VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00786
Package ID: USCOURTS-cofc-1_21-vv-00786
Petitioner: Kathryn Alexander
Filed: 2021-01-22
Decided: 2025-02-25
Vaccine: pneumococcal conjugate vaccine
Vaccination date: 2018-01-26
Condition: shoulder injury related to vaccine administration (“SIRVA”), and chronic left shoulder pain
Outcome: dismissed
Award amount USD: 

AI-assisted case summary:
Kathryn Alexander, born in 1973, received a pneumococcal conjugate vaccine (Prevnar 13) on January 26, 2018. She alleged that this vaccine caused a shoulder injury related to vaccine administration (SIRVA) and chronic left shoulder pain. Her Table claim for SIRVA was dismissed because the evidence did not support that her pain and limited range of motion were confined to the vaccinated shoulder, and there were other potential explanations for her symptoms, such as ankylosing spondylitis and cervical radiculopathy. The court noted that her left shoulder showed normal range of motion when examined and that her symptoms radiated beyond the shoulder to her arm, neck, and jaw. The decision also highlighted that her medical records indicated other conditions, like cervical radiculopathy, which is an exclusionary diagnosis for SIRVA under the Table criteria. The court dismissed the Table SIRVA claim and ordered Petitioner to show cause by March 14, 2025, why her off-Table claim should not be dismissed for insufficient proof and failure to prosecute, requiring her to file outstanding medical records related to a motor vehicle accident, dermatology, and neurology.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00786-0
Date issued/filed: 2025-02-25
Pages: 11
Docket text: PUBLIC ORDER/RULING (Originally filed: 01/14/2025) regarding 60 Findings of Fact & Conclusions of Law,, Order to Show Cause, Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00786-UNJ Document 61 Filed 02/25/25 Page 1 of 11
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0786V
KATHRYN ALEXANDER, Chief Special Master Corcoran
Petitioner,
v. Filed: January 14, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Mark Theodore Sadaka, Law Offices of Sadaka Associates, LLC, Englewood, NJ, for
Petitioner.
Austin Joel Egan, U.S. Department of Justice, Washington, DC, for Respondent.
(I) FINDINGS OF FACT AND CONCLUSIONS OF LAW DISMISSING TABLE CLAIM
AND (II) ORDER TO SHOW CAUSE1
Kathryn Alexander alleges that she suffered a “shoulder injury related to vaccine
administration (“SIRVA”), and chronic left shoulder pain, that were either ‘caused-in-
fact’… or significantly aggravated by” a pneumococcal conjugate vaccine (“PCV,” or
“Prevnar 13”) received on January 26, 2018. Petition filed Jan. 22, 2021 (ECF No. 1) at
Preamble.2 The claim was assigned to the Special Processing Unit (the “SPU”) in May
2022 (ECF No. 23). After Petitioner filed additional medical records, Respondent
completed his review and advised that he would defend against the claim. Rule 4(c)
Report filed Sept. 13, 2024 (ECF No. 59). No further filings have been received.
1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required
to post it on the United States Court of Federal Claims' website in accordance with the E-Government Act
of 2002. 44 U.S.C. § 3501 note (2012) (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), Petitioner has 14 days to identify and move to redact medical or other information,
the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I agree that
the identified material fits within this definition, I will redact such material from public access.
2 See also Amended Petition filed Aug. 23, 2022 (ECF No. 30) (adding citations to additionally obtained
medical records but alleging the same injury); but see PAR Questionnaire filed Nov. 12, 2021 (ECF No. 30)
at 1 (listing a vaccine injury of “cervical radiculopathy and exacerbation of chronic pain syndrome”).

Case 1:21-vv-00786-UNJ Document 61 Filed 02/25/25 Page 2 of 11
Because the record does not support the conclusion that Petitioner’s injury was
limited to the vaccinated shoulder, and reveals the existence of potentially more likely
explanations (specifically ankylosing spondylitis (“AS”) and cervical radiculopathy (“CR”)),
her Table SIRVA claim must be DISMISSED. To the extent she wishes to proceed with a
causation-in-fact claim, Petitioner must demonstrate that sufficient record evidence to
support such a claim has been filed.
I. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). Compensation may not be awarded “based on the claims of a petitioner
alone, unsubstantiated by medical records or by medical opinion.” Section 13(a)(1). A
special master must consider, but is not bound by, any diagnosis, conclusion, judgment,
test result, report, or summary concerning the nature, causation, and aggravation of
petitioner’s injury or illness that is contained in a medical record. Section 13(b)(1).
