VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_22-vv-01269
Package ID: USCOURTS-cofc-1_22-vv-01269
Petitioner: Alan Correira
Filed: 2021-08-27
Decided: 2025-06-03
Vaccine: influenza
Vaccination date: 2019-09-20
Condition: Guillain-Barre syndrome (GBS)
Outcome: denied
Award amount USD: 

AI-assisted case summary:
On August 27, 2021, Alan Correira filed a petition alleging that an influenza vaccine administered on September 20, 2019 caused Guillain-Barre syndrome. The public decision identifies him as an adult petitioner but does not state his exact age.

Mr. Correira underwent prostate surgery with nitrous oxide on October 1, 2019. His first neurologic complaints were documented on November 23, 2019, when he reported six days of bilateral upper-extremity numbness and tingling beginning November 18. Early examinations were largely unremarkable, but symptoms progressed in December to facial weakness, abnormal gait, absent reflexes, decreased sensation, difficulty swallowing and breathing, and elevated CSF protein. Treating physicians considered GBS or a variant; EMG/NCS later showed neuropathy with demyelinating and axonal components, and he was treated with a five-day IVIG course.

Petitioner relied on Dr. Norman Latov, a Weill Cornell neurologist, who proposed molecular mimicry or bystander activation and argued the 57-to-59-day onset interval remained medically acceptable. Respondent disputed causation. Chief Special Master Corcoran accepted that influenza vaccine can cause GBS generally, but denied compensation because timing failed Althen prong three. He found the contemporaneous records showed onset on November 18, 2019, 59 days after vaccination, outside both the Table period and the medically acceptable non-Table risk interval. Because timing was dispositive, he did not need to resolve every aspect of prong two. No compensation was awarded.

Theory of causation field:
Influenza vaccine September 20, 2019; alleged GBS in adult petitioner. DENIED. First documented symptom onset November 18, 2019 (59 days): paresthesias progressing in December to facial weakness, gait abnormality, absent reflexes, swallowing/breathing complaints, elevated CSF protein, abnormal EMG/NCS, and IVIG treatment. Petitioner expert Dr. Norman Latov proposed molecular mimicry/bystander activation; CSM Corcoran accepted flu vaccine can cause GBS generally but found onset too late for Table or non-Table causation. Decision June 3, 2025; no award. Petition filed August 27, 2021.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_22-vv-01269-0
Date issued/filed: 2025-07-08
Pages: 10
Docket text: PUBLIC DECISION (Originally filed: 06/03/2025) regarding 28 DECISION of Special Master Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-1269V
UNPUBLISHED
ALAN CORREIRA, Chief Special Master Corcoran
Petitioner, Filed: June 3, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
James Vincent Lopez, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION1
On August 27, 2021, Alan Correira filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleges that he received an influenza (“flu”) vaccine on
September 20, 2019, and thereafter suffered Guillain-Barré syndrome (“GBS”) that was
caused in fact by the vaccination. Amended Petition at 1. The case was assigned to the
Special Processing Unit of the Office of Special Masters. For the reasons discussed
below, this claim is hereby DISMISSED.
1 Because this unpublished fact 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 fact 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 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for ease
of citation, all section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 2 of 10
I. Procedural History
After the claim’s initiation, Petitioner filed an amended petition with citations to the
record. Amended Petition (“petition”), ECF No. 18. Respondent filed a Rule 4(c) Report
opposing compensation, arguing Petitioner has not provided a medical or scientific
showing that the vaccination caused his alleged GBS. Respondent’s Rule 4(c) Report
(“Res. Rep”) ECF No. 21, at 1. Petitioner was ordered to show cause why this case should
not be dismissed. ECF No. 24. The order noted that onset of Petitioner’s GBS appeared
to have occurred outside the longest time accepted for a non-table flu/GBS claim. Id.
Petitioner filed his response and additional evidence on September 12, 2023.
Petitioner’s Response to the Court’s August 1, 2023 Show Cause Order (“Pet. Res.”),
ECF No. 27. Petitioner argues that he has established a prima facie case for causation.
Id. at 22-31.
II. Fact History
a. Medical Records
Petitioner received a flu vaccine on September 20, 2019. Ex. 1 at 1. Ten days later,
he underwent prostate surgery that involved nitrous oxide. Ex. 8 at 6 (noting that Petitioner
had prostate surgery on October 1, 2019).
On November 23, 2019, Petitioner sought care at the emergency department. Ex.
7 at 5-8. He complained of numbness and tingling in his bilateral upper extremities that
began on November 18, 2019, and “[c]onstant sensation for the past 6 days.” Id. A
physical exam was unremarkable, and he was diagnosed with bilateral upper extremity
neuropathy. Id.
On November 26, 2019, Petitioner saw his primary care physician, Dr. Irvin, for a
follow-up. Ex. 2 at 26-27. He reported numbness in his upper extremities, feet, tongue,
and lips, but denied weakness. Id. Petitioner also stated that his symptoms had improved
over the past three days, but were still present. Id. An examination showed normal gait,
and no motor or sensory deficits. Petitioner was assessed with paresthesia of unclear
etiology. Id.
Petitioner saw Dr. Leber, a neurologist, on November 27, 2019, for numbness in
his forearms, tongue, and left foot. Ex. 8 at 6. He stated that on November 18, 2019, he
woke with his hands and forearms feeling cold and somewhat numb. Id. He also reported

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 3 of 10
the prostate surgery on October 1, 2019, which Dr. Leber noted could cause myelopathy
in patients with previous anemia. Id. A neurologic exam was “basically unremarkable,”
but he recorded a slight Bell’s palsy of the left eyelid and mild absent sensation in the
right foot. Id. at 7. Dr. Leber noted that due to the sudden onset of numbness, “one has
to think of cervical myelopathy or cervical issues.” Id. at 7-8. A subsequent MRI was
unremarkable. Id. 15-16. Additionally, his B12 and folic acid were within normal limits. Id.
at 10.
Petitioner returned to Dr. Leber on December 6, 2019, reporting recent onset of
stumbling, slurring speech and tingling in his face and scalp. Ex. 8 at 10. Dr. Leber noted
there was “no objective abnormality on examination, other than residual from previous
left Bell’s palsy.” Id. He also stated he could not explain the described subjective sensory
symptoms, and prescribed alprazolam for his anxiety. Id.
Later on December 6, 2019, Petitioner was seen at the emergency department for
increased left facial droop that started that morning. Ex. 3 at 32. He was diagnosed with
Bell’s palsy. Id. at 35-36. Three days later, on December 9, 2019, Petitioner saw his
primary care physician. Ex. 9 at 9. A physical and neurologic examination was
unremarkable, but he was referred to a neurologist for a second opinion. Id. at 10.
Petitioner returned to the emergency department on December 12, 2019,
complaining of numbness throughout his body, upper extremity pain, dizziness, and
difficulty walking that started just prior to his arrival. Ex. 4 at 575. He showed left sided
facial droop, absent bilateral reflexes, and an abnormal gait. Id. at 578. A lumbar puncture
showed elevated protein levels. Id. at 752. The admitting physician noted that Petitioner
“had a flu shot back in September. Question progressive [GBS] versus Lambert-Eaton
syndrome.” Id. at 403.
An addendum from December 13, 2019, states that Petitioner reported only
subjective symptoms, and no objective abnormalities could be observed. But Dr.
Khademi, a neurologist, could not rule out the possibility of an autoimmune neuropathy,
“[i]n this case [GBS], predominantly sensory variant….” Ex. 4 at 1451. Dr. Khademi also
noted that the nadir of the weakness is usually 3-4 weeks from onset. Id. at 1451, 416.
Petitioner was discharged on December 14, 2019, with possible diagnoses including GBS
and Labert-Eaton syndrome, an autoimmune neurological condition. Ex. 7 at 9-10.
A follow-up on December 16, 2019, with Dr. Irvin included a suspected diagnoses
of the “predominantly sensory form” of GBS. Ex. 2 at 30-31. Petitioner saw Dr. Khademi
for a second opinion on December 20, 2019. Ex. 5 at 9-10. An examination showed
absent reflexes, left peripheral facial weakness, impaired gait, reduced sensation, but

