Annamma Varughese v. HHS - Influenza, transverse myelitis (2026)

Annamna Varughese, a 66-year-old woman, received an influenza vaccination on September 21, 2021. Three days later, she presented with chest pain, back pain, leg weakness, numbness, and nausea, reporting a gradual onset of symptoms over two days, placing onset the day after vaccination.

She was initially evaluated for Guillain Barré Syndrome (GBS) or a spinal cord lesion. Later, her primary care provider suspected transverse myelitis (TM), and a repeat MRI suggested a "progression of demyelinating or inflammatory process." She was treated with IV Solu-Medrol.

A VAERS report submitted by the pharmacy indicated symptom onset on September 22, 2021. Her neurologist, Dr.

Sengul, noted an impression of "idiopathic transverse myelitis, likely provoked by vaccine." The petitioner's expert, Dr. Steinman, proposed a theory of molecular mimicry, suggesting the flu vaccine's hemagglutinin shared amino acid sequences with neurofascin, a molecule implicated in TM.

Respondent's experts, Dr. Merkler and Dr.

He, disagreed, citing a lack of epidemiological evidence linking the flu vaccine to TM and challenging the molecular mimicry theory and the rapid onset timeframe. The Special Master found that the petitioner failed to establish a sound and reliable medical theory under Althen prong one, as the literature did not support neurofascin as a cause of acute TM and the molecular mimicry theory was not sufficiently demonstrated.

Furthermore, the Special Master found that the onset of TM within 24 hours was too short to be causally related, even assuming a recall response, thus failing Althen prong three. Although Dr.

Sengul's opinion suggested a vaccine provocation, it was not sufficiently supported by reasoning regarding the timing or mechanism. Consequently, the Special Master denied the petition for compensation, finding insufficient proof of causation.