VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_24-vv-00229
Package ID: USCOURTS-cofc-1_24-vv-00229
Petitioner: Nahed Refaat
Filed: 2024-02-14
Decided: 2025-11-04
Vaccine: influenza
Vaccination date: 2022-02-14
Condition: Guillain-Barre syndrome / chronic inflammatory demyelinating polyneuropathy
Outcome: pending
Award amount USD: 

AI-assisted case summary:
On February 14, 2024, Nahed Refaat filed a petition alleging that an influenza vaccine administered on February 14, 2022 caused Guillain-Barre syndrome (GBS). The petition initially proceeded as a Table GBS claim.

The medical record contained competing diagnostic signals. Ms. Refaat had a history of positive ANA testing and Sjogren's syndrome. In her declaration she said she had body aches a few days after the flu shot and, seven to ten days after vaccination, developed severe body pain, numbness, weakness, fatigue, and tingling in her feet that made walking and driving difficult. On March 7, 2022, she reported body aches beginning a day or two after the vaccination and numbness in her lower extremities. She went to the emergency room the same day with body aches and tingling in her hands, feet, knees, and legs. A neurologist considered her symptoms suggestive of GBS; a hematology-oncology consultation also noted leukopenia, Sjogren's syndrome, and low-normal vitamin B12. She received three doses of IVIG and was discharged.

Follow-up records continued to describe neuropathic symptoms, but later testing and neurology records raised chronic inflammatory demyelinating polyneuropathy (CIDP). A May 2022 EMG showed demyelinating polyneuropathy with acute and chronic motor axon loss in both lower extremities, which the neurologist considered consistent with CIDP. By October 2022, records still referenced GBS but also stated that she remained symptomatic and had CIDP.

Respondent argued that CIDP was a more likely alternative diagnosis and that a one-to-two-day onset would not satisfy the Table GBS window. Chief Special Master Brian H. Corcoran dismissed only the Table GBS claim on November 4, 2025, because CIDP is an exclusionary diagnosis under the GBS Table criteria. He did not decide the off-Table causation claim. Ms. Refaat elected to proceed on a causation-in-fact theory, and the case was transferred out of the Special Processing Unit for expert development.

Theory of causation field:
Influenza vaccine on February 14, 2022, allegedly causing GBS/peripheral neuropathy; TABLE GBS DISMISSED, off-Table claim pending. Facts: Sjogren's/positive ANA history; body aches within 1-2 days or a few days; severe pain, numbness, weakness, fatigue and foot tingling 7-10 days; March 2022 hospitalization, IVIG x3, normal head CT/brain MRI; May 2022 EMG showed demyelinating polyneuropathy with acute/chronic motor axon loss; neurologist later listed CIDP. Respondent argued CIDP and too-early onset defeated Table GBS. Chief SM Brian H. Corcoran dismissed Table claim under CIDP exclusion but allowed non-Table causation claim to proceed; petition filed February 14, 2024; ruling November 4, 2025. Attorney: Ronald C. Homer, Conway Homer, Boston MA.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_24-vv-00229-0
Date issued/filed: 2026-04-15
Pages: 6
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/04/2025) regarding 26 Findings of Fact & Conclusions of Law,, Order Reassigning Case Special Master, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 1 of 6
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 24-229V
NAHED REFAAT, Chief Special Master Corcoran
Petitioner, Filed: November 4, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Emily Hanson, U.S. Department of Justice, Washington, DC, for Respondent.
FINDINGS OF FACT AND CONCLUSIONS OF LAW DISMISSING TABLE CLAIM1
On February 14, 2024, Nahed Refaat 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 (under the Vaccine Act Table) that she suffered from
Guillain-Barré syndrome (“GBS”) as a result of an influenza (“flu”) vaccine she received
on February 14, 2022. Pet. at 1.
Respondent’s Rule 4(c) Report (filed on December 20, 2024,) set forth objections
to the Table claim asserted herein. Respondent’s Report, ECF No. 22. Respondent
argues that the medical records support a more likely alternative diagnosis – chronic
1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required
to post it on the United States Court of Federal Claims' website in accordance with the E-Government Act
of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government
Services). This means the Ruling will be available to anyone with access to the internet. In accordance
with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other information,
the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I agree that
the identified material fits within this definition, I will redact such material from public access.
2 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 (2018).

Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 2 of 6
inflammatory demyelinating polyneuropathy (“CIDP”) - which means a Table claim is not
viable.3 Id. at 8-9.
In response to Respondent’s arguments, on September 11, 2025, I ordered
Petitioner to show cause why her Table GBS claim should not be dismissed. ECF No. 24.
I explained that the record as it stands contains several items of evidence supporting a
possible alternate “exclusionary” diagnosis for Petitioner’s GBS – including CIDP. Id. at
3. More so, I noted that (while not the basis of the Order to Show Cause) Petitioner’s
reports of a two-day onset likewise do not support the Table’s requirements for GBS, and
her Table claim would thus fail either way. Id. at 3-4. In reaction, Petitioner filed a status
report stating that she wishes to proceed with a causation-in-fact claim, and understands
her case will be transferred out of SPU. ECF No. 25. Resolution of Petitioner’s Table claim
is now ripe for consideration.
I. Factual Background4
Petitioner’s medical history is relevant for positive ANA testing in October 2020
and Sjögren’s syndrome. Ex. 5 at 7-9; Ex. 6 at 30-31, 38. Petitioner received the subject
flu vaccine on February 14, 2022, during an annual visit with her primary care provider
(“PCP”). Ex. 2 at 25, 28.
In her witness declaration (authored in February 2024), Petitioner attests that “a
few days after [her] flu vaccine,” she had some body aches. Ex. 11 ¶ 4. Then, “seven to
ten days after” vaccination, she “began to experience symptoms that [she] had never felt
before[,]” including severe pain throughout her body, numbness, significant weakness,
and fatigue. Id. She also described tingling in her feet, which made it difficult to walk or
drive. Id.
On March 7, 2022, Petitioner had a telemedicine visit with her PCP and reported
body aches that began a day or two after her February 14th visit and vaccination. Ex. 7 at
14. She also complained of bilateral lower extremity numbness (that had improved), pain
radiating down the bilateral lower extremities, plus low back pain. Id.
The same day, Petitioner went to the ER complaining of body aches and tingling
in her hands, feet, and knees/legs that began “[a] few days after receiving a flu vaccine 2
weeks ago.” Ex. 6 at 30. Following a neurology consultation on March 8, 2022, and a
3 Respondent also contended that the medical records establish a one-to-two-day onset of her injury, which
is inconsistent with the Table’s 3-42 window for a Table GBS claim. ECF No. 22 at 9-10.
4 A more complete recitation of the facts can be found in the Petition and Respondent’s Rule 4(c) Report.
Although I have reviewed all of the records filed to date, I have limited my discussion in this Ruling to the
records most relevant to the resolution of Petitioner’s Table claim, with a particular focus on diagnosis and
the onset of Petitioner’s alleged injury, where appropriate.
2

Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 3 of 6
normal head CT, the neurologist thought that Petitioner had “symptoms suggestive of
[GBS].” Id. at 40.
While hospitalized, Petitioner had a consultation with a hematologist-oncologist.
Ex. 6 at 42. The treater noted that Petitioner’s white blood cell count was low the previous
week and thus evaluated her for leukopenia. See id. Following an unremarkable brain
MRI, the treater assessed Petitioner with GBS, possible leukopenia “due to GBS vs
autoimmune d/o,” Sjögren’s syndrome, and a low/normal vitamin B12 level. Id. at 45. After
treatment with three doses of IVIG, Petitioner was discharged the next day with
“symptoms suggestive of [GBS].” Id. at 58.
On March 15, 2022, Petitioner had a visit with her PCP and noted ongoing tingling,
weakness, and some chest pain since her hospital discharge. Ex. 2 at 11-12. The PCP
assessed Petitioner with GBS (that had improved with IVIG) and “other neutropenia.” Id.
at 12.
Later that month (on March 23, 2022), Petitioner followed up with her neurologist.
Ex. 3 at 9. The neurologist noted Petitioner’s recent history of “symptoms of [GBS],” that
she was treated with IVIG (during her hospitalization), “and her symptoms of paresthesias
and weakness of the extremities improved somewhat.” Id. Petitioner had “continued
paresthesias in the face and pain in the legs when she exerts herself.” Id. Petitioner’s
“ongoing diagnoses” included GBS and “chronic inflammatory demyelinating polyneuritis
[CIDP].” Id. at 10. Despite both listed diagnoses, the treater’s impression was that
Petitioner’s “symptoms [were] suggestive of [GBS] . . . as a result of influenza
vaccination.” Id. The neurologist prescribed weekly IVIG. Id.
At the direction of her neurologist, Petitioner underwent an EMG of the lower
extremities on May 22, 2022. Ex. 3 at 13. The impression was “demyelinating
polyneuropathy affecting the lower extremities” associated with “acute and chronic motor
axon loss” in the bilateral lower extremities. Id. The neurologist thought “[t]his is consistent
with a diagnosis of CIDP.” Id.
During an October 31, 2022 neurology follow-up visit, Petitioner had ongoing
paresthesias and weakness in her bilateral lower extremities. Ex. 8 at 5. The neurologist
reiterated her earlier impression – that Petitioner had GBS and “[t]his was a result of
influenza vaccination.” Id. at 6. But the neurologist also noted that Petitioner “continue[d]
to remain symptomatic and had CIDP.” Id. Both GBS and CIDP were listed among
Petitioner’s “ongoing diagnoses.” Id. There are no records of any subsequent treatment
pertinent to Petitioner’s GBS diagnosis or the onset of her post-vaccination injury.
3

Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 4 of 6
II. Applicable Legal Standards
Under Section 13(a)(1)(A) of the Act, a petitioner must preponderantly
demonstrate that all requirements for a petition set forth in section 11(c)(1) have been
satisfied. A petitioner may prevail on her claim if the vaccinee for whom she seeks
compensation has “sustained, or endured the significant aggravation of any illness,
disability, injury, or condition” set forth in the Vaccine Injury Table (the Table). Section
11(c)(1)(C)(i). The most recent version of the Table, which can be found at 42 C.F.R. §
100.3, identifies the vaccines covered under the Program, the corresponding injuries, and
the time period in which the particular injuries must occur after vaccination. Section 14(a).
If petitioner establishes that the vaccinee has suffered a “Table Injury,” causation is
presumed.
In order to qualify for a Table presumption of causation for GBS, a petitioner must
establish that she experienced the onset of her symptoms within 3-42 days of the subject
flu vaccination, and that she satisfies the criteria set forth in the Act’s Qualifications and
Aids to Interpretation (“QAIs”). 42 C.F.R. Section 100.3(c)(15). The QAIs require a
showing of (A) bilateral flaccid limb weakness and decreased or absent deep tendon
reflexes in weak limbs; (B) a monophasic illness pattern; (C) an interval between onset
and nadir of weakness between 12 hours and 28 days; (D) subsequent clinical plateau
(which leads to either stabilization at the nadir of symptoms or subsequent improvement
without significant relapse); and (E) the absence of an identified more likely alternative
diagnosis – including (in relevant part) CIDP and vasculitis. Sections 100.3(c)(15)(ii), (vi).
If, however, the vaccinee suffered an injury that either is not listed in the Table or
did not occur within the prescribed time frame, petitioner must prove that the administered
vaccine caused injury to receive Program compensation on behalf of the vaccinee.
Section 11(c)(1)(C)(ii) and (iii). In such circumstances, petitioner asserts a “non-Table or
[an] off-Table” claim and to prevail, petitioner must prove her claim by preponderant
evidence. Section 13(a)(1)(A). This standard is “one of . . . simple preponderance, or
‘more probable than not’ causation.” Althen v. Sec’y of Health & Human Servs., 418 F.3d
1274, 1279-80 (Fed. Cir. 2005) (referencing Hellebrand v. Sec’y of Health & Human
Servs., 999 F.2d 1565, 1572-73 (Fed. Cir. 1993). The Federal Circuit has held that to
establish an off-Table injury, petitioners must “prove . . . that the vaccine was not only a
but-for cause of the injury but also a substantial factor in bringing about the injury.”
Shyface v. Sec’y of Health & Human Servs., 165 F.3d 1344, 1351 (Fed. Cir 1999). Id. at
1352. The received vaccine, however, need not be the predominant cause of the injury.
Id. at 1351.
The determination that a petitioner is entitled to compensation must not be “based
on the claims of a petitioner alone, unsubstantiated by medical records or by medical
opinion.” Section 13(a)(1). Further, contemporaneous medical records are presumed to
4

Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 5 of 6
be accurate and complete in their recording of all relevant information as to petitioner’s
medical issues. Cucuras v. Sec’y of Health & Human Servs., 993, F.2d 1525, 1528 (Fed.
Cir. 1993). Testimony offered after the events in questions is considered less reliable than
contemporaneous reports because the need for accurate explanation of symptoms is
more immediate. Reusser v. Sec’y of Health & Human Servs., 28 Fed. Cl. 516, 523
(1993).
Analysis
As articulated in my Order to Show Cause, Petitioner’s medical records contain at
least two proposed diagnoses: GBS and CIDP – with at least her treating neurologist
opining that her EMG findings were consistent with CIDP as the most accurate diagnosis.
Ex. 3 at 13. Thus, it is not facially evident that Petitioner did suffer from GBS, as alleged.
Indeed, this record suggests that what may have been thought to be GBS initially was
deemed later to be something else.
The presence of CIDP as an identified more likely alternative diagnosis precludes
Petitioner from establishing a Table GBS claim, as her injury is inconsistent with the
Table-defined version of GBS in the QAIs. Section 100.3(c)(15)(vi) (“[e]xclusionary criteria
for the diagnosis of all subtypes of GBS include the ultimate diagnosis of any of the
following conditions: chronic immune demyelinating polyradiculopathy (CIDP) . . . .”). For
this reason, her Table GBS claim must be dismissed.
Because Petitioner has not demonstrated a GBS diagnosis consistent with the
QAIs, I do not find it necessary to make a determination regarding onset at this time. I will
note, however, there exist notations in the contemporaneous medical records that could
support a one-to-two day onset of her overall injury.5 See, e.g., Ex. 7 at 14 (reporting that
she “noticed [b]ody-aches [sic] 1-2 days after last visit during which she received the flu
shot, she also noticed numbness in [bilateral] lower ext[remities] off and on which since
improved.”). Although a claimant might seek to argue (on a non-Table basis) that a one-
to-two-day onset was medically acceptable, more often than not such arguments fail.6
5 On the other hand, there also exists at least one notation placing onset of her body aches and tingling in
her hands, feet, and legs beginning a “few days after receiving a flu vaccine 2 weeks ago.” Ex. 6 at 30. This
notation thus could be interpreted in favor of onset occurring within the Table’s 3-42 day window.
6 See, e.g., Rowan v. Sec’y of Health & Human Servs., No. 17-760V, 2020 WL 2954954, at *16-19 (Fed.
Cl. Spec. Mstr. Apr. 28, 2020) (finding a GBS onset sooner than three days post vaccination was not
scientifically or medically supported by the record, given that GBS is known to be mediated by antibodies
produced via the adaptive immune system, and this process takes longer than 3 days to result in
symptoms); Orton v. Sec’y of Health & Human Servs., No. 13-631V, 2015 WL 1275459, at *3-4 (Fed. Cl.
Spec. Mstr. Feb. 23, 2015) (finding a 1-day onset of GBS following a flu vaccination was not substantiated
by the evidence).
5

Case 1:24-vv-00229-UNJ Document 32 Filed 04/15/26 Page 6 of 6
Only under special circumstances has such a short onset succeeded.7 While these prior
determinations do not control this outcome, they demonstrate that what is known
medically/scientifically about the pathogenesis of GBS and weighs against findings of flu
vaccine causality when the onset is too close temporally to the vaccination event.
Despite this, it certainly is not the case in the Program that a claimant can never
establish a vaccine-caused peripheral neuropathy based on a very short onset. And here,
it is conceivable that a non-Table claim could likewise be viable or, alternatively, that
onset was actually later than one-to-two days post vaccination. However, expert support
will be necessary for the resolution of a causation-in-fact claim and a determination
regarding proper diagnosis and onset.
Conclusion
Petitioner cannot proceed on a Table GBS claim in this matter, and therefore any
such claim is hereby DISMISSED. Petitioner’s remaining non-Table claim, however, may
proceed. Because of the factual and medical issues to be decided (requiring amplification
via experts), the claim is unlikely to be expeditiously resolved in SPU. For this reason,
transfer is appropriate. Pursuant to Vaccine Rule 3(d), the above-captioned case is
hereby transferred out of SPU and reassigned randomly to a Special Master by the
Clerk’s Office. Further proceedings will be determined by the assigned Special
Master.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
7 See, e.g., Lehrman v. Sec’y of Health & Human Servs., No. 13-901V, 2018 WL 1788477, at *14-19 (Fed.
Cl. Spec. Mstr. Mar. 19, 2018) (finding entitlement for a petitioner who established a pre-vaccination history
of an upper respiratory infection, which, in combination with the flu vaccination, was found to have resulted
in an upregulation of the petitioner’s immune system that led to a rapid onset of GBS and thus a 1-day
onset was appropriate); Shyface v. Sec’y of Health & Human Servs., 165 F.3d 1344, 1352-53 (Fed. Cir.
1999) (finding that a petitioner must prove that the vaccine was a substantial factor – not the only factor –
in causing the illness and that the harm would not have occurred in the absence of the vaccination).
6