Natalie Sword v. HHS - DPT, encephalopathy (1999)

Natalie Sword, born February 13, 1975, received her second Diphtheria-Pertussis-Tetanus (DPT) vaccination approximately five weeks after her first. Prior to the second vaccination, a physician examined her and noted she laughed and babbled, had a small cough, and was developing a chest problem, but her lungs were clear.

Natalie was vaccinated around 10:30 a.m. She immediately began crying, drank some formula, and fell asleep, never to awaken.

Within four hours of the vaccination, she died. Petitioners presented expert testimony from Dr.

Marcel Kinsbourne and Dr. John J.

Shane. Dr.

Kinsbourne concluded Natalie suffered an on-Table encephalopathy caused by the DPT vaccine, which, in combination with her underlying congenital cystic adenomatoid malformation (CCAM), led to her death. Dr.

Shane also testified that Natalie's death resulted from DPT-encephalopathy, persuaded by classic indications of encephalopathy and the lack of CCAM symptomology. The respondent presented expert opinions from Dr.

Russell D. Snyder, Dr.

Lester S. Adelman, and Dr.

Virginia M. Anderson.

Dr. Anderson attributed Natalie's death solely to her CCAM condition, though her testimony was inconsistent and lacked a clear causal explanation.

Dr. Snyder did not believe Natalie had an acute encephalopathy, relying principally on Dr.

Anderson's report and attributing the death to a pulmonary difficulty, though he was unaware of CCAM. Dr.

Adelman testified that Natalie suffered from a form of bacterial lung infection but deferred to Dr. Anderson's opinion on the cause of death.

The Special Master found that the DPT vaccine caused an encephalopathy that led to Natalie's death, either as an on-Table injury or through causation in fact and significant aggravation of her CCAM. The Special Master's explanation was that Natalie experienced drowsiness, a typical response to DPT, and because of her underlying CCAM, she could not recover from this drowsiness due to insufficient air reserve and died.

The Court of Federal Claims affirmed the Special Master's decision, finding it supported by the record and not arbitrary or capricious. The court rejected the Government's arguments regarding procedural unfairness and the Special Master's adoption of a theory not explicitly advanced by the petitioners, noting the Special Master's expertise and duty to investigate the facts.

The court also found that any error in not explicitly stating the 'substantial factor' test from Shyface was harmless, as the Special Master's findings compelled the conclusion that the DPT vaccine was the predominant factor in Natalie's death. The court denied the Government's motion for review.