VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00530
Package ID: USCOURTS-cofc-1_23-vv-00530
Petitioner: Sally A. Cevasco
Filed: 2023-04-18
Decided: 2025-06-17
Vaccine: influenza
Vaccination date: 2021-01-11
Condition: ulnar nerve lesion, left upper limb
Outcome: denied
Award amount USD: 

AI-assisted case summary:
Sally A. Cevasco, born in 1957, filed a petition for compensation on April 18, 2023, alleging that an influenza vaccine administered on January 11, 2021, caused a lesion of her left ulnar nerve. Ms. Cevasco received the vaccine at a Walgreens Pharmacy, administered by Justin Costa. Shortly after the vaccination, she experienced numbness in her left hand. She reported this to the pharmacist and later contacted her primary care physician, Dr. Uma Kolli, who recommended she see a neurologist. Ms. Cevasco saw neurologist Dr. Megan Callahan on March 1, 2021. Dr. Callahan diagnosed a "lesion of [the left] ulnar nerve, left upper limb," noting mild weakness in her left fingers and decreased sensation in her left ring and small fingers. Dr. Callahan's initial assessment suggested the vaccine was correctly placed and unlikely to have caused direct injury to the ulnar nerve, but later noted in follow-up records that the ulnar neuropathy had "sudden onset with flu vaccination." Nerve conduction studies performed on May 7, 2021, confirmed Ms. Cevasco suffered from a left ulnar neuropathy. The Secretary of Health and Human Services disputed Ms. Cevasco's claim, arguing she had not provided sufficient evidence, particularly an expert report, to support causation. Both parties retained experts: Dr. Bodor for Ms. Cevasco and Dr. Donofrio for the Secretary. Ms. Cevasco's petition proceeded as an off-Table claim, requiring her to prove causation-in-fact under the Althen standard. Dr. Bodor proposed a theory that the vaccine was injected into the teres minor tendon, causing pseudo ulnar neuropathy, and that the diagnosed ulnar neuropathy at the elbow was incidental. He rejected direct nerve trauma due to the needle's length and the absence of immediate pain, and immune-mediated reaction due to the rapid onset of symptoms. Dr. Donofrio questioned the proximity of the teres minor tendon to the deltoid muscle where the vaccine was administered and found Dr. Bodor's dismissal of the confirmed ulnar neuropathy as incidental to be unpersuasive. The Special Master, Christian J. Moran, reviewed the expert reports and arguments. The public decision does not describe the specific dollar amount of any award or annuity, as Ms. Cevasco's petition was denied. The Special Master found that Ms. Cevasco failed to establish the second prong of the Althen test, which requires a logical sequence of cause and effect. While Dr. Callahan's records noted a temporal association between the vaccination and the onset of symptoms, this was not considered sufficient proof of causation. Crucially, Ms. Cevasco's primary symptom was numbness, not the pain described in the literature supporting Dr. Bodor's theory (Escobar article), and her nerve conduction studies confirmed an ulnar neuropathy, which Dr. Bodor dismissed as incidental, a conclusion the Special Master found unpersuasive, contrasting with Dr. Donofrio's view that it was "bold to call the ulnar neuropathy at the elbow incidental in the setting of 3 abnormal EMGs." Because Ms. Cevasco failed to establish a logical sequence of cause and effect, her petition for compensation was denied. Petitioner counsel was Elizabeth M. Muldowney, and respondent counsel was Alec Saxe. The decision was issued on June 17, 2025.

Theory of causation field:
Petitioner Sally A. Cevasco, born in 1957, received an influenza vaccine on January 11, 2021, and subsequently developed numbness in her left hand, diagnosed as left ulnar neuropathy. The case was litigated as an off-Table claim, requiring proof of causation-in-fact under Althen v. Sec'y of Health & Hum. Servs. Petitioner's expert, Dr. Bodor, proposed a theory that the vaccine was injected into the teres minor tendon, causing pseudo ulnar neuropathy, and that the diagnosed ulnar neuropathy was incidental. This theory was supported by the Escobar article, which described pain from teres minor stimulation. Respondent's expert, Dr. Donofrio, questioned the anatomical basis of this theory and found the dismissal of the confirmed ulnar neuropathy as incidental unpersuasive. The Special Master, Christian J. Moran, denied compensation, finding that Ms. Cevasco failed to establish a logical sequence of cause and effect. Key factors in the denial included that Ms. Cevasco's primary symptom was numbness, not pain as described in supporting literature, and that her confirmed ulnar neuropathy, evidenced by EMG/NCS studies, was not persuasively explained as incidental by the petitioner's expert. The decision was issued on June 17, 2025. Petitioner counsel: Elizabeth M. Muldowney. Respondent counsel: Alec Saxe.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_23-vv-00530-0
Date issued/filed: 2025-06-17
Pages: 10
Docket text: PUBLIC DECISION (Originally filed: 05/27/2025) regarding 55 DECISION of Special Master. Signed by Special Master Christian J. Moran. (jjb) Service on parties made.
