{"package_id":"USCOURTS-cofc-1_20-vv-01150","decision_granule_id":"USCOURTS-cofc-1_20-vv-01150-0","petitioner_identifier":"H.V.L.","is_minor":1,"age_at_vaccination":1.0,"age_unit_raw":"years","vaccine_type":"MMR","vaccination_date":"2018-09-10","condition_raw":"thrombocytopenic purpura","condition_category":"other","autism_spectrum_adjacent":0,"outcome":"denied","award_amount_usd":null,"decision_date":"2023-12-15","extraction_version":"gemini-v2","extracted_at":"2026-04-30T01:16:54.152825+00:00","number_of_concurrent_vaccines":3,"dose_number":null,"time_to_onset_days":21,"theory_of_causation":"Petitioner alleged that H.V.L., a minor, suffered a Table injury, specifically thrombocytopenic purpura (ITP), after receiving the MMR vaccine on September 10, 2018, or alternatively, that the MMR, hepatitis A, and varicella vaccines caused H.V.L.'s ITP. The core issue was whether H.V.L.'s injury met the National Childhood Vaccine Injury Act's six-month severity requirement. Medical records indicated ITP onset around October 1, 2018, with fluctuating platelet counts. Petitioner argued the injury and associated activity restrictions persisted until April 1, 2019, exceeding six months post-vaccination. Respondent contended the injury resolved by February 4, 2019, when H.V.L.'s platelet count reached 149,000, which is above current diagnostic thresholds for ITP (typically <100,000/mm³). The Special Master, Herbrina Sanders, found Petitioner failed to prove the six-month duration by preponderant evidence, citing medical literature and the Vaccine Injury Table's qualifications, and found insufficient evidence of residual effects from activity restrictions. The petition was denied. Petitioner's counsel: Michael A. London. Respondent's counsel: Lauren Kells.","is_death":0,"date_of_death":null,"petition_filed_date":"2020-09-04","case_summary":"On September 4, 2020, Brett Van Leer-Greenberg, as father and natural guardian of his minor child H.V.L., filed a petition alleging that H.V.L. suffered a Table injury, specifically thrombocytopenic purpura (ITP), after receiving the measles, mumps, and rubella (MMR) vaccine on September 10, 2018. The petition alternatively alleged that H.V.L.'s ITP was caused-in-fact by the MMR, hepatitis A, and varicella vaccines received on the same date. The primary issue was whether H.V.L.'s alleged injury lasted for at least six months following vaccination, as required by the National Childhood Vaccine Injury Act. \n\nH.V.L. was born on September 5, 2017. On October 1, 2018, approximately three weeks after vaccination, H.V.L. presented with worsening bruising and petechiae, leading to a diagnosis of ITP with a platelet count of 7,000. He was admitted to the hospital and treated with intravenous immunoglobulin (IVIG), which improved his platelet count to 18,000. He was discharged on October 3, 2018, with a platelet count of 18,000, noted as rising. Subsequent follow-ups with pediatric hematologist-oncologist Dr. Shipra Kaicker showed fluctuating platelet counts, with a low of 28,000 on October 16, 2018, and a rise to 52,000 by October 25, 2018. Dr. Kaicker advised monitoring and watchful waiting, with restrictions on NSAIDs, head trauma, and additional vaccines. \n\nFollow-up platelet counts with pediatrician Dr. Rebecca Farber showed a gradual increase: 45,000 on November 5, 2018; 62,000 on November 14, 2018; 79,000 on November 26, 2018; 94,000 on December 10, 2018; and 118,000 on January 3, 2019. H.V.L. received other vaccines on January 2, 2019. On February 4, 2019, H.V.L.'s platelet count was 149,000. On February 28, 2019, he presented with a buccal laceration and bruise after a fall, with bleeding that stopped quickly. Dr. Farber noted his platelet count was close to 200,000 and that his ITP was improving, with no other bruising or bleeding observed. On March 11, 2019, his platelet count was not explicitly noted, but ITP was no longer listed in the diagnosis section of his record. On April 1, 2019, H.V.L.'s platelet count was 150,000. \n\nPetitioner argued that H.V.L.'s ITP and associated activity restrictions lasted until April 1, 2019, which would be more than six months post-vaccination. Respondent contended that H.V.L.'s platelet count of 149,000 on February 4, 2019, indicated resolution of the ITP, as current medical literature defines ITP with a threshold of less than 100,000 platelets/mm³. The Special Master considered medical literature defining ITP, noting that the International Working Group (IWG) proposed a threshold of less than 100 x 10^9/L for diagnosis, and that the Vaccine Injury Table's qualifications define ITP with a platelet count less than 50,000/mm³ along with clinical manifestations. \n\nThe Special Master found that Petitioner failed to provide preponderant evidence that H.V.L.'s ITP lasted for at least six months. The platelet count of 149,000 on February 4, 2019, was considered inconsistent with ITP based on current medical literature. The letters from treating physicians, Dr. Farber and Dr. Kaicker, suggesting resolution around April 1, 2019, were given less weight, particularly Dr. Farber's, whose expertise in hematology was unclear and whose letter contained phrasing similar to a sample letter provided by Petitioner. The Special Master also found insufficient evidence that activity restrictions constituted a residual effect that lasted for six months, noting that the medical records did not consistently document these restrictions or their lifting, and that H.V.L. received vaccinations in January and March 2019, suggesting restrictions were not in place for the entire six-month period. \n\nUltimately, the Special Master determined that Petitioner did not meet the six-month severity requirement of the National Childhood Vaccine Injury Act. The petition was denied. Petitioner's counsel was Michael A. London. Respondent's counsel was Lauren Kells. Special Master was Herbrina Sanders.","is_minor_inferred":null,"is_pediatric_broad":1,"special_master":"Herbrina Sanders Young","petitioner_identifier_original":null,"caption_petitioner_name":null,"petitioner_attorney_name":"Michael Andrew London","petitioner_attorney_firm":"Douglas & London, P.C.","petitioner_attorney_location":"New York, NY","adjudicator_name":null,"caption_people_backfilled_at":null,"attorney_canonical_keys":"|michael-london|","firm_canonical_key":"douglas-and-london","package_title":"VAN LEER-GREENBERG v. SECRETARY OF HEALTH AND HUMAN SERVICES","canonical_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01150","plain_text_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01150.txt","json_url":"https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01150.json","source_documents":[{"granule_id":"USCOURTS-cofc-1_20-vv-01150-0","title":"VAN LEER-GREENBERG v. 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