NORA BETH DORSEY, Special Master.
On April 21, 2014, Markus and Candace Heinze ("petitioners"), filed a petition for compensation on behalf of their daughter, J.H., under the National Vaccine Injury Compensation Program ("the Program" or the "Vaccine Act")
In this case, petitioners allege a "causation-in-fact" injury, thus a medical opinion as to causation is required.
Petitioners filed their petition on April 21, 2014. Medical records and a Statement of Completion were filed over the next four months. On July 21, 2014, respondent filed her report pursuant to Vaccine Rule 4(c), stating that the medical personnel of the Division of Vaccine Injury Compensation reviewed the petition and medical records and concluded that the case was not appropriate for compensation under the Vaccine Act.
The Rule 5 status conference was held on August 7, 2014. The undersigned reviewed the medical records and the information set forth in the Rule 4(c) report, and provided petitioners with time to determine how they wanted to proceed with their case.
On November 20, 2014, petitioners filed a Motion for Judgment on the Administrative Record ("Motion for Judgment") requesting that the undersigned rule on the record as it now stands. Respondent filed a response to the Motion for Judgment on December 15, 2014, stating that respondent does not oppose having the Special Master rule on entitlement on the current record, and relying on the arguments set forth in the Rule 4(c) report.
This case is now ripe for a decision on the record.
J.H. was born on [redacted]. Other than a diagnosis for anisocoria (unequal sized pupils), J.H.'s medical history was otherwise unremarkable.
Eleven days after administration of the MMR vaccine, on May 3, 2011, Markus Heinze called Pediatric Associates, PSC ("PA") to report that J.H. was vomiting and experiencing a rash on her abdomen that occurred the night before. Pet's Ex. 2 at 116. The provider stated that the symptoms could be a result of the MMR vaccine and instructed the parents to monitor the rash.
On May 24, 2011 (32 days after vaccination), J.H. was seen due to a fever lasting two days, a hoarse voice, runny nose, cough, and decreased appetite. Pet's Ex. 2 at 121. That examination was normal except for an erythematic pharynx.
Four months and 18 days after the MMR vaccine (September 9, 2011), J.H. was seen for a rash that started at her navel but spread over her whole body, which her father described as hive-like. Pet's Ex. 2 at 129. The nurse who examined J.H. noted bilateral, cloudy nose drainage, a morbilliform rash on the torso and thigh regions and clear breath sounds.
On September 13, 2011, J.H. was seen for a possible upper respiratory infection, with symptoms starting several weeks prior with a cough. Pet's Ex. 2 at 130-131. J.H. was diagnosed with allergic rhinitis.
The months following J.H.'s diagnosis of Type 1 diabetes included strict monitoring of her blood glucose and blood sugar. Pet's Ex. 2 at 166. Doctors did not document any skin problems during this time until May 1, 2012.
J.H.'s diabetes has been closely monitored since her diagnosis and her doctors created a treatment plan to help manage J.H.'s condition. That management plan includes adjusting the dosage of medication as J.H. grows and develops. Pet's Ex. 3 at 789.
The Vaccine Act established the Program to compensate vaccine-related injuries and deaths. § 300aa-10(a). "Congress designed the Vaccine Program to supplement the state law civil tort system as a simple, fair and expeditious means for compensating vaccine-related injured persons. The Program was established to award `vaccine-injured persons quickly, easily, and with certainty and generosity.'"
To receive compensation under the Vaccine Act, a petitioner must prove either: (1) that she suffered a "Table Injury"—i.e., an injury listed on the Vaccine Injury Table—corresponding to a vaccine that she received, or (2) that she suffered a "causation-in-fact" injury, that is an injury that was actually caused by the vaccine she received.
To establish causation in fact, a petitioner must show by a preponderance of the evidence that but for the vaccination, petitioner would not have been injured, and that the vaccination was a substantial factor in bringing about the injury.
"The special master . . . may not make [] a finding based on the claims of a petitioner alone, unsubstantiated by medical records or by medical opinion." § 300aa-13(a)(1). Causation is determined on a case-by-case basis, with "no hard and fast
If there is no Table Injury, petitioners must prove that the vaccine caused J.H.'s injury. To do so, they must establish, by preponderant evidence: (1) a medical theory causally connecting the vaccine and the injury ("
This case does not involve a Table injury for the MMR vaccine, or any other vaccine. Thus, petitioners must prove that the MMR vaccine was the cause-in-fact of J.H.'s injuries and any injuries she suffered as a result of that vaccine persisted for more than six months. The petitioners have failed to do so.
Petitioners allege that the MMR vaccine caused J.H. to suffer immune dysregulation resulting in erythema multiforme. The medical records do not demonstrate that J.H. was diagnosed with immune dysregulation. J.H. was diagnosed with erythema multiforme on September 9, 2011 (four months and 18 days after vaccination). It is unclear if J.H. had an erythema multiforme rash or a morbilliform rash as both were documented during that visit. Regardless of the correct characterization of the rash, it was gone by September 13, 2011, after persisting for four days. Prior to that diagnosis, J.H. experienced a nonspecific, papular rash on May 3, 2011, eleven days after receiving the MMR vaccine. By May 24, 2011, J.H.'s skin was clear of any rashes or lesions. The doctor suggested that the rash in May could have been a reaction to the MMR vaccine. Assuming, without deciding that the doctor was correct, J.H. suffered from that rash for no more than 21 days. Thus, neither the erythema multiforme rash nor the nonspecific papular rash meet the threshold requirement of an injury lasting six months, as required by the Vaccine Act, and are therefore not compensable injuries.
In addition, the medical records do not indicate any connection between the non-specific papular rash, which occurred in May 2011, and the morbilliform rash or erythema multiforme that was diagnosed in September 2011. During the time between May and September 2011, J.H. had several medical appointments, none of which recorded skin rashes or lesions. Further, even if the two rashes were the result of the same cause, the latest rash ended on September 13, 2011, which is four months and 22 days after vaccination, falling short of the six month requirement.
Petitioners also claim that the MMR vaccine caused J.H. to develop Type 1 diabetes. J.H. does have Type 1 diabetes but there is no medical expert opinion that suggests the MMR vaccine caused her injuries. In addition, prior case law has not supported claims that the MMR vaccination can be causally linked to Type 1 diabetes.
For the reasons discussed above, the undersigned finds that petitioner has not established entitlement to compensation and his petition must be dismissed.