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Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * *
SALLY A. CEVASCO, *
* No. 23-0530V
* Special Master Christian J. Moran
Petitioner, *
v. *
* Filed: May 27, 2025
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * *
Elizabeth M. Muldowney, Sands Anderson P.C., Richmond, VA, for Petitioner;
Alec Saxe, United States Dep’t of Justice, Washington, D.C., for Respondent.
PUBLISHED DECISION DENYING COMPENSATION1
Sally Cevasco alleges that an influenza (“flu”) vaccine damaged her ulnar
nerve. Am. Pet., filed May 7, 2024. The Secretary disputes Ms. Cevasco’s
entitlement to compensation. Both parties have supported their positions with
reports from expert witnesses and argued through memorandum. A review of the
evidence and arguments shows that Ms. Cevasco is not entitled to compensation.
1 Because this decision contains a reasoned explanation for the action taken in this case, it
must be made publicly accessible and will be posted on the United States Court of Federal
Claims’ website, and/or at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in
accordance with the E-Government Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal
Management and Promotion of Electronic Government Services). This means the decision will
be available to anyone with access to the internet. In accordance with Vaccine Rule 18(b), the
parties have 14 days to identify and move to redact medical or other information, the disclosure
of which would constitute an unwarranted invasion of privacy. Any changes will appear in the
document posted on the website.

Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 2 of 10
I. Facts2
Ms. Cevasco was born in 1957. Although she suffered from various medical
problems, the Secretary has not alleged that any of these problems affect whether
she is entitled to compensation. See Resp’t’s Rep. at 2, 10-11.
Ms. Cevasco received the allegedly causal flu vaccination at a Walgreens
Pharmacy on Monday, January 11, 2021. Exhibit 16 at 10; Exhibit 19 at 1-2.
Justin Costa administered the vaccine into her left arm. Exhibit 19 at 2. According
to a record created on March 1, 2021, the vaccine was “correctly placed.” Exhibit
21 at 3. Ms. Cevasco has not asserted that the vaccine was administered into an
unusual place. See Exhibit 1 (petitioner’s affidavit).
After receiving the vaccination, Ms. Cevasco remained in the store. She felt
her left hand was going numb. Exhibit 1 at 1. Ms. Cevasco told the pharmacist,
who advised that because more than 15 minutes had elapsed, she could leave.
However, he asked her to call him if the numbness did not go away that afternoon.
Exhibit 1 at 2.
After the pain did not go away, the next day, Ms. Cevasco told the
pharmacist that the numbness continued. Exhibit 1 at 2. Ms. Cevasco averred that
the pharmacist told her: “‘Obviously the needle must have hit a nerve.’” Id. The
pharmacist directed Ms. Cevasco to consult her primary care physician.
Ms. Cevasco messaged her primary care physician, Uma Kolli, through the
practice’s patient portal system on Friday, January 15, 2021. Ms. Cevasco
complained about numbness in her left hand. More specifically, Ms. Cevasco
wrote:
I got the flu shot for the first time this past Monday.
Within a few minutes[,] my hand started getting numb.
The pharmacist asked me to call him back each day to
report about it. He said if it didn’t go away within a few
days[,] that he would file a report about it. Well, this is
Friday[,] and it is the same. Still having numbness.
2 The parties generally agree that the medical records created contemporaneously with the
events described in the medical records are accurate. Compare Am. Pet., filed May 7, 2024, at 2-
5 with Resp’t’s Rep., filed Jan. 8, 2024, at 2-6. Thus, the summary of this evidence is relatively
brief. More details can be found in the Amended Petition and the Respondent’s Report.
2

Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 3 of 10
Exhibit 17 at 4.