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 4 of 10
normal motor strength. Id. He was assessed with inflammatory polyneuropathy and
possible GBS. Id.
On December 21, 2019, Petitoiner returned to the emergency department for
worsening paresthesia, and trouble breathing and swallowing. Ex. 4 at 1052. He exhibited
decreased sensation in his trunk and chest, decreased grip strength, left sided facial
droop, and absent reflexes. Id. at 1055. The differential diagnosis included GBS versus
variant, a more chronic condition such as chronic demyelinating syndrome, and Eaton-
Lambert syndrome. Id.
Petitioner saw another neurologist, Dr. Huntley, on December 21, 2019, reporting
a five-week history of progressive weakness. Ex. 4 at 836. An examination showed
“wildly” uncontrolled ambulation and absent reflexes. Id. at 837. He was assessed with
paresthesia, dysphagia, a history of Bell’s palsy with gait disorder. Id. at 837. Dr. Huntley
also noted that he had “a hard time piecing this all together. The patient tells me Dr.
Khademi was ordering IVIG, but it had not been set up yet…. I am wondering if he really
needs IVIG.” Id. at 837-38. Results from an EMG/NCS on December 24, 2019 were
consistent with neuropathy with demyelinating and axonal components “in the family of
GBS.” Id. at 386. Dr. Huntley noted this was a “[f]ascinating case, a lot of overly but at
the core [Petitioner] has [GBS].” Id. at 850.
Petitioner underwent a five-day course of IVIG, and was discharged on December
26, 2019. Ex. 4 at 79. Thereafter, Petitioner’s symptoms improved. Ex. 2 at 37 (follow-up
on December 30, 2019 stating symptoms have improved since his discharge); Ex. 9 at
12 (record from March 20, 2020, stating that Petitioner has improved approximately 80%).
By May 20, 2020, he reported some residual numbness but also significant improvement
to Dr. Vasquez, a neurologist. Ex. 6 at 8. Dr. Vasquez noted he had no flu-like symptoms
before onset, no diarrhea, but he “did have a flu shot in September of last year.” Ex. 6 at
8.
b. Affidavit Evidence
Petitioner submitted an affidavit in support of his claim on March 6, 2023. Ex. 12.
Petitioner states that he received a flu vaccine on September 20, 2019. Id. at 1. He began
experiencing numbness in his hands in November of 2019, although he could not recall
the precise onset date. Id. Additionally, he states that he “did experience worsening
symptoms for at least one week before seeking care….” Id.

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 5 of 10
c. Expert Report
Petitioner submitted an expert report from Dr. Norman Latov, M.D., Ph.D (“Ex.
Rep.), dated July 24, 2023. Dr. Latov attended the University of Pennsylvania to complete
his medical and doctorate degree. Ex. 15 at 1. He completed his residency in neurology
and immunology at Columbia University and is now on the faculty at Weill Cornell
Medicine. Id. at 3. Dr. Latov directs a peripheral neuropathy center as well as serving as
a professor of neurology and neuroscience, and being an attending neurologist. Id., Ex.
Rep. at 2. In his clinical practice he has “devoted a substantial portion … to the evaluation,
diagnosis, and treatment of patients with peripheral neuropathies including Guillain–Barré
syndrome (GBS) chronic inflammatory demyelinating polyneuropathy (CIDP). Id.
Dr. Latov opined that that vaccines can induce autoimmune disease such as GBS
through molecular mimicry or bystander activation. Ex. Rep. at 5-6. Both molecular
mimicry and bystander activation have been accepted by the Institute of Medicine
(“IOM”)10 as possible explanations for post-vaccination adverse events. Id. (citing
INSTITUTE OF MEDICINE, ADVERSE EFFECTS OF VACCINES: EVIDENCE AND
CAUSALITY 57 (Stratton et al. eds., 2012) [hereinafter 2012 IOM Report] (Ex. 25)).3 By
Dr. Latov's description “[m]olecular mimicry occurs when there is a structural homology,
in sequence or conformation, between an exogenous agent, such as a vaccine or
infection, and a self or autoantigen that is subsequently targeted by the immune response.
Induction of immune reactivity against the foreign agent results in cross reactivity with the
self-antigen, with subsequent tissue damage and autoimmune disease.” Id. at 6.
Regarding bystander activation, he observes that the normal immune state incudes auto-
reactive cells that are suppressed by immune tolerance, thereby preventing autoimmune
3 The Institute of Medicine (known as the National Academy of Medicine since 2015) is the medical arm of
the National Academy of Sciences. The National Academy of Sciences (“NAS”) was created by Congress
in 1863 to be an advisor to the federal government on scientific and technical matters (see An Act to
Incorporate the National Academy of Sciences, ch. 111, 12 Stat. 806 (1863)), and the Institute of Medicine
is an offshoot of the NAS established in 1970 to provide advice concerning medical issues. When it enacted
the Vaccine Act in 1986, Congress directed that the IOM conduct studies concerning potential causal
relationships between vaccines and illnesses. See § 300aa–1. However, the IOM employs a standard for
finding causation that is higher than what is required by petitioner's burden of proof. E.g. Raymo v. Sec'y
of Health & Hum. Servs., No. 11-654V, 2014 WL 1092274, at *21, n. 39 (Fed. Cl. Spec. Mstr. Feb. 24,
2014). Accordingly, IOM reports and findings should be approached with caution. Special Masters may rely
on IOM reports as evidence, but they are not dispositive. See, e.g., Crutchfield v. Sec'y Health & Hum.
Servs., 125 Fed. Cl. 251, 262 (2014) (noting that “it was appropriate for the special master to consider the
medical literature presented, including the IOM report” and that “the court often has relied on the findings
of the Institute of Medicine.”); see also, Isaac v. Sec'y Health & Hum. Servs., 108 Fed. Cl. 743, 755 (2013),
aff'd, 540 Fed. Appx. 999 (Mem.) (Fed. Cir. 2013) (affirming the special master's reliance on findings of the
IOM); Porter v. Sec'y Health & Hum. Servs., 663 F.3d 1242, 1252 (Fed.Cir.2011) (noting the special
master's comment that “IOM reports are favored, although not dispositive, in the Vaccine Act Program,”
then affirming the special master's decision).

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 6 of 10
disease. Bystander activation occurs when infection or immunization stimulate the
immune system in such a way as to overcome that immune tolerance. Id.
In petitioner's case, Dr. Latov observed, GBS most likely developed on or around
November 16, 2019, or 57-59 days post vaccination. Ex. Rep. at 7. According to Dr. Latov,
this is within the time period of elevated risk for developing GBS due to a vaccine. Id. To
support this conclusion, Dr. Latov cited a study that examined incidences of GBS
following a 1976 program for vaccination against the swine flu. Id. That study found that
most post-vaccination GBS cases occurred within five weeks of vaccination, but also
observed an increased risk lasting up to nine or ten weeks. L. Schonberger et al., Guillain-
Barré Syndrome Following Vaccination in the National Influenza Program, United States,
1976-77, 110 Am. J. Epid. 2:105-123 (1979), filed as Ex. 13.
Additionally, Dr. Latov concluded it is logical that Petitioner developed GBS as a
consequence of his vaccination. Ex. Rep. at 8. And he noted that there were no other
potential causes identified that could have triggered his GBS. Id.
III. Legal Standard
Before compensation can be awarded under the Vaccine Act, a petitioner must
demonstrate, by a preponderance of evidence, all matters required under Section
11(c)(1), including the factual circumstances surrounding his claim. Section 13(a)(1)(A).
In making this determination, the special master or court should consider the record as a
whole. Section 13(a)(1). Petitioner’s allegations must be supported by medical records or
by medical opinion. Id.
To resolve factual issues, the special master must weigh the evidence presented,
which may include contemporaneous medical records and testimony. See Burns v. Sec'y
of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (explaining that a special
master must decide what weight to give evidence including oral testimony and
contemporaneous medical records). 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, the Federal Circuit has recently “reject[ed] as incorrect the
presumption that medical records are always accurate and complete as to all of the
patient’s physical conditions.” Kirby v. Sec'y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021). Medical professionals may not “accurately record everything” that
they observe or may “record only a fraction of all that occurs.” Id.
In addition to requirements concerning the vaccination received, the duration and

