Rachel Leah Reiss-Plavin v. HHS - DPT/DTP, alleged DPT Table residual seizure disorder/significant aggravation of tuberous sclerosis; seizures and developmental delay (1998)

On October 30, 1991, a petition was filed on behalf of Rachel Leah Reiss-Plavin, born June 8, 1989, seeking compensation under the National Childhood Vaccine Injury Act. Rachel received her first Diphtheria-Pertussis-Tetanus (DPT) vaccination on August 4, 1989, and her second on September 15, 1989.

Petitioners alleged that the second DPT vaccination significantly aggravated Rachel's pre-existing Tuberous Sclerosis (TS) by triggering a residual seizure disorder (RSD) within the Vaccine Injury Table time period. The public text does not specify the petitioners' counsel or respondent's counsel.

Rachel's medical history indicated that on September 26, 1989, she was admitted to Humana Hospital after her mother noticed occasional trembling of her left hand while nursing and one blank stare. Dr.

Jacqueline Campbell diagnosed a seizure disorder, noting the second DPT vaccination had been administered ten days prior without apparent reaction. In November 1989, Rachel was diagnosed with TS, a genetic neurocutaneous disorder that can cause cortical tubers in the brain, leading to seizures and developmental problems.

Dr. Robert J.

Baumann, a pediatric neurologist, recorded in November 1989 that Rachel's mother had observed left-arm shaking episodes starting around two months of age, which appeared to be seizures by two and a half months. Records from the University of Kentucky Medical Center indicated seizure onset at three and a half months.

Dr. Bryan C.

Hall noted on December 12, 1989, that Rachel's first seizure occurred on September 15, 1989, after her DPT vaccination, involving left arm vibration, shaking, and staring while nursing. Dr.

Campbell's letter of March 15, 1991, documented that on the day of the second DPT vaccination, Rachel's mother reported fussiness, apparent abdominal cramping, and occasional brief arm tremor. Rachel continued to experience seizures and developmental delay, lagging approximately two years behind in gross and fine motor skills.

Initially, Special Master Laura D. Millman granted entitlement on December 29, 1994, finding that Rachel suffered an on-Table significant aggravation of TS in the form of a partial focal afebrile seizure following the second DPT vaccination.

This decision relied on prior TS/DPT cases and the testimony of Dr. Manuel Gomez, who suggested DPT could trigger seizures in children with TS.

However, the entitlement ruling was reopened after respondent presented new evidence, including a February 2, 1995 letter from Dr. Gomez expressing concerns about the interpretation of his earlier testimony and stating there was no concrete evidence supporting the DPT triggering theory.

Respondent also cited new literature linking cerebral dysfunction, seizures, and mental retardation in TS to the extent of cortical tubers. In an Omnibus Decision on September 15, 1997, Special Master Millman found that while petitioners initially met the Table/significant-aggravation burden, respondent had rebutted the presumption by demonstrating that TS caused Rachel's initial seizure and current condition.

This conclusion was based on evidence that Rachel had at least forty-three tubers, comprising twenty to thirty percent of her cortex and subcortex, and the views of Dr. Gomez and Dr.

Mary Ann Guggenheim that Rachel's seizures were caused by cortical lesions and TS, respectively. On September 18, 1997, Special Master Millman vacated the prior grant of entitlement and dismissed Rachel's petition.

On review, Judge Moody R. Tidwell III reversed the Special Master's broad finding that DPT does not cause infantile spasms or the type of afebrile seizure Rachel experienced, stating this risked undermining the Table presumption.

However, the court affirmed that TS is a legally valid factor unrelated to vaccination and that substantial evidence supported the scientific finding that cortical tubers can cause seizures. The court remanded the case for the Special Master to clarify whether her finding that TS caused Rachel's on-Table seizure still stood independently of the reversed finding about DPT, and to consider whether Rachel had other symptoms of a vaccine reaction beyond the seizure, such as the fussiness and abdominal cramping reported by her mother.

The court affirmed the Special Master's decision to reopen entitlement proceedings and rejected petitioners' challenges regarding respondent's contact with and use of Dr. Gomez.

The public text does not include a final post-remand decision or any compensation award.