The next day, Dr. Kolli responded. Exhibit 20 at 2. After more electronic
correspondence, Dr. Kolli recommended that Ms. Cevasco consult a neurologist.
Id.
The Walgreens staff member, Mr. Costa, informed the Vaccine Adverse
Event Reporting System that Ms. Cevasco “started having numbness in her left
hand 15 minutes after an injection” on January 11, 2023. Exhibit 23 at 1-2
(VAERS form submitted on Jan. 19, 2021). Mr. Costa also reported that the
numbness had continued for eight days. Id. at 2.
Ms. Cevasco averred that she had difficulty finding a neurologist with an
open appointment. Exhibit 1 at 2. The appointment took place on March 1, 2021,
and the neurologist whom Ms. Cevasco saw was Megan Callahan. Exhibit 21 at 2-
4. Ms. Cevasco informed Dr. Callahan that she first started experiencing left hand
numbness within minutes of receiving a flu shot on January 11, 2021. In this
appointment, Ms. Cevasco stated that the vaccination did not seem to be placed
abnormally.
Dr. Callahan examined Ms. Cevasco. Dr. Callahan detected mild weakness
on abduction and adduction of the left fingers. Exhibit 21 at 3. Ms. Cevasco had
decreased sensation in her left ring finger and left small finger. Dr. Callahan
diagnosed Ms. Cevasco as having a “lesion of [the left] ulnar nerve, left upper
limb.” Dr. Callahan also commented about potential causes:
63-year-old woman with onset of paresthesias in the left
ulnar nerve distribution immediately after a vaccination.
By her description the back seen [sic, probably “the
vaccine”] was correctly placed so it would not relate to
direct injury to the ulnar nerve. It may relate to a lower
trunk brachial plexopathy but she does not describe
having severe pain. No evidence of a polyneuropathy or
of transverse myelitis. She does have sensitivity over
ulnar nerve and also the scalene muscles on the left side.
Exhibit 21 at 3. Dr. Callahan anticipated a progressive improvement and
recommended a return visit.
In conjunction with the follow-up appointment, Ms. Cevasco underwent
EMG/NCS testing. Exhibit 21 at 8 (May 7, 2021). This testing confirmed Ms.
Cevasco suffered from a left ulnar neuropathy. Id. The parties’ experts agree that
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Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 4 of 10
Ms. Cevasco had a left ulnar neuropathy. Exhibit 34 (Dr. Bodor’s report) at 5-7;
Exhibit A (Dr. Donofrio’s report) at 6.
Ulnar Neuropathy
Ulnar neuropathy “is more common in middle age and typically peaks
between 50 and 80 years of age.” Exhibit A-1 (Andrew Hannaford and Neil G.
Simon, “Ulnar Neuropathy,” in Handbook of Clinical Neurology (C. Chalk ed.)) at
103. After carpal tunnel syndrome, ulnar neuropathy is the second most common
compressive neuropathy. Id.
The ulnar nerve originates with cervical and thoracic nerves and goes to the
fourth and fifth digits of the hand. Id. at 104. Ulnar neuropathy at the elbow is
“most frequently caused by chronic compression or traction of the nerve.” Id. at
107.
Ms. Cevasco continued to see doctors about her ulnar neuropathy
periodically. These visits to care for her ulnar neuropathy do not shed much, if
any, light on the cause of the ulnar neuropathy.
II. Procedural History3
Ms. Cevasco initiated the case by filing her petition on April 18, 2023.
(Later, she amended her petition). She supported her claim by submitting
affidavits and medical records the next day. An initial comprehensive scheduling
order was issued August 31, 2023.
The Secretary reviewed the material and recommended that compensation be
denied. Resp’t’s Rep., filed Jan. 8, 2024. In the particular, the Secretary
maintained that Ms. Cevasco had not provided the report of a medical expert to
support her claim. Id. at 10.
The parties supported their positions by filing expert reports. Each party
retained one expert: Dr. Bodor for Ms. Cevasco and Dr. Donofrio for the Secretary.
Each expert, in turn, wrote two reports: Exhibits 34 and 46 for Dr. Bodor and
Exhibits A and C for Dr. Donofrio.
Each party enjoyed an opportunity to argue through memoranda. In accord
with the Initial Comprehensive Scheduling Order, Ms. Cevasco identified three
cases that supported her claim for compensation. Pet’r’s Status Rep., filed May 13,
3 The procedural history is straightforward.
4

Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 5 of 10
2024. The Secretary distinguished these cases and brought forward other cases
that, in the Secretary’s view, were in line with a denial of entitlement.
