) regarding 118 DECISION Stipulation/Proffer. Signed by Special Master Nora Beth Dorsey. (aevw) Service on parties made.","date_issued":"2024-11-12","pdf_url":"https://api.govinfo.gov/packages/USCOURTS-cofc-1_20-vv-01067/granules/USCOURTS-cofc-1_20-vv-01067-2/pdf","pdf_bytes":361191,"triage_decision":"keep","triage_reason":"docketText matches keep keyword 'stipulation'","download_status":"ok","registry_pdf_url":"https://vicp-registry.org/pdf/USCOURTS-cofc-1_20-vv-01067/USCOURTS-cofc-1_20-vv-01067-2"},{"granule_id":"USCOURTS-cofc-1_20-vv-01067-3","title":"COONS v. SECRETARY OF HEALTH AND HUMAN SERVICES","docket_text":"PUBLIC DECISION (Originally filed: 01/17/2025) regarding 125 DECISION of Special Master - Fees. Signed by Special Master Nora Beth Dorsey. (kp) Service on parties made.","date_issued":"2025-04-04","pdf_url":null,"pdf_bytes":null,"triage_decision":"skip","triage_reason":"fees-only decision (attorney compensation)","download_status":"skipped"}]}