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 7 of 10
severity of petitioner’s injury, and the lack of other award or settlement,4 a petitioner
must establish that he suffered an injury meeting the Table criteria (i.e. a Table injury),
in which case causation is presumed, or an injury shown to be caused-in-fact by the
vaccination she received. If a petitioner cannot establish a Table injury, he or she may
pursue causation-in-fact under the legal standard set forth in Althen v. Sec'y of Health
& Human Servs., 418 F. 3d 1274, 1278 (Fed. Cir. 2005): “(1) a medical theory causally
connecting the vaccination and the injury; (2) a logical sequence of cause and effect
showing that the vaccination was the reason for the injury; and (3) a showing of
proximate temporal relationship between vaccination and injury.”
The association between the flu vaccine and GBS is well-established in the
Vaccine Program. See, e.g., Strong v. Sec'y of Health & Human Servs., No. 15-1108V,
2018 WL 1125666 (Fed. Cl. Spec. Mstr. Jan. 12, 2018); Stitt v. Sec'y of Health & Human
Servs., No. 09-653V, 2013 WL 3356791 (Fed. Cl. Spec. Mstr. May 31, 2013); Stewart
v. Sec'y of Health & Human Servs., No. 06-777V, 2011 WL 3241585, at *16 (Fed. Cl.
Spec. Mstr. July 8, 2011); see also Barone v. Sec'y of Health & Human Servs., No. 11-
707V, 2014 WL 6834557 (Fed. Cl. Spec. Mstr. Nov. 12, 2014). Indeed, GBS was added
in 2017 as a Table Claim for the flu vaccine (although this case does not involve such
a claim). See 42 C.F.R. § 100.3(a). Accordingly, my resolution of Petitioner's claim does
not turn on a finding, under Althen prong one, that (for purposes of adjudicating a
Program claim) the flu vaccine “can cause” GBS, for that question has been thoroughly
examined and answered in the affirmative.
There are nevertheless limits to the kinds of fact patterns that successfully
establish that the flu vaccine “did cause” a particular petitioner's GBS under the second
Althen prong. In most successful non-Table cases, onset of symptoms is demonstrated
to have occurred no longer than six to eight weeks after vaccination. See, e.g., Barone,
2014 WL 6834557, at *13 (eight weeks is the longest reasonable timeframe for a
flu/GBS injury). This means up to 56 days.
4 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories; suffered the residual effects of his injury for more than six
months, died from his injury, or underwent a surgical intervention during an inpatient hospitalization; and
has not filed a civil suit or collected an award or settlement for his injury. See § 11(c)(1)(A)(B)(D)(E).

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 8 of 10
IV. Petitioner's GBS Onset Occurred Too Long After His Receipt of the Flu
Vaccine to Satisfy the Third Althen Prong5
Petitioner asserts that he is entitled to compensation because he has established
a prima facie case that his injury was caused-in-fact by the flu vaccine and has satisfied
the Althen prongs. Pet. Res. at 23-31. The following factual findings are made after a
complete and thorough review of the record, including all medical records, affidavits,
and all other additional evidence and filings from the parties.6
The third Althen prong requires establishing a “proximate temporal relationship”
between the vaccination and the injury alleged. Althen, 418 F.3d at 1281. A petitioner
must offer “preponderant proof that the onset of symptoms occurred within a timeframe
for which, given the medical understanding of the disorder's etiology, it is medically
acceptable to infer causation.” Bazan v. Sec'y of Health & Human Servs., 539 F.3d 1347,
1352 (Fed. Cir. 2008).
In this case, Petitioner’s expert frames his discussion of onset in reference to a
study examining an outbreak of GBS following administration of the 1976 swine flu
vaccine – Schonberger, et al., (Ex. 14 at 6 (citing Schonberger). The medical literature
offered in this case establishes that a reasonable timeframe for onset of GBS after
vaccine administration would be no more than six to eight weeks, however. Schonberger
at 105. Specifically, Schonberger indicates that most GBS cases after the flu vaccine that
it evaluated occurred around 13-17 days, with their latest happening 41 days. Id. at 112.
This is echoed by the timeframe set for the Table version of the claim (see 42 C.F.R. §
100.3 (2017)). (It is in fact arguably the case that any onsets that exceed the 3-42 day
timeframe are suspect from a medical/scientific standpoint, since the onset timeframe is
specifically engineered to be over-inclusive, rather than to reflect a precise framework in
which a vaccine can, or cannot, cause injury).
5 As already noted, I do not include an extended discussion of the first Althen prong (which Petitioner
effectively satisfied). I also do not engage in an extended Althen prong two analysis, given my determination
that the timeframe for onset of Petitioner's GBS was too remote from vaccination to be deemed medically
reasonable. See, e.g., Hunt v. Sec'y of Health & Human Servs., 123 Fed. Cl. 509, 524-25 (2015) (citing
Veryzer v. Sec'y of Health & Human Servs., 100 Fed. Cl. 344, 355-56, aff'd, 475 F. App'x 765 (Fed. Cir.
2012) ). However, I note that the record does not conclude that the flu vaccine “did cause” Petitioner's GBS.
His symptoms do not reflect the manner in which GBS most commonly would progress. He initially reported
no motor or sensory deficits, showed some improvements shortly after reporting numbness, and exhibited
little objective abnormalities prior to December 6, 2019.
6 Though every document is not specifically referenced in this ruling, the complete record was reviewed and
considered. See Moriarty ex rel. Moriarty v. Sec’y of Health & Human Servs., 844 F.3d 1322, 1328 (Fed.
Cir. 2016) (“We generally presume that a special master considered the relevant record evidence even
though he does not explicitly reference such evidence in his decision.”).

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 9 of 10
Here, contemporaneous medical records preponderantly establish that the initial
symptoms of Petitioner’s GBS did not occur before November 18, 2019, 59 days after
his vaccination. Thus, when he presented to the hospital on November 23, 2019,
Petitioner complained of numbness and tingling in his extremities that began on
November 18, 2019, and had “[c]onstant sensation” for the past six days. Ex. 7 at 5-8.
He repeated this timeline on November 27, 2019. Ex. 8 at 6. This evidence outweighs
the record interpretation proposed by Dr. Latov for a slightly earlier onset (and I am not
obligated to accept his ipse dixit on this point). Ex. 14 at 6 (arguing that Petitioner’s
symptoms began 57-59 days after vaccination).
Measuring from the September 20, 2019 vaccination, then, a Table version of the
claim in this case could only succeed if onset had occurred on or before November 1,
2019 – which clearly did not occur. But even a causation-in-fact claim would have needed
to be based on symptoms beginning no more than two weeks after – or by November 15,
2019, at the latest. This also did not occur.
These facts accordingly are inconsistent with even the longest timeframes (eight
weeks) accepted for a similar non-Table claims recognized in reasoned Program
decisions.7 See, e.g., Barone, 2014 WL 6834557, at *13. Petitioner’s onset thus occurred
far too long after vaccination to be considered “medically acceptable to infer causation-
in-fact.” See de Bazan, 539 F.3d at 1352; De La Cruz v. Sec'y of Health & Hum. Servs.,
No. 17-783V, 2018 WL 945834, at *1 (Fed. Cl. Jan. 23, 2018) (finding onset of GBS more
than two months after flu vaccination to be not compensable under either a theory of
causation in fact or significant aggravation).
7 Admittedly, other special masters have accepted a comparably-lengthy timeframe. See, e.g., Cooper v. Sec'y of
Health & Hum. Servs., No. 18-1885V, 2024 WL 1522331, at *20 (Fed. Cl. Mar. 12, 2024) (finding 60-day onset of GBS
following a vaccination allows inference of causation); Spayde v. Sec'y of Health & Hum. Servs., No. 16-1499V, 2021
WL 686682, at *19 (Fed. Cl. Jan. 27, 2021). But such decisions do not control this outcome. Moreover, they either
involve a different vaccine (for Cooper, the pneumococcal vaccine), or were based on reasoning that justified
stretching the eight-week timeframe a few days, in the interests of the Program’s emphasis on generosity and a
desire not to apply a hard, bright-line “rule.” Spayde, 2021 WL 686682, at *19. Of course, the proposed up-to-eight
weeks timeframe itself already exceeds the “rule” of the Table claim for the flu vaccine, and does not itself constitute
something that can be deemed accepted as a general matter. Moreover, this thinking reflects a logic whereby any
onset not shown to be facially impossible (say, more than 90 days) should be deemed medically acceptable. I do not
consider that kind of reasoning consistent with the science applicable to how vaccines are thought to cause GBS,
and it is not demanding scientific certainty to reject it.

