E.A.F. v. HHS - MMR, immune thrombocytopenic purpura (ITP) (2024)
Case summary [AI summaries can sometimes make mistakes]
Stephanie and Ashton Felix, parents of E.A.F., a minor child, filed a petition under the National Vaccine Injury Compensation Program on August 19, 2021. E.A.F. received a measles-mumps-rubella (MMR) vaccine on August 6, 2018, at approximately 2.8 years of age.
Approximately two weeks later, E.A.F. developed symptoms of immune thrombocytopenic purpura (ITP), characterized by bruising and a significantly low platelet count of 7,000/mm³. E.A.F. was hospitalized and received intravenous immune globulin (IVIg) treatment, which increased his platelet count to 20,000/mm³ after one dose.
The discharge summary noted a diagnosis of ITP and mild anemia, and recommended holding vaccines for at least six months after IVIg and avoiding rough play. Subsequent platelet counts on August 24, 2018, were 140,000/mm³ (with a note of potential clumping), followed by counts between 72,000/mm³ and 117,000/mm³ through October 18, 2018.
On October 22, 2018, a pediatric hematology-oncology fellow assessed E.A.F. as having a stable platelet count and improving iron deficiency anemia, with a plan to avoid live vaccines for 6-12 months and no rough play while thrombocytopenic. Platelet counts thereafter rose to 166,000/mm³ on November 5, 2018, 225,000/mm³ on December 12, 2018, and 301,000/mm³ on April 1, 2019.
The petition alleged that E.A.F. suffered residual effects and complications from the ITP lasting more than six months. The petitioners presented medical records and sworn statements from family members and their pediatrician, Dr.
Sarah Giguere, arguing that restrictions on physical activity and delayed vaccinations constituted ongoing medical care and residual effects. The respondent, the Secretary of Health and Human Services, moved to dismiss the claim, arguing that the ITP had resolved within six months and that the alleged restrictions were not medically directed or necessary.
Chief Special Master Brian H. Corcoran granted the motion to dismiss on April 29, 2024, finding that the petitioners failed to establish the statutory severity requirement, as E.A.F.'s condition resolved well within six months and there was insufficient evidence of medically directed ongoing restrictions.
Special Master Corcoran noted that the medical records did not document any ongoing restrictions after E.A.F.'s platelet count normalized, and that Dr. Giguere's later statement appeared to endorse a course of conduct after the fact rather than describe real-time medical instructions.
The Special Master also found that alleged psychological distress and vaccine restrictions did not satisfy the severity requirement, citing Wright v. Secretary of Health & Human Services.
This decision was reviewed by Judge Armando O. Bonilla of the Court of Federal Claims, who sustained the Special Master's dismissal on August 14, 2024, agreeing that the evidence did not demonstrate residual effects lasting more than six months, particularly in light of the Federal Circuit's decision in Wright v.
Secretary of Health & Human Services, which clarified that ongoing monitoring and precautionary measures do not necessarily constitute residual effects. The case was ultimately dismissed for failure to meet the severity requirement.
Petitioners were represented by John Leonard Shipley, and Respondent was represented by Mallori Browne Openchowski. The Special Master was Brian H.
Corcoran, and the reviewing judge was Armando O. Bonilla.
Theory of causation
Petitioners alleged that E.A.F., a 2.8-year-old child, developed immune thrombocytopenic purpura (ITP) after receiving an MMR vaccine on August 6, 2018. The ITP was characterized by a low platelet count and bruising, requiring hospitalization and IVIg treatment. The petition alleged residual effects and complications lasting more than six months. The Special Master, Brian H. Corcoran, dismissed the claim, finding that the ITP resolved within six months, as evidenced by normalized platelet counts by November 5, 2018, and that there was insufficient evidence of medically directed ongoing physical activity restrictions or other residual effects. The Court of Federal Claims, Judge Armando O. Bonilla, sustained the dismissal, agreeing that the evidence did not meet the six-month severity requirement under the Vaccine Act, citing Wright v. Secretary of Health & Human Services, which held that ongoing monitoring and precautionary measures like avoiding rough play while thrombocytopenic or delaying vaccinations due to IVIg treatment do not constitute residual effects. Petitioners were represented by John L. Shipley, and Respondent by Mallori B. Openchowski.