“Medical records, in general, warrant consideration as trustworthy evidence. The records
contain information supplied to or by health professionals to facilitate diagnosis and
treatment of medical conditions. With proper treatment hanging in the balance, accuracy
has an extra premium. These records are also generally contemporaneous to the medical
events.” Cucuras v. Sec’y of Health & Hum. Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. In Lowrie, the special master wrote that “written records which
are, themselves, inconsistent, should be accorded less deference than those which are
internally consistent.” Lowrie, 2005 WL 6117475, at *19.
The United States Court of Federal Claims has recognized that “medical records
may be incomplete or inaccurate.” Camery v. Sec’y of Health & Hum. Servs., 42 Fed. Cl.
381, 391 (1998). The Court later outlined four possible explanations for inconsistencies
between contemporaneously created medical records and later testimony: (1) a person’s
failure to recount to the medical professional everything that happened during the relevant
time period; (2) the medical professional’s failure to document everything reported to her
or him; (3) a person’s faulty recollection of the events when presenting testimony; or (4)
a person’s purposeful recounting of symptoms that did not exist. La Londe v. Sec’y of
Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013), aff’d, 746 F.3d 1335 (Fed. Cir.
2014).
2

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The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery, 42 Fed.
Cl. at 391 (citing Blutstein v. Sec’y of Health & Hum. Servs., No. 90-2808, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The credibility of the individual
offering such testimony must also be determined. Andreu v. Sec’y of Health & Hum.
Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Hum. Servs.,
991 F.2d 1570, 1575 (Fed. Cir. 1993).
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing § 12(d)(3); Vaccine Rule 8); see also Burns v. Sec’y of
Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within the special
master’s discretion to determine whether to afford greater weight to medical records or to
other evidence, such as oral testimony surrounding the events in question that was given
at a later date, provided that such determination is rational).
Beyond severity and other requirements concerning the vaccination received, and
the lack of other award or settlement, see Section 11(c)(1)(A), (B), (D), and (E), a
petitioner must establish that he or she either suffered an injury meeting the Table criteria,
in which case causation is presumed, or an injury shown to be caused-in-fact by the
vaccination she received. Section 11(c)(1)(C).
The most recent version of the Vaccine Injury Table, which can be found at 42
C.F.R. § 100.3, identifies the vaccines covered under the Program, the corresponding
injuries, and the time period in which the particular injuries must occur after vaccination.
Pursuant to the Table, a SIRVA is compensable if it manifests within 48 hours of the
administration of a covered vaccine. 42 C.F. R. § 100.3(a). The criteria establishing a
SIRVA under the accompanying Qualifications and Aids to Interpretation (“QAI”) are as
follows:
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
3

Case 1:21-vv-00786-UNJ Document 61 Filed 02/25/25 Page 4 of 11
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g., NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
If the petitioner’s injury does not fit within a Table listing, the petitioner must prove
that the administered vaccine was the cause in fact of the injury. Section 11(c)(1)(C)(ii)
and (iii). In such circumstances, petitioner asserts a “non-Table or [an] off-Table” claim
and to prevail, petitioner must prove the claim by preponderant evidence. Section
13(a)(1)(A). This standard is “one of . . . simple preponderance, or ‘more probable than
not’ causation.” Althen v. Sec’y of Health & Human Servs., 418 F.3d 1274, 1279-80 (Fed.
Cir. 2005) (referencing Hellebrand v. Sec’y of Health & Human Servs., 999 F.2d 1565,
1572-73 (Fed. Cir. 1993). The Federal Circuit has held that to establish an off-Table injury,
petitioners must “prove . . . that the vaccine was not only a but-for cause of the injury but
also a substantial factor in bringing about the injury.” Shyface v. Sec’y of Health & Human
Servs., 165 F.3d 1344, 1351 (Fed. Cir 1999). The received vaccine, however, need not
be the predominant cause of the injury. Id.