Case 1:22-vv-01269-TMD Document 32 Filed 07/08/25 Page 10 of 10
Conclusion
The evidentiary record does not support Petitioner's contention that his GBS began
in a medically-acceptable timeframe after vaccination. Petitioner has thus not established
entitlement to a damages award, and therefore I must DISMISS his claim.
In the absence of a timely-filed motion for review (see Appendix B to the
Rules of the Court), the Clerk shall enter judgment in accordance with this
Decision.8
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
8 If Petitioner wishes to bring a civil action, he must file a notice of election rejecting the judgment pursuant
to § 21(a) “not later than 90 days after the date of the court’s final judgment.”

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DOCUMENT 2: USCOURTS-cofc-1_22-vv-01269-1
Date issued/filed: 2025-12-03
Pages: 12
Docket text: JUDGE VACCINE REPORTED OPINION (PUBLIC VERSION) of 37 Opinion and Order on Motion for Review. Signed by Judge Thompson M. Dietz. (sbp) Service on parties made.
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Case 1:22-vv-01269-TMD Document 38 Filed 12/03/25 Page 1 of 12
In the United States Court of Federal Claims
No. 22-1269
(Filed Under Seal: November 12, 2025)
(Reissued: December 3, 2025)1
**************************************
ALAN CORREIRA, *
*
Petitioner, *
*
v. *
*
SECRETARY OF HEALTH AND HUMAN *
SERVICES, *
*
Respondent. *
**************************************
Ronald C. Homer, with whom was Meredith Daniels, Conway, Homer, P.C., Boston, MA,
counsel for Petitioner.
James V. Lopez, U.S. Department of Justice, Civil Division, Washington, DC, counsel for
Respondent.
OPINION AND ORDER
DIETZ, Judge.
Petitioner Alan Correira seeks review of Chief Special Master (“CSM”) Brian Corcoran’s
decision denying him compensation under the National Childhood Vaccine Injury Act of 1986,
42 U.S.C. §§ 300aa-1 et seq. (“Act”). Mr. Correira alleges that he suffered from Guillain-Barré
Syndrome (“GBS”) because of an influenza (“flu”) vaccine. The CSM concluded that, because
the onset of Mr. Correira’s GBS symptoms fell outside a medically acceptable timeframe, his
illness was not caused in fact by the flu vaccine. Mr. Correira contends that the CSM’s decision
was arbitrary, capricious, or otherwise not in accordance with the law. The Court agrees.
Therefore, the Court GRANTS the petition, VACATES the decision, and REMANDS the case
for further action in accordance with this opinion.
1 Pursuant to Vaccine Rule 18(b) of the Rules of the United States Court of Federal Claims, the Court issued this
Opinion and Order under seal on November 12, 2025, and directed the parties to file a proposed public version of
this Opinion and Order on or before November 26, 2025. See [ECF 37]. The parties did not file a proposed public
version of the Opinion and Order, nor did they otherwise propose any redactions. Accordingly, the Court reissues
this Opinion and Order without redactions.

Case 1:22-vv-01269-TMD Document 38 Filed 12/03/25 Page 2 of 12
I. BACKGROUND2
On September 20, 2019, Mr. Correira received a flu vaccine. Correira v. Sec’y of Health
& Hum. Servs., No. 22-1269, 2025 WL 1892886, at *1 (Fed. Cl. June 3, 2025). On October 1,
2019, he underwent prostate surgery, during which he received nitrous oxide. Id. On November
23, 2019, sixty-four days after receiving the vaccine, Mr. Correira went to the Emergency
Department (“ED”), complaining of “numbness and tingling in his bilateral upper extremities.”
Id. Mr. Correira claimed these symptoms began on November 18, 2019, five days earlier. Id. He
was examined and “diagnosed with bilateral upper extremity neuropathy.” Id. Thereafter, on
November 26, 2019, Mr. Correira had a follow-up appointment with his primary care physician,
Dr. Irwin. Id. During that visit, Mr. Correira complained of “numbness in his upper extremities,
feet, tongue, and lips, but denied [any] weakness.” Id. He “also stated that his symptoms had
improved over the past three days, but were still present.” Id. He was examined and “assessed
with paresthesia of unclear etiology,” but his gait was deemed normal, and he did not display any
“motor or sensory deficits.” Id. The next day, Mr. Correira visited a neurologist, Dr. Leber. Id.
At that visit, Mr. Correira complained of “numbness in his forearms, tongue, and left foot,” and
“stated that on November 18, 2019, he woke with his hands and forearms feeling cold and
somewhat number.” Id. He also told Dr. Leber that he had undergone “prostate surgery on
October 1, 2019, which Dr. Leber noted could cause myelopathy in patients with previous
anemia.” Id. Dr. Leber conducted a neurologic exam and noted “a slight Bell’s palsy of the left
eyelid and mild absent sensation in the right foot.” Id. Additionally, Dr. Leber noted that given
the sudden onset of numbness, “one has to think of cervical myelopathy or cervical issues.” Id.
“A subsequent MRI was unremarkable,” and Mr. Correira’s “B12 and folic acid were within
normal limits.” Id.
On December 6, 2019, Mr. Correira again saw Dr. Leber. Correira, 2025 WL 1892886,
at *2. This time, although Mr. Correira complained of a “recent onset of stumbling, slurring
speech and tingling in his face and scalp,” Dr. Leber did not note any “objective abnormality on
examination, other than residual from previous left Bell’s palsy.” Id. Additionally, Dr. Leber did
not have an explanation for Mr. Correira’s “subject sensory symptoms.” Id. Dr. Leber
“prescribed alprazolam for his anxiety.” Id. Later that day, Mr. Correira returned to the ED,
complaining of “increased left facial droop that started that morning.” Id. There, he was
diagnosed with Bell’s palsy. Id.
On December 9, 2019, Mr. Correira returned to his primary care physician, who
examined him, found nothing remarkable, and then referred him to a neurologist. Correira, 2025
WL 1892886, at *2. Three days later, Mr. Correira returned once more to the ED. Id. This time,
he presented with “numbness throughout his body, upper extremity pain, dizziness, and difficulty
walking that started just prior to his arrival.” Id. The left side of his face was drooping, and he
displayed “absent bilateral reflexes, and an abnormal gait.” Id. Mr. Correira was given a lumbar
puncture, which “showed elevated protein levels.” Id. The admitting ED physician noted that Mr.
Correira had received a flu vaccine in September and questioned whether he had “progressive
[GBS] versus Lambert-Eaton syndrome.” Id. (alteration in original). Additionally, notes taken
the following day indicated that while Mr. Correira reported subjective symptoms, “no objective
2 The factual background is derived from the CSM’s decision. See Correira v. Sec’y of Health & Hum. Servs., No.
22-1269, 2025 WL 1892886 (Fed. Cl. June 3, 2025).
2