The case can be resolved on the papers without receiving oral testimony.
See Kreizenbeck v. Sec'y of Health & Hum. Servs., 945 F.3d 1362, 1365 (Fed. Cir.
2020). Ms. Cevasco has enjoyed a full and fair opportunity to present evidence
and argument. See Pet’r’s Status Rep., filed Nov. 18, 2024 (declining to present
additional expert reports).
III. Standards for Adjudication
A petitioner is required to establish her case by a preponderance of the
evidence. 42 U.S.C. § 300aa–13(1)(a). The preponderance of the evidence
standard requires a “trier of fact to believe that the existence of a fact is more
probable than its nonexistence before [he] may find in favor of the party who has
the burden to persuade the judge of the fact's existence.” Moberly v. Sec’y of
Health & Hum. Servs., 592 F.3d 1315, 1322 n.2 (Fed. Cir. 2010) (citations
omitted). Proof of medical certainty is not required. Bunting v. Sec’y of Health &
Hum. Servs., 931 F.2d 867, 873 (Fed. Cir. 1991).
Distinguishing between “preponderant evidence” and “medical certainty” is
important because a special master should not impose an evidentiary burden that is
too high. Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379-80 (Fed.
Cir. 2009) (reversing special master's decision that petitioners were not entitled to
compensation); see also Lampe v. Sec’y of Health & Hum. Servs., 219 F.3d 1357
(Fed. Cir. 2000); Hodges v. Sec’y of Health & Hum. Servs., 9 F.3d 958, 961 (Fed.
Cir. 1993) (disagreeing with dissenting judge's contention that the special master
confused preponderance of the evidence with medical certainty).
The Vaccine Act requires that petitioners establish five elements. 42 U.S.C.
§ 300aa–11(c)(1)(A) through (E). Here, the parties dispute whether Ms. Cevasco
has established that the flu vaccine caused her ulnar neuropathy. Because the
Vaccine Injury Table does not associate the flu vaccine with vasculitis, Ms.
Cevasco must pursue a claim that the flu vaccine was the cause-in-fact of the ulnar
neuropathy. See Am. Pet. at 1 (preamble). For causation-in-fact claims, a
petitioner bears a burden “to show by preponderant evidence that the vaccination
brought about [the vaccinee’s] 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.” Althen v.
Sec’y of Health & Hum. Servs., 418 F.3d 1274, 1278 (Fed. Cir. 2005).
5

Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 6 of 10
IV. Causation
A. Althen Prong One – Medical Theory
To explain how the flu vaccination harmed Ms. Cevasco, Dr. Bodor
proposes that the vaccination was administered into the teres minor tendon of the
rotator cuff and caused pseudo ulnar neuropathy. Exhibit 34 at 6, 8. In doing so,
Dr. Bodor opined that “the finding of ulnar neuropathy at the elbow is incidental.”
Id. at 8. Dr. Bodor cited nine articles of which the potentially most supportive is
the article filed as Exhibit 40 (PL Escobar and J. Ballesteros, “Teres minor.
Sources of symptoms resembling ulnar neuropathy or C8 radiculopathy,” 67 Am.
J. Phys. Med. Rehabil. 120 (1988)).
In proposing this theory, Dr. Bodor explicitly rejects two other theories.
First, he stated that a vaccination needle is too short to reach the ulnar nerve
because a vaccination is placed into the deltoid muscle, which is on the opposite
side of the arm from the ulnar nerve. In addition, if the needle caused direct
trauma to the ulnar nerve, the pain would manifest immediately and Ms. Cevasco
did not have pain immediately. Exhibit 34 at 6. Second, Dr. Bodor rejected the
possibility that the vaccination led to an immune-mediated reaction. Dr. Bodor
stated that the onset of Ms. Cevasco’s numbness within 15 minutes precluded an
immune-mediated reaction. Id.
With respect to the abstract theory Dr. Bodor proposed, the response from
Dr. Donofrio is not a model of clarity. (As discussed next, Dr. Donofrio makes
persuasive points about Ms. Cevasco specifically.) Although Dr. Bodor proposes a
theory based upon an injection into the “teres minor tendon,” Dr. Donofrio states
that the deltoid muscle, into which the flu vaccine was administered, is “a great
distance from the teres minor muscle, which is located posteriorly in the shoulder
region.” Exhibit A at 6 (italics added). Thus, Dr. Donofrio’s opinion as to whether
a needle for a vaccination administered into the deltoid muscle can reach the teres
minor tendon is unclear.