II. Record Evidence
• Petitioner was born in 1973. All medical encounters discussed herein occurred in
the Portland, Oregon metropolitan area. As Respondent discusses in the Rule 4(c)
Report at 2 - 4, Petitioner’s medical history included a traumatic brain injury (“TBI”)
4

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in 2015, CR,3 and AS.4 In May 2016, an x-ray of Petitioner’s sacroliliac (“SI”) joints
found mild sclerosis, Ex. 2 at 335 – 36. In June 2016, X-rays of her spine found
scoliosis, moderate C5-C7 degenerative disc disease, and loss of normal cervical
lordosis – but no evidence of spondylarthritis. Ex. 3 at 35. Also in June 2016, HLA-
B27 testing was positive. Ex. 4 at 553. In August 2016, Petitioner received steroid
injections in both hips, and started taking the anti-TNF medication Humira
(adalimumab) to treat her diagnosed AS. Ex. 3 at 91 – 95, 116, 123.
• Petitioner received the at-issue Prevnar 13 vaccine in her left deltoid on January
26, 2018. Ex. 4 at 1; Ex. 3 at 298. The vaccination occurred during a rheumatology
appointment for management of her AS. Ex. 3 at 298. During that appointment,
Petitioner reported that she had recently lost her job, enrolled in a state-sponsored
health insurance plan, and had been unable to fill her Humira prescription. Id. at
301. She also reported a six to seven-week history of itching and rash on both
arms, and additional symptoms of muscle pain, aches, and cramps; joint pain; back
pain; and neck pain. Id. The rheumatologist reauthorized Petitioner’s prescription
for Humira. Id.
• At a February 9, 2018, primary care appointment, Petitioner complained of a
persistent rash. Ex. 2 at 255 (noting: “saw dermatology recently, they noted rash,
suspected contact dermatitis”). She also reported “acute on [sic?] chronic neck
pain and left deltoid pain” after her vaccination; the arm was “sore, hurts with yoga,
and she [was] worried about a reaction.” Id. A physical examination found a rash
on both arms; left deltoid tenderness to palpation; full range of motion (“ROM”);
and no weakness. Id. Robert E. Morgan, D.O., wrote the ”left deltoid pain” was
lasting longer than expected, but Petitioner should try gentle exercise and follow
up if it did not improve. Id.
• On February 23, 2018, Petitioner telephoned her rheumatologist reporting post-
vaccination left arm “nerve-type pain,” stiffness, weakness, numbness, and
tingling. Ex. 3 at 318.
3 Radiculopathy is defined as “disease of the nerve roots, such as from inflammation or impingement by a
tumor or a bony spur.” Dorland's Medical Dictionary Online (hereinafter “Dorland’s”),
https://www.dorlandsonline.com/dorland/definition?id=42742 (last accessed Jan. 10, 2025).
4 Ankylosing spondylitis is “a chronic multisystem inflammatory disorder associated with the presence of
HLA-B27 antigen, and thus one of the group of seronegative spondyloarthropathies; it usually initially affects
the sacroiliac joints and often later involves other joints of the axial skeleton and peripheral joints, causing
pain and progressive stiffness and restricted range of motion. Extra-skeletal manifestations include ocular,
pulmonary, cardiovascular, renal, and neurologic complications.” Dorland's,
https://www.dorlandsonline.com/dorland/definition?id=107826&searchterm=ankylosing+spondylitis (last
accessed Jan. 10, 2025).
5

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• Petitioner was scheduled for a March 2, 2018 rheumatology appointment – at
which time she recounted: “Ha[ving] a bruise from the vaccine, but then afterward
had a deep pain creeping up into her shoulder. Couldn’t put weight on the arm.
However, after a few days the pain subsided. However, now has tingling in the
area of the shoulder that radiates down the arm, has a numb arm in the middle of
the night. Tingling also radiates to the neck. Pain even radiates to the jaw.” Ex. 3
at 324. Physical examination found slightly decreased sensation at the deltoid, full
ROM of the left shoulder with minimal pain on full abduction, and a positive
Spurling test.5 Id. at 325. The rheumatologist believed that the “arm numbness/
tingling… symptoms are most consistent with cervical radiculopathy [CR].” Id. at
326. Agreeing with Petitioner’s preference for conservative treatment, the
rheumatologist prescribed gabapentin; offered a physical therapy referral;6 and “if
there is no improvement after 4 – 6 weeks would consider imaging or EMG.” Id.7
• On March 8, 2018, a dermatologist opined that Petitioner did not have signs of a
primary dermatologic process, and proposed instead that her rash was more likely
secondary to picking and scratching at her skin. Ex. 14 at 93. The “[d]istribution of
symptoms [was] most suggestive of brachioradial pruritis, which is… a neuropathic
problem. Given her history of neck/spine symptoms, this makes sense.” Id.