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abnormalities could be observed.” Id. A neurologist, Dr. Khademi, opined that he “could not rule
out the possibility [that Mr. Correira was suffering from] an autoimmune neuropathy” such as
GBS. Id. He “also noted that the nadir of the weakness [was] usually 3-4 weeks from onset.” Id.
On December 14, 2019, the ED discharged Mr. Correira “with possible diagnoses including GBS
and La[m]bert-Eaton syndrome, an autoimmune neurological condition.” Id.
On December 16, 2019, Mr. Correira followed up with Dr. Irvin, who suspected that he
had a “predominantly sensory form of GBS.” Correira, 2025 WL 1892886, at *2 (internal
quotation marks omitted). Four days later, Mr. Correira went to Dr. Khademi for a second
opinion. Id. Dr. Khademi examined Mr. Correira and noted that he presented with “absent
reflexes, left peripheral facial weakness, impaired gait, [and] reduced sensation, but [that he had]
normal motor strength.” Id. Dr. Khademi concluded that he had “inflammatory polyneuropathy
and possible GBS.” Id.
On December 21, 2019, Mr. Correira returned once more to the ED, complaining of
“worsening paresthesia, and trouble breathing and swallowing.” Correira, 2025 WL 1892886, at
*2. He presented with “decreased sensation in his trunk and chest, decreased grip strength, left
sided facial droop, and absent reflexes.” Id. He was alternatively diagnosed with “GBS versus
variant, a more chronic condition such as chronic demyelinating syndrome, and Eaton-Lambert
syndrome.” Id. While there, Mr. Correira saw another neurologist, Dr. Huntley, and told him that
he had experienced five weeks of “progressive weakness.” Id. Dr. Huntley noted that Mr.
Correira demonstrated “‘wildly’ uncontrolled ambulation and absent reflexes,” and assessed him
“with paresthesia, dysphagia, [and] a history of Bell’s palsy with gait disorder.” Id. Dr. Huntley
also indicated that he was unsure whether Mr. Correira required Intravenous Immunoglobulin
(“IVIG”), which Dr. Khademi had ordered but which had not yet been set up, and concluded that
“at the core [Mr. Correira] has [GBS].” Id. (second alteration in original). Mr. Correira received
“a five-day course of IVIG and was discharged on December 26, 2019.” Id. at *3. His symptoms
improved markedly after his discharge and on May 20, 2020, although “he reported some
residual numbness,” he also reported “significant improvement to Dr. Vasquez, a neurologist.”
Id.
On September 9, 2022, Mr. Correira sought compensation under the Act. Pet. for Vaccine
Compensation [ECF 1]. He amended his petition on March 6, 2023, alleging that he contracted
GBS from the flu vaccine. Am. Pet. for Vaccine Compensation [ECF 18] at 1.3 On August 1,
2023, because Mr. Correira’s “alleged first symptoms appeared outside of the longest time
accepted for a non-Table flu/GBS claim,” the CSM ordered Mr. Correira to show cause why his
claim should not be dismissed and to file any additional evidence. [ECF 24] at 1 (emphasis in
original). Thereafter, Mr. Correira filed a medical expert report and additional medical literature,
[ECF 25], and responded to the show cause order, [ECF 27]. On June 3, 2025, the CSM denied
Mr. Correira’s request for compensation and dismissed his claim. Correira, 2025 WL 1892886,
at *7. Mr. Correira sought review of the CSM’s decision on June 30, 2025. Pet’r’s Mot. for
Review [ECF 29]. The government responded on July 29, 2025, Resp. [ECF 33], and the Court
held oral argument on October 30, 2025.
3 All references to page numbers within documents filed electronically with the Court refer to the page numbers
generated by the CM/ECF system.
3

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II. STANDARD OF REVIEW
This Court has jurisdiction under the Act to review a special master’s decision. 42 U.S.C.
§ 300aa-12(e)(2). In reviewing a special master’s decision, this Court may:
(A) uphold the findings of fact and conclusions of law of the special
master and sustain the special master’s decision, (B) set aside any of
the findings of fact or conclusions of law of the special master found
to be arbitrary, capricious, and abuse of discretion, or otherwise not
in accordance with law and issue its own findings of fact and
conclusions of law, or (C) remand the petition to the special master
for further action in accordance with the court’s direction.
42 U.S.C. §§ 300aa-12(e)(2)(A)-(C).
This Court reviews a special master’s findings of fact under the “arbitrary and
capricious” standard, legal questions under the “not in accordance with law” standard, and
discretionary rulings under the “abuse of discretion” standard. Turner v. Sec’y of Health & Hum.
Servs., 268 F.3d 1334, 1337 (Fed. Cir. 2001). With respect to the arbitrary and capricious
standard, “no uniform definition . . . has emerged,” but it is “a highly deferential standard of
review” such that “[i]f the special master has considered the relevant evidence of record, drawn
plausible inferences and articulated a rational basis for the decision, reversible error will be
extremely difficult to demonstrate.” Hines v. Sec’y of Health & Hum. Servs., 940 F.2d 1518,
1527-28 (Fed. Cir. 1991); accord Motor Vehicle Mfrs. Ass’n of U.S., Inc. v. State Farm Mut.
Auto Ins. Co., 463 U.S. 29, 43 (1983) (a decision is arbitrary and capricious only if it is “so
implausible that it could not be ascribed to a difference in view”). The “not in accordance with
law” standard, on the other hand, is applied without deference to legal determinations such as
“[w]hether the special master applied the appropriate standard of causation . . . .” Deribeaux v.
Sec’y of Health & Hum. Servs., 717 F.3d 1363, 1366 (Fed. Cir. 2013). Lastly, the abuse of
discretion standard applies to the special master’s evidentiary rulings, such as determinations
regarding the qualification of experts and the admissibility of their testimony. Piscopo v. Sec’y of
Health & Hum. Servs., 66 Fed. Cl. 49, 53 (2005) (citing Kumho Tire Co. v. Carmichael, 526 U.S.
137, 152 (1999)).4
The United States Court of Appeals for the Federal Circuit has made it clear that special
masters, as the finders of fact, have the responsibility to weigh the persuasiveness and reliability
of evidence presented to them, and if appropriate, the credibility of testimony. Moberly v. Sec’y
of Health & Hum. Servs., 592 F.3d 1315, 1325 (Fed. Cir. 2010); see Terran v. Sec’y of Health &
Hum. Servs., 195 F.3d 1302, 1316 (Fed. Cir. 1999) (“[T]he rules of evidence require that the trial
judge determine whether the testimony has a reliable basis in the knowledge and experience of
[the relevant] discipline.” (internal quotation marks omitted) (second alteration in original)).
Further, the special masters have broad discretion in determining the credibility of witnesses and
weighing the evidence, and these credibility determinations are “virtually unreviewable” by the
4 “The [abuse of discretion standard] will rarely come into play except where the special master excludes evidence.”
Munn v. Sec’y of Health & Hum. Servs., 970 F.2d 863, 870 n.10 (Fed. Cir. 1992); accord Caves v. Sec’y of Health &
Hum. Servs., 100 Fed. Cl. 119, 131 (2011), aff’d, 463 F. App’x 932 (Fed. Cir. 2012).
4