Dr. Bodor makes a similar point in his responsive report. He wrote that
although Dr. Donofrio is “correct with regard to the teres minor muscle, [he] is not
correct with regard to the teres minor tendon, which lies precisely under the deltoid
muscle when a patient is in a typical seated position with their arm at their side.”
Exhibit 46 at 1.
This evidence supports a finding that there is at least some basis for finding
that a needle injected into the deltoid muscle could penetrate the teres minor
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tendon. (The undersigned notes that the experts have not discussed potentially
relevant anatomic dimensions, such as the thickness of the deltoid muscle.) A
firmer finding as to whether this theory has been established with preponderant
evidence is not required because even if the theory is accepted, Ms. Cevasco has
not met her burden of proof in other respects as discussed next.
B. Althen Prong Two – Logical Sequence
The second Althen prong requires a preponderant presentation of “a logical
sequence of cause and effect showing that the vaccination was the reason for the
injury.” Althen, 418 F.3d at 1278. With respect to this prong, at least two factors
are relevant. The first is the views of a treating doctor. Capizzano v. Sec’y of
Health & Hum. Servs., 440 F.3d 1317, 1326 (Fed. Cir. 2006). Another is whether
the reaction to the vaccine was consistent with the theory articulated by the
petitioner’s expert. See Hibbard v. Sec'y of Health & Human Servs., 698 F.3d
1355, 1364 (Fed. Cir. 2012); Dodd v. Sec'y of Health & Human Servs., 114 Fed.
Cl. 43, 52-57 (2013); La Londe v. Sec'y of Health & Human Servs., 110 Fed. Cl.
184, 205 (2013), aff’d, 746 F.3d 1334 (Fed. Cir. 2014).
As to the views of treating doctors, Ms. Cevasco identified three potential
places in the record each involving her neurologist, Dr. Callahan. Pet’r’s Status
Rep., filed Oct. 16, 2023. In the earliest record, Dr. Callahan exonerated the flu
vaccine as causing a “direct injury” to the ulnar nerve. Exhibit 21 at 3 (Mar. 1,
2021). In the next record, Dr. Callahan wrote that the ulnar neuropathy had
“sudden onset with flu vaccination.” Id. at 6 (May 4, 2021). In the most recent
record, the history of present illness stated: “initial symptoms of ulnar neuropathy
occurred after a flu shot; patient with subsequent vaccinations with no problem.”
Exhibit 22 at 5 (July 7, 2022). These latter notations, the ones from May 4, 2021
and July 7, 2022, constitute the memorialization of a sequence of events. A
treating doctor’s recognition that a vaccination preceded the onset of a problem is
not the same as an expression of causation. Cedillo v. Sec’y of Health & Hum.
Servs., 617 F.3d 1328, 1347–48 (2010); La Londe v. Sec’y of Health & Hum.
Servs., 110 Fed. Cl. 184, 206 (2013), aff’d on other ground, 746 F.3d 1334 (Fed.
Cir. 2014); Langland v. Sec’y of Health & Hum. Servs., 109 Fed. Cl. 421, 439
(2013) (stating that the special master was not arbitrary in finding that the records
from treating doctors “reflect no more than intake histories or temporal
associations”); Caves v. Sec’y of Health & Hum. Servs., 100 Fed. Cl. 119, 139–40
(2010), aff'd without opinion, 463 Fed. App’x 932 (Fed. Cir. 2012).
Ms. Cevasco also has not demonstrated that she responded in a way that her
expert’s theory predicted. The Escobar article presents four people who felt pain
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similar to the pain associated with ulnar neuropathy when their teres minor muscle
was stimulated. An easily understood diagram shows a “trigger point” and
“referred pain.” Exhibit 40 (Escobar) at 121.
However, Ms. Cevasco’s problem was numbness, not pain. Exhibit 17 at 4
(email to Dr. Kolli); Exhibit 21 at 2-4 (appointment with neurologist Dr. Callahan).