Petitioner also complained of pain and numbness in her vaccinated arm – but she
had tolerated her first dose of gabapentin well, and no corresponding exam
findings, diagnosis, or additional treatment plan was noted in the dermatology
record. Id. at 92 – 93.
• On March 14, 2018, the PCP Dr. Morgan recorded Petitioner’s complaint of “pain
significantly worse in the neck lately… located midline lower neck… also has
significant discomfort in her neck muscles trapezius and ‘rotator cuff.’” Ex. 2 at 269.
The PCP’s examination found tenderness to palpation over the cervical spine and
the bilateral paraspinal, trapezius, rotator cuff, and biceps tendon muscles. Id. at
270. The PCP assessed this complaint as AS “of multiple sites in spine.” Id. at 268.
He ordered x-rays of the spine which showed mild to moderate degenerative disc
5 In a Spurling test, “the examiner presses down on the top of the head while the patient rotates the head
laterally and into hyperextension; pain radiating into the upper limb ipsilateral to a rotation position of the
head indicates radiculopathy.”
Dorland’s, https://www.dorlandsonline.com/dorland/definition?id=112983&searchterm=Spurling%20test
(last accessed Jan. 10, 2025).
6 As noted below, Petitioner did not start PT until it was authorized by a different provider in May 2018.
7 As noted below, Petitioner’s next communication with her rheumatologist occurred in May 2018, but her
subsequent rheumatology appointment occurred in April 2019. Those records do not describe an ongoing
post-vaccination injury. Additionally, Petitioner never underwent imaging or EMG of the left upper extremity.
6

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disease. Id. at 337. Additionally, the PCP concurred with the dermatologist’s
assessment of the rash as representing brachioradial pruritis. Id. (noting that “a
review of the literature suggests that this may be due to cervical spine
neuropathy”). Id. at 268. Finally, the PCP believed that Petitioner’s new complaints
of blurry vision and photophobia could represent uveitis (another condition
associated with AS). Id.
• On April 4, 2018, the dermatologist suggested that Petitioner undergo an MRI of
the cervical spine to evaluate for “an anatomic issue creating compression of the
brachioradial nerves.” Ex. 14 at 77, 79. But on April 26, 2018, a neurologist8
deferred an MRI because her “neck pain and pruritis [were…] adequately treated
with gabapentin.” Id. at 82.
• On May 7, 2018, Petitioner reported that her pruritis was much better with
increased gabapentin. Ex. 2 at 284. But given her history of AS, a brain injury, x-
ray findings of cervical disc degeneration, and “severe cervical radiculopathy,” the
PCP Dr. Morgan decided to obtain an MRI of the cervical spine. Id.
• A May 16, 2018, MRI of Petitioner’s cervical spine found multi-level degenerative
disc disease, facet arthropathy, and foraminal narrowing. Ex. 2 at 338.
• On May 22, 2018, Petitioner telephoned her rheumatologist, reporting that her
Humira dosage was not working, and that she wanted to “inject before it’s time to.”
Ex. 3 at 347. She was offered a June 20th appointment, id., which did not occur.
• Petitioner was referred9 to PT for a diagnosis of cervicalgia and a goal of treating
cervical pain. Ex. 13 at 1. At the May 30, 2018, PT initial evaluation, Petitioner
reported her previous TBI and AS, and that “In Jan she had a flu shot and her pain
seemed to worsen after that time. The pain is in the neck and upper traps and
much worse on the L side with tingling and itching into the LUE. Around that time,
she also lost her job and insurance and had to go off Humira…” Ex. 13 at 3.
Physical examination found restricted and painful ROM throughout the neck and
cervical spine. Id. at 3 – 4. ROM was “unremarkable” at the left shoulder, and full
but somewhat painful at the right shoulder. Id. at 4. The therapist assessed
Petitioner with a “recent worsening of chronic neck pain,” id. at 5, and provided
formal therapy (including instruction on home exercises) 1 – 2 times per week. Id.
8 This neurologist was treating Petitioner after past concerns of seizures. See Rule 4(c) Report at 4 (internal
citations omitted).
9 As noted below, the records from this referring physician, named at Ex. 14 at 1, do not appear to have
been filed.