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reviewing court. Bradley v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir.
1993). In other words, the reviewing court does not reweigh the evidence, assess whether the
special master correctly evaluated the evidence, or examine the probative value of the evidence
or the credibility of the witnesses because these matters are within the purview of the factfinder.
Broekelschen v. Sec’y of Health & Hum. Servs., 618 F.3d 1339, 1349 (Fed. Cir. 2010); accord
Loyd v. Sec’y of Health & Hum. Servs., No. 2022-1371, 2023 WL 1878572, at *2 (Fed. Cir. Feb.
10, 2023). As explained by the Federal Circuit, which applies the same standard of review, this
Court is highly deferential to the special masters’ factual determinations:
We review de novo decisions of the Claims Court arising under the
Vaccine Act, applying the same standard of review as the Claims
Court applied to its review of the special master’s decision. We owe
no deference to the Claims Court or the special master on questions
of law. We uphold the special master’s findings of fact unless they
are arbitrary or capricious. Thus, although we are reviewing as a
matter of law the decision of the Claims Court under a non-
deferential standard, we are in effect reviewing the decision of the
special master under the deferential and capricious standard on
factual issues. We do not reweigh the factual evidence, assess
whether the special master correctly evaluated the evidence, or
examine the probative value of the evidence or the credibility of the
witnesses—these are all matters within the purview of the fact
finder. Rather, as long as a special master’s finding of fact is based
on evidence in the record that [is] not wholly implausible, we are
compelled to uphold that finding as not being arbitrary or capricious.
It is not our role to second guess the Special Master[’]s fact-
intensive conclusions particularly in cases in which the medical
evidence of causation is in dispute.
Porter v. Sec’y of Health & Hum. Servs., 663 F.3d 1242, 1248-49 (Fed. Cir. 2011) (internal
citations and quotation marks omitted) (alterations in original); accord White v. Sec’y of Health
& Hum. Servs., 153 F.4th 1214, 1220 (Fed. Cir. 2025) (noting that while the Federal Circuit
reviews United States Court of Federal Claims’ decisions de novo, it applies the same legal
standards).
III. LEGAL STANDARDS
The Act was established to compensate individuals for a vaccine-related injury or death
after a showing that the vaccine caused that injury or death. 42 U.S.C. §§ 300aa-10(a)-13(a). The
Act provides two ways for a petitioner to establish causation. Munn, 970 F.2d at 865. First, a
petitioner may demonstrate causation through a statutorily prescribed presumption by showing
that the alleged injury meets the criteria listed on the vaccine injury table (“Table”). 42 U.S.C. §
300aa-14. Thus, in a Table case, “if a petitioner can establish that [he] received a listed vaccine
and experienced such symptoms or injuries within the specified timeframes, [he] has met [his]
prima facie burden to prove that the vaccine caused [his] injuries.” de Bazan v. Sec’y of Health &
Hum. Servs., 539 F.3d 1347, 1351 (Fed. Cir. 2008); accord Grant v. Sec’y of Health & Hum.
5

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Servs., 956 F.2d 1144, 1147 (Fed. Cir. 1992) (“The Table replaces traditional tort standards of
causation in fact with a causation in law based on temporal association.”). Alternatively, if a
petitioner suffered an injury listed on the Table but not within the specified time period or if a
petitioner suffered an “off-Table injury,” he must prove “causation-in-fact” by a preponderance
of the evidence.5 See 42 U.S.C. §§ 300aa-11(c)(1)(C)(ii); see also Broekelschen, 618 F.3d at
1341-42. “[C]ausation-in-fact in the Vaccine Act context is the same as ‘legal cause’ in the
general torts context.” de Bazan, 539 F.3d at 1351 (quoting Shyface v. Sec’y of Health & Hum.
Servs., 165 F.3d 1344, 1352 (Fed. Cir. 1999)). Thus, “the vaccine is a cause-in[-]fact when it is
‘a substantial factor in bringing about the harm.’” Id. (quoting Restatement (Second) of Torts
§ 431(a)).
In Althen v. Secretary of Health and Human Services, the Federal Circuit articulated the
following three-part test for demonstrating causation-in-fact:
[A petitioner must] show by preponderant evidence that the
vaccination brought about [the] injury by providing: (1) a medical
theory causally connecting the vaccination and the injury; (2) a
logical sequence of cause and effect showing that the vaccination
was the reason for the injury; and (3) a showing of a proximate
temporal relationship between vaccination and injury.
418 F.3d 1274, 1278 (Fed. Cir. 2005). “The third Althen factor—a proximate temporal
relationship between the vaccination and the injury—serves as a check on the first two factors.”
Cerrone v. Sec’y of Health & Hum. Servs., 146 F.4th 1113, 1121-22 (Fed. Cir. 2025). Further,
“[w]hile this court’s cases make clear that temporal association is not enough by itself to prove
causation, the absence of temporal association can be enough to defeat a claim of causation.” Id.
(internal citations omitted). Before applying the Althen test, however, the Court must determine
whether a petitioner has shown by preponderant evidence a “medically recognized” injury that is
“more than just a symptom or manifestation of an unknown injury.” Lombardi v. Sec’y of Health
& Hum. Servs., 656 F.3d 1343, 1352-53 (Fed. Cir. 2011) (explaining that “if the existence and
nature of the injury itself is in dispute,” then “identification of a petitioner’s injury is a
prerequisite to an Althen analysis of causation”). Next, “[w]hen applying Althen, the special
master must consider the degree to which each factor is satisfied.” Cerrone, 146 F.4th at 1122.
“[A]fter weighing the degree to which the petitioner has proved each factor and considering any
remaining evidence bearing on causation, the special master must determine whether the
petitioner has proved that it is more likely than not that the vaccine caused his injury.” Id.
“Once the petitioner has established a prima facie case for entitlement to compensation
and thus met [his] burden to prove causation-in-fact, the burden shifts to the government to prove
‘[by] a preponderance of the evidence that the [petitioner’s injury] is due to factors unrelated to
the administration of the vaccine described in the petition.’” de Bazan, 539 F.3d at 1352 (quoting
42 U.S.C. § 300aa-13(a)(1)(B) (second and third alterations in original)). Under the Act, “factors
unrelated to the administration of the vaccine” may include “infection, toxins, trauma (including
5 “This court has interpreted the ‘preponderance of the evidence’ standard referred to in the Vaccine Act as one of
proof by a simple preponderance, of ‘more probable than not’ causation.” Althen v. Sec’y of Health & Hum. Servs.,
418 F.3d 1274, 1279 (Fed. Cir. 2005).
6

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birth trauma and related anoxia), or metabolic disturbances which have no known relation to the
vaccine involved, but which in the particular case are shown to have been the agent or agents
principally responsible for causing the petitioner’s illness, disability, injury, condition, or death.”
42 U.S.C. § 300aa-13(a)(2)(B). Significantly, while a petitioner need only demonstrate that the
vaccine was a substantial factor in bringing about the alleged harm, the government must
demonstrate that an unrelated factor “was the sole substantial factor in bringing about the
injury.” de Bazan, 539 F.3d at 1354 (emphasis added). In addition, the government’s proof of
alternative actual causation-in-fact must satisfy the same standard as the petitioner’s proof of
actual causation-in-fact in off-Table cases. See Deribeaux, 717 F.3d at 1368 (“The Secretary was
‘required not only to prove the existence of [a factor unrelated], but also to prove by a
preponderance of the evidence that the [factor unrelated] actually caused’ the injury alleged.”)
(alterations in original) (quoting Knudsen v. Sec’y of Health & Hum. Servs., 35 F.3d 543, 549
(Fed. Cir. 1994)). However, if the Court finds that the government failed to prove alternative
actual causation-in-fact, the petitioner is entitled to compensation. de Bazan, 539 F.3d at 1352. If
the Court finds the parties’ evidence to be in equipoise, the petitioner is still entitled to
compensation. Heinzelman v. Sec’y of Health & Hum. Servs., No. 07-01, 2008 WL 5479123, at
*19 (Fed. Cl. Dec. 11, 2008) (citing Knudsen, 35 F.3d at 550).
IV. ANALYSIS
The CSM denied Mr. Correira’s petition, concluding that “[t]he evidentiary record [did]
not support [his] contention that his GBS began in a medically-acceptable timeframe after
vaccination.” Correira, 2025 WL 1892886, at *7. Mr. Correira argues that the CSM erroneously
found—under the third Althen prong—that there was no proximate temporal relationship
between the flu vaccine he received and his GBS symptoms. Pet’r’s Mem. [ECF 30] at 11.
Specifically, he asserts that the CSM arbitrarily conflated eight weeks with two months, id. at 12,
that the CSM’s interpretation of the pertinent medical study is flawed, id. at 15, and that the
CSM erred by establishing an inflexible eight-week onset deadline, id. at 19.6 For the reasons
provided below, the Court concludes that the CSM’s analysis under the third Althen prong was
arbitrary, capricious, or otherwise not in accordance with the law. Thus, the Court remands the
case to the CSM under 42 U.S.C. § 300aa-12(e)(2)(C) for further action in accordance with this
opinion.
To begin, the Court is not persuaded that the CSM conflated eight weeks with two
months. Mr. Correira argues that the CSM arbitrarily equated eight weeks (or fifty-six days) with
two months (or approximately sixty days), [ECF 30] at 12, and that, because Mr. Correira’s onset
occurred fifty-nine days after he was vaccinated, the CSM’s “failure to distinguish between these
terms is not a mere technicality,” id. at 14. While the CSM references the term “two months” on
one occasion in his decision, see Correira, 2025 WL 1892886, at *6, and cites to other vaccine
cases that appear to use the terms “two months” and “eight weeks” interchangeably, id. at *5-6,
the CSM clearly applied an eight-week or fifty-six day timeframe in finding that Mr. Correira’s
GBS symptoms did not begin in a medically-acceptable timeframe, id. at *7. This is evident
throughout the decision. See id. at *5 (stating that “onset of symptoms is demonstrated to have
occurred no longer than six to eight weeks after vaccination” and that “[t]his means up to 56
6 Mr. Correira does not challenge the CSM’s finding that his GBS symptoms began “on or around November 18,
2019,” fifty-nine days after he was vaccinated. Id. at 7.
7