As discussed by Dr. Donofrio, Ms. Cevasco did not complain about pain until June
7, 2022. Exhibit A at 6, citing Exhibit 22 at 6-7. The latency between the
vaccination and Ms. Cevasco’s onset of pain distinguishes her case from those
Escobar reported.
Another important difference between Ms. Cevasco and the four people
described in the Escobar case series concerns the presence of an ulnar neuropathy.
The four patients in Escobar had EMG’s and/or nerve conduction studies and all
were negative. In contrast, Ms. Cevasco’s EMG and nerve conduction studies
revealed that she had ulnar neuropathy. Exhibit 21 at 8 (May 7, 2021), Exhibit 22
at 6, 9 (July 7, 2022); Exhibit 32 at 1-7 (Nov. 2, 2023). While Dr. Bodor dismissed
the results of the EMG as “incidental,” Exhibit 34 at 7, Dr. Donofrio persuasively
wrote: “It is bold to call the ulnar neuropathy at the elbow incidental in the setting
of 3 abnormal EMGs.” Exhibit A at 7. Dr. Bodor did not answer this critique.
See Exhibit 46 (responsive report).
Finally, a finding that Ms. Cevasco has not established that the flu
vaccination caused her problems in her ulnar nerve is consistent with the outcome
of a case the Secretary had cited, B.T. v. Sec’y of Health & Hum. Servs., No. 21-
1213V, 2024 WL 4973025 (Fed. Cl. Spec. Mstr. Nov. 8, 2024). See Resp’t’s
Status Rep., filed July 17, 2024). In B.T., the petitioner did not persuasively
establish that the vaccine was administered poorly and did not report any
paresthesias, numbness, or pain until approximately two weeks after the
vaccination. B.T., 2024 WL 4973025, at *2 (chronology), *18 (analysis). In
finding that B.T. was not entitled to compensation, the chief special master
distinguished an earlier case in which a vaccine was found to cause an ulnar
neuropathy: Salazar v. Sec’y of Health & Hum. Servs., No. 15-817V, 2021 WL
319393 (Fed. Cl. Spec. Mstr. Jan. 5, 2021). In Salazar, critical facts included that
petitioner established that the vaccine was administered in an unusual way and the
petitioner experienced pain immediately. Neither of these facts are present in Ms.
Cevasco’s case.
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For all these reasons, Ms. Cevasco’s attempt to assemble a series of steps
connecting her vaccination with her ulnar nerve trouble is not logical.4 Therefore,
she has failed to establish Althen prong two. The absence of persuasive proof on
this element means that Ms. Cevasco cannot receive compensation. W.C. v. Sec’y
of Health & Hum. Servs., 704 F.3d 1352, 1358 (Fed. Cir. 2013) (“a petitioner must
establish all three prongs of the Althen test”); Hibbard v. Sec’y of Health & Hum.
Servs., 698 F.3d 1355, 1365 (Fed. Cir. 2012); Langland v. Sec’y of Health & Hum.
Servs., 109 Fed. Cl. 421, 438 (2013) (“prong one of Althen must be demonstrated,
for prongs two and three to matter”).
C. Althen Prong Three – Timing
Ms. Cevasco’s numbness began within approximately 15 minutes of her
vaccination. Although this onset might raise a suspicion that the vaccine caused
her ulnar neuropathy, “[t]emporal association is not sufficient, however, to
establish causation in fact.” Grant v. Sec’y of Health & Hum. Servs., 956 F.2d
1144, 1148 (Fed. Cir. 1992). Further resolution is not required due to the failure of
proof on prong two.
V. Conclusion
After the flu vaccination, Ms. Cevasco has experienced problems with her
ulnar nerve. Her medical condition warrants sympathy. However, an assessment
of the evidence shows that Ms. Cevasco has not met her burden of establishing that
the flu vaccination harmed her.
The Clerk's Office is instructed to enter judgment in accord with this
decision unless a motion for review is filed. Information about filing a motion for
review, including the deadline, can be found in the Vaccine Rules, which are
available on the website for the Court of Federal Claims.
4 Because Ms. Cevasco’s claim concerns her ulnar nerve, the outcome of Ms. Cevasco’s
case does not necessarily suggest a similar outcome for claims that a vaccination caused trauma
to other nerves in the arm.
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Case 1:23-vv-00530-UNJ Document 56 Filed 06/17/25 Page 10 of 10
IT IS SO ORDERED.
s/Christian J. Moran
Christian J. Moran
Special Master
10