7

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At the last sessions in July 2018, she reported worsened “left-sided numbness and
tingling,” as well as worsened tightness in her upper trapezius and scalene
muscles. Id. at 13, 14.
• Next, on August 23, 2018, Petitioner had a primary care appointment with resident
Stephanie L. Frana, M.D. Ex. 2 at 314. Petitioner reported ongoing pruritis. Id. at
315. She also requested an updated PT referral to address, in addition to her neck
pain, “L shoulder pain since getting a pneumonia vaccination in January 2018.
Shoulder has tingling nerve pain and feels like ‘sand is being poured’ through her
shoulder.” Id. The physical examination findings were normal except for
“excoriations along R [right] arm,” with no specific reference to the left shoulder.
Id. at 316. But Dr. Frana updated the PT authorization as requested. Ex. 13 at 24.
• Petitioner has not cited any further medical records addressing an ongoing vaccine
injury or her overall medical status. See Amended Petition at ¶¶ 12 – 13.
• In contrast, Respondent has observed that the November 2018 PT evaluation
again documented pain in the neck, as opposed to the vaccinated left shoulder.
Rule 4(c) Report at 8, citing Ex. 13 at 31. And subsequent medical records
documented new right-sided shoulder pain (in February 2019); bilateral carpal
tunnel syndrome (with tendon releases in October and December 2020); and
ongoing pain, numbness and hypersensitivity throughout her body. The differential
diagnoses included ongoing brachioradial pruritis; AS; cervical radiculopathy;
and/or fibromyalgia. See generally Rule 4(c) Report at 8 – 13 (internal citations
omitted). Therefore, Respondent avers that Petitioner only had “fleeting” post-
vaccination left deltoid pain – and any ongoing symptoms “appear to be part of a
larger disease affecting many parts of Petitioner’s body.” Id. at 15.
• My own review of the later medical records identified that during an August 2019
rheumatology appointment, Petitioner declined another vaccination because she
“had a bad arm problem with neurological pain during the PCV13 vaccine.” Ex. 4
at 267. But that was not documented as an ongoing concern in August 2019, see
id. at 263 – 267, or in any other medical records from my review.
• I have also reviewed Petitioner’s recollections of developing left arm soreness and
pain within hours of vaccination, and “stiffness, weakness, numbing, and tingling
in [her] arm” by two weeks post-vaccination. Ex. 9 at ¶¶ 7 – 8. Petitioner recalls
that her pain “went away” during her initial PT course (in May – July 2018), but she
“could not fully use [her] left arm” later that summer, she requested additional PT
for her shoulder in August 2018. Id. at ¶¶ 13 – 15. Petitioner describes “being able
to adjust [her] way of doing things, so [she] does not feel too much pain in her [left]
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shoulder” and that in August 2021, she had ”recently start[ed] physical therapy in
hopes of strengthening both shoulders.” Id. at ¶ 16 (emphasis added)
III. Table SIRVA Dismissal
Petitioner’s Table SIRVA claim is not feasible because she cannot establish the
third QAI requirement of “pain and reduced range of motion [that] are limited to the
shoulder in which the intramuscular vaccine was administered.” 42 C.F.R. §
100.3(c)(10)(iii). Instead, the site of vaccination at the deltoid muscle was painful for
several weeks. Ex. 2 at 255. But within one month post-vaccination, Petitioner’s injury
had evolved to include “nerve-type pain” as well as stiffness, weakness, numbness, and
tingling throughout her left arm – radiating to her neck, and at times extending to her jaw.
Ex. 3 at 318, 324. And subsequent medical examinations and assessments tended to
focus on “neck” pain which was bilateral, even if “worse” on the left side. See, e.g., Ex. 2
at 269 – 270; Ex. 14 at 77, 79, 82; Ex. 13 at 3. Petitioner’s request for additional PT to
address a purportedly ongoing left shoulder injury is not borne out in the medical records.
Compare Ex. 2 at 314 (Petitioner’s report) with id. at 316 (physical examination findings
during the same encounter) and Ex. 13 at 31 (PT reevaluation record).
Moreover, when it was examined, Petitioner’s left shoulder displayed normal ROM.
See, e.g., Ex. 2 at 255; Ex. 3 at 325; Ex. 13 at 4. This is an additional Table requirement
under 42 C.F.R. § 100.3(c)(iii), see Bolick v. Sec’y of Health & Hum. Servs., No. 20-
0893V, 2023 WL 8187307, at *8 (Fed. Cl. Spec. Mstr. Oct. 19, 2023). For these reasons,
the third QAI criteria cannot be met.