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days” (first alteration in original)); id. at *6 (stating that “[t]hese facts accordingly are
inconsistent with even the longest timeframes (eight weeks) accepted for a similar non-Table
claims” (alteration in original)); id. *6 n.7 (referring to “the proposed up-to-eight weeks
timeframe”). Thus, there is no evidence that the CSM arbitrarily conflated eight weeks with two
months.
However, the Court nevertheless finds that the CSM’s decision is arbitrary. In the
decision, the CSM stated that “[m]easuring from the September 20, 2019 vaccination, . . . a
Table version of the claim in this case could only succeed if onset had occurred on or before
November 1, 2019 – which clearly did not occur” and that “even a causation-in-fact claim would
have needed to be based on symptoms beginning no more than two weeks after – or by
November 15, 2019, at the latest.” Correira, 2025 WL 1892886, at *6 (emphasis added). In
other words, the CSM stated that, for Mr. Correira’s non-Table claim to succeed, the onset of his
symptoms needed to occur, at latest, eight weeks or fifty-six days from vaccination. Yet, the
CSM failed to articulate a rational basis for imposing such an eight-week deadline to deny Mr.
Correira compensation. See Exum v. Sec’y of Health and Hum. Servs., 175 Fed. Cl. 681, 700
(“[A] special master must clearly articulate its reasons for its conclusions.”).
In his discussion of the applicable legal standard, the CSM made the following statement
regarding the temporal requirements a petitioner must meet to establish causation-in-fact under
Althen:
There are nevertheless limits to the kinds of fact patterns that
successfully establish that the flu vaccine “did cause” a particular
petitioner’s GBS under the second Althen prong. In most successful
non-Table cases, onset of symptoms is demonstrated to have
occurred no longer than six to eight weeks after vaccination. See,
e.g., Barone, 2014 WL 6834557, at *13 (eight weeks is the longest
reasonable timeframe for a flu/GBS injury). This means up to 56
days.
Correira, 2025 WL 1892886, at *5. It appears that the CSM is referring to the following
statement in Barone:
Other special masters have never gone beyond a two-month
(meaning eight week) interval in holding that a vaccination caused
a demyelinating illness. See, e.g., Aguayo v. Sec’y of Health &
Human Servs., No. 12-563V, 2013 WL 441013, at *3 (Fed. Cl. Spec.
Mstr. Jan. 15, 2013); Corder v. Sec’y of Health & Human Servs.,
No. 08-228V, 2011 WL 2469736, at *27-*29 (Fed. Cl. Spec. Mstr.
May 31, 2011) (proposed four month onset period from vaccination
to GBS too long; two months is longest reasonable timeframe).
Barone, 2014 WL 6834557, at *13. If the CSM was referring to the first sentence in the above
paragraph, wherein he (the author of Barone) states that “[o]ther special masters have never gone
beyond a two-month (meaning eight week) interval in holding that a vaccination caused a
8

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demyelinating illness,” id., then the CSM failed to provide any support for his conclusion in
Corriera because the statement alone is conclusory. Alternatively, if the CSM was referring to
the cases he cited after the first sentence, the CSM similarly failed to provide support for his
conclusion in Corriera. In both Aguayo and Corder, the special master concluded that three and
one-half months and fourth months, respectively, was too long an interval between vaccination
and GBS symptom onset to support an inference of causation.7 The difference between Mr.
Correira’s fifty-nine-day interval and fifty-six days (eight weeks) is hardly comparable to the
difference between the ninety-eight day interval (approximately three and one half months or
fourteen weeks) in Aguayo or the 112 day interval (approximately four months or sixteen weeks)
in Corder and fifty-six days. While these cases serve as examples of onset timeframes that fall
far outside of the medically-acceptable window for inferring causation, they do not support the
CSM’s conclusion that, “[i]n most successful non-Table cases, onset of symptoms is
demonstrated to have occurred no longer than six to eight weeks after vaccination.” Correira,
2025 WL 1892886, at *5 (alteration in original). Nor do these cases support the CSM’s
conclusion that Mr. Correira’s fifty-nine-day onset—three days outside of the eight-week
mark—is not medically acceptable.
Next, in his analysis of a medical study offered by Mr. Correira’s unrebutted expert,8 the
CSM stated:
The medical literature offered in this case establishes that a
reasonable timeframe for onset of GBS after vaccine administration
would be no more than six to eight weeks, however. Schonberger at
105. Specifically, Schonberger indicates that most GBS cases after
the flu vaccine that it evaluated occurred around 13-17 days, with
their latest happening 41 days. Id. at 112. This is echoed by the
timeframe set for the Table version of the claim (see 42 C.F.R. §
100.3 (2017)). (It is in fact arguably the case that any onsets that
exceed the 3-42 day timeframe are suspect from a medical/scientific
standpoint, since the onset timeframe is specifically engineered to
be over-inclusive, rather than to reflect a precise framework in
which a vaccine can, or cannot, cause injury).
Correira, 2025 WL 1892886, at *6 (emphasis in original) (citing Lawrence B. Schonberger et
al., Guillain Barre Syndrome Following Vaccination in the National Influenza Immunization
Program, United States, 1976-1977, 110 Am. J. Epidemiology 105-23 (1979) (“the Study”)).9
According to the CSM, the Study’s authors concluded on page 105 that “a reasonable timeframe
7 In Aguayo, the special master noted that the petitioner did not provide an expert report to support his contention
that his GBS was caused by the flu vaccine he received three and one-half months earlier. 2013 WL 441013, at *3.
In Corder, the special master discussed all three Althen prongs. 2011 WL 2469736, at *27-29. Regarding the third
prong, he stated that a four-month interval between vaccination and the onset of GBS symptoms was too long to be
deemed caused by the flu vaccine. Id. at *29.
8 The government neither offered its own expert nor submitted any evidence.
9 The Study compared the incidence of GBS in adults in the United States who received the 1976-1977 swine
influenza vaccine with the incidence of GBS in unvaccinated adults. Schonberger, 110 Am. J. Epidemiology at 105.
9

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for onset of GBS after vaccine administration would be no more than six to eight weeks.” Id.
However, there is no explicit reference to such a timeframe on that page. Schonberger, 110 Am.
J. Epidemiology at 105. Rather, in what appears to be a summary of the Study, the authors only
make the following statement regarding the timing of GBS onset following vaccination: “The
period of increased risk [of contracting GBS] was concentrated primarily within the 5-week
period after vaccination, although it lasted for approximately 9 or 10 weeks.” Id.
Additionally, the CSM stated that on page 112 of the Study, the authors “indicate[] that
most GBS cases after the flu vaccine that [they] evaluated occurred around 13-17 days, with their
latest happening 41 days.” Correira, 2025 WL 1892886, at *6. Figure 5 on page 112 graphically
depicts the number of reported GBS cases by two-day incremental periods as follows:
Schonberger, Study, 110 Am. J. Epidemiology at 112. However, the CSM’s statement that the
latest GBS case the authors evaluated occurred forty-one days after vaccination is incorrect. As
noted above, in the introduction to the Study, the authors state that “[t]he period of increased risk
[of contracting GBS following vaccination] . . . lasted for approximately 9 or 10 weeks.” Id. at
105. Additionally, Figure 6, which graphically depicts the “[GBS] attack rates for population
over 17 years of age, by week of onset after [flu] vaccination,” shows .42 cases in week nine, and
.40 cases in week ten. Id. at 113. Thus, while Figure 5 supports the CSM’s conclusion that the
highest concentration of GBS cases “occurred around 13-17 days” after vaccination, Correira,
2025 WL 1892886, at *6, it does not establish that the latest GBS case occurred on day forty-one
or that the forty-one-day mark represents the outer limit of the risk period under the Study.
Schonberger, 110 Am. J. Epidemiology at 112. Consequently, the CSM failed to explain how the
Study “establishes that a reasonable timeframe for onset of GBS after vaccine administration
would be no more than six to eight weeks.” Correira, 2025 WL 1892886, at *6 (emphasis
added).
After finding that “contemporaneous medical records preponderantly establish that the
initial symptoms of Petitioner’s GBS did not occur before November 18, 2019, 59 days after his
vaccination,” Correira, 2025 WL 1892886, at *6, the CSM concluded:
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These facts accordingly are inconsistent with even the longest
timeframes (eight weeks) accepted for a similar non-Table claims
recognized in reasoned Program decisions. See, e.g., Barone, 2014
WL 6834557, at *13. Petitioner’s onset thus occurred far too long
after vaccination to be considered “medically acceptable to infer
causation-in-fact.” See de Bazan, 539 F.3d at 1352; De La Cruz v.
Sec’y of Health & Hum. Servs., No. 17-783V, 2018 WL 945834, at
*1 (Fed. Cl. Jan. 23, 2018) (finding onset of GBS more than two
months after flu vaccination to be not compensable under either a
theory of causation in fact or significant aggravation).
Id. (emphasis in original) (footnote omitted). Once more, the CSM cited Barone for the
proposition that, in similar non-Table claims, special masters have concluded that eight weeks is
the outer limit when determining whether a flu vaccination was the cause in fact of an
individual’s GBS. Id. As discussed above, neither Barone nor the cases cited therein provide
adequate legal support for this proposition. Further, while the special master in De La Cruz
found that the onset of petitioner’s GBS symptoms occurred “more than eight weeks after her flu
vaccination,” 2018 WL 945834, at *1, and that she did “not consider onset more than two
months after flu vaccination to be compensable under either a theory of causation in fact or
significant aggravation,” id., the only case she cited in support of his conclusion was Corder, id.
Again, as noted above, the timeframe at issue in Corder was four months—roughly twice as long
as the timeframe at issue in the instant case. See Corder, 2011 WL 2469736, at *29. Also, the
Court notes that De La Cruz is barely a two-page decision with no substantive analysis, that the
decision hinges, at least in part, on the petitioner’s lack of a medical expert report, and that the
petitioner concedes that she is unable to demonstrate entitlement to compensation. De La Cruz,
2018 WL 945834, at *1-*2. In contrast, Mr. Correira provided a medical expert report and
claims entitlement to compensation.
Lastly, in a footnote at the end of the decision, the CSM stated:
Admittedly, other special masters have accepted a comparably-
lengthy timeframe. See, e.g., Cooper v. Sec’y of Health & Hum.
Servs., No. 18-1885V, 2024 WL 1522331, at *20 (Fed. Cl. Mar. 12,
2024) (finding 60-day onset of GBS following a vaccination allows
inference of causation); Spayde v. Sec’y of Health & Hum. Servs.,
No. 16-1499V, 2021 WL 686682, at *19 (Fed. Cl. Jan. 27, 2021).
But such decisions do not control this outcome. Moreover, they
either involve a different vaccine (for Cooper, the pneumococcal
vaccine), or were based on reasoning that justified stretching the
eight-week timeframe a few days, in the interests of the Program’s
emphasis on generosity and a desire not to apply a hard, bright-line
“rule.” Spayde, 2021 WL 686682, at *19. Of course, the proposed
up-to-eight weeks timeframe itself already exceeds the “rule” of the
Table claim for the flu vaccine, and does not itself constitute
something that can be deemed accepted as a general matter.
Moreover, this thinking reflects a logic whereby any onset not
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shown to be facially impossible (say, more than 90 days) should be
deemed medically acceptable. I do not consider that kind of
reasoning consistent with the science applicable to how vaccines are
thought to cause GBS, and it is not demanding scientific certainty to
reject it.
Correira, 2025 WL 1892886, at *6 n.7 (emphasis in original). While it is of course true that a
petitioner seeking to establish that the flu vaccine caused GBS in a Table claim need only
demonstrate that the symptoms occurred within three and forty-two days of vaccination, 42
C.F.R. § 100.3(a), the CSM failed to explain why the instant case is distinguishable from Spayde,
which he described as being “based on reasoning that justified stretching the eight-week
timeframe a few days, in the interests of the Program’s emphasis on generosity and a desire not
to apply a hard, bright-line ‘rule,’” Correira, 2025 WL 1892886, at *6 n.7. In other words, it is
unclear why the CSM found that “the interests of the Program’s emphasis on generosity and a
desire not to apply a hard, bright-line ‘rule’” did not apply in the instant case. Id.; see Althen, 418
F.3d at 1279-80 (stating that under the “Vaccine Act’s preponderant evidence standard . . . close
calls regarding causation are resolved in favor of injured claimants”). Although the cited
decisions are not binding on the CSM, the fact that other special masters have found similar
onset timeframes that extend beyond eight weeks or fifty-six days from vaccination to be suitable
for inferring causation conflicts with the CSM’s decision to impose an inflexible “up-to-eight
weeks timeframe” in this case. Furthermore, the facts of this case do not require the CSM to
consider whether an onset timeframe that has not been “shown to be facially impossible” should
be “deemed medically-acceptable.” Correira, 2025 WL 1892886, at *6 n.7. Instead, Mr.
Correira’s GBS symptoms began fifty-nine days after vaccination—just outside of the suggested
eight-week timeframe. See [ECF 30] at 7. Because the CSM failed to articulate a rational basis
for imposing an eight-week or fifty-six day symptom onset deadline in this case, the Court finds
the decision to be arbitrary. See Paluck v. Sec’y of Health and Hum. Servs., 786 F.3d 1373, 1384
(Fed. Cir. 2015) (finding that “the special master had no reasonable basis for setting a hard and
fast deadline” where the relevant medical evidence “do[es] not purport to establish any definitive
timeframe for the onset of clinical symptoms”).
V. CONCLUSION
Accordingly, Mr. Correira’s motion for review of the CSM’s decision, [ECF 29], is
GRANTED, and the CSM’s decision of June 3, 2025, is VACATED. This case is
REMANDED for further action in accordance with this Opinion and Order. Pursuant to 42
U.S.C. § 300aa-12(e)(2)(C), the CSM shall issue a remand decision within 90 days. The parties
SHALL CONFER and FILE a notice with a proposed public version of this Opinion and Order
on or before November 26, 2025.
IT IS SO ORDERED.
s/ Thompson M. Dietz
THOMPSON M. DIETZ, Judge
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