Petitioner also has not carried her burden to rule out “other condition[s] or
abnormalit[ies] that would explain [her] symptoms.” 42 C.F.R. § 100.3(c)(10)(iv). The
condition or abnormality must qualify as an explanation for the symptoms a petitioner is
experiencing, but need not be a better or more likely explanation. Durham v. Sec’y of
Health & Hum. Servs., No. 17-1899V, 2023 WL 3196229, at *13 – 14 (Fed. Cl. Spec.
Mstr. Apr. 7, 2023). This Table element does not impose on Respondent the obligation to
prove an “alternative cause” for the injury, but instead merely that the record contains
sufficient evidence of a competing explanation to “muddy” a finding that vaccine
administration was the cause.
In this case, Respondent argues that any post-vaccination left arm and neck pain
“appear[s] to be part of a larger disease affecting many parts of Petitioner’s body.” Rule
4(c) Report at 14. And when discussing Petitioner’s post-vaccination arm and neck pain,
treating medical providers tended to discuss Petitioner’s AS and CR – the latter of which
is specifically listed as an exclusionary diagnosis in the Table. See, e.g., Ex. 3 at 236; Ex.
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2 at 268; Ex. 13 at 1, 5. The later medical records, discussed in Respondent’s Rule 4(c)
Report at 8 – 13, illustrate the ongoing complexity of her medical picture. Overall, this is
a case with “significant and potentially confounding neurologic signs and symptoms
[which is] better addressed on a causation-in-fact basis.” Durham, 2023 WL 3196229, at
*14.
Accordingly, Petitioner’s Table SIRVA claim is DISMISSED.
IV. Order to Show Cause
I recognize that this Petition was filed without supporting medical records at a time
when Respondent was proposing to remove SIRVA from the Vaccine Injury Table, and
thus the filing of the matter with insufficient record proof in support may reflect a good
faith effort to preserve any possible Table SIRVA claim. Nevertheless, the subsequently-
obtained medical records demonstrate that no such claim is feasible. Accordingly, the
only avenue left for success would be an off-Table causation-in-fact or significant
aggravation claim.
If Petitioner wishes to proceed in such a manner, however, she must ensure that
the evidentiary record is complete. To that end, she shall specifically obtain and file
certified and complete copies of any outstanding and/or updated medical records –
specifically addressing the following categories:
• Records stemming from a motor vehicle accident, and from several later
emergency room and urgent care encounters. See Rule 4(c) Report at n. 1, 4
– 9.
• Dermatology records from at least one year pre-vaccination to the present. See
Ex. 14 at 92 (scanned record of dermatology appointment, which references a
prior appointment on Feb. 3, 2018).
• Neurology records. See Ex. 2 at 284 and Ex. 4 at 126 (PCP’s referral to a
specific specialist); Ex. 13 at 1 (reflecting that specialist’s referral to PT).
Petitioner will be afforded one further opportunity to bolster her claim – but she
should take this task seriously. Petitioner’s failure to respond to this or other orders issued
in this action, as well as failure to file required supporting evidence, will be interpreted as
a failure to prosecute resulting in dismissal of Petitioner’s claim. Tsekouras v. Sec’y of
Health & Hum. Servs., 26 Cl. Ct. 439 (1992), aff’d, 991 F.2d 810 (Fed. Cir. 1993) (per
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curiam); Sapharas v. Sec’y of Health & Hum. Servs., 35 Fed. Cl. 503 (1996); Vaccine
Rule 21(b).
Accordingly, by no later than Friday, March 14, 2025, Petitioner shall show
cause why her off-Table claim should not be dismissed for insufficient proof and
failure to prosecute. Petitioner shall specifically file the outstanding medical records
discussed herein, followed by a supplemental Statement of Completion, and a Status
Report confirming whether or not she wishes to proceed with an off-Table claim.
If Petitioner states that the evidentiary record is complete, but she wishes to
proceed with an off-Table claim, the matter will very likely be transferred out of the SPU
– in light of the case’s age and the complexities discussed herein.
In the alternative, if Petitioner wishes to exit the Vaccine Program, counsel shall
file the appropriate motion, Stipulation, or Notice. See
https://www.uscfc.uscourts.gov/vaccine-sample-filings.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
11