back to look at the decision of the special master found the leak case which we reference the leak case the special master found that the vaccine caused the headache that headache triggered fibromyalgia in this case dr bloody went far beyond th doctor bloodies testimony and that in the leak case there was no testimony about how it back same cause that headache or how a headache triggers fiber malinger that was just that was accepted in the league kids in this case dr blondie went to extreme detail to talk about th through any of these routes and it isn't the problem here that the special master missing disagree with this general causation notion special master said that the evidence shows that these symptoms existed before the vaccine w first two vaccinations the first vaccination was given march second unable and if i could i'd like to talk about the details of that because they are important and it's important to see why the special master rejected this evidence i think it's very very clear when i explain this prayer is a vaccination is robert had a complicated medical history this detail beginning on page eight of our brief his last visit to the doctor before his vaccinations was on february sixteenth one thousand ninety eight and that's vaccination he experienced diarrhea he experienced a shoulder and scapular muscle pains but those resolved that evidence is also confirmed to the government's point is that yes that's what he testified to find his medical records don't pain in the right arm that spread to his neck and then into the left arm mr it was adamant that this did not start until after that second vaccination so let's look at the medical records this is the important one in an office visit on april twenty hundred eight which is eight zero six says he complains of right arm and shoulder pain times two to three weeks left arm and shoulder beginning yesterday the special master said ok if it was two weeks before that would be after the second vaccination if it was three weeks before it would be for the second vaccination so the special master ignored the testimony of the petitioner says you can't you can't accept this test whether occurred after the vaccination even though this is totally actual medical records where there is a discrepancy how can we as a where you see that that are putting because the record here two to three weeks is consistently his testimony two weeks before his after the second vaccination so there's nothing inconsistent about that if you're in pain for two weeks believe me it feels like three weeks it made you feel like four or five times so when you go to a doctor he says how long this been going on the last two or three weeks how many of us are specific there's no specific date but he's added his testimony and we have the affidavits in the record from other people including a close friend that confirmed this did not happen until after the vaccination was an inconsistency regarding the diarrhea really  from that point on going back to what we said earlier even if you look better even if you accepted three weeks before the vaccination so that they could before the second vaccine it still was less than a month after the first vaccine and if you go on page eight one zero eight four dr brenner says that we know that there can be several months between the inciting event and the onset of symptoms so even dr brenner is saying there can be several months between the onset of symptoms and the triggering event so even if you accept that it occurred three weeks before and not two weeks before it still is less than a month after the first vaccination and well within the timeframe that dr brenner himself sets for inciting a triggering event so there's no diary became worse the medical records are totally consistent with this on september twenty fourth he saw dr moses as an eight nine four and dr moses describes sematic complaints water sematic complaints on page then there's a subsequent visit october twenty thousand nine hundred eighty eight which is a one seven three and there the doctor says complains of one month history of burning neck pain with some extension into his interest kettler region as well as  proximal sole shoulders go back one month a month over twenty eight that september twenty eighth september twenty eighth this forty days after the september twenty four vaccination these records are totally consistent the only thing that the special master picked up on was this two to three weeks and the two to three to say two to three weeks puts it either after the second one for before the second but still a first one should have no effect on this case as a matter of fact if you go to  brenner's testimony a one zero nine two he talks about another way that vaccines can cause a vaccine can cause by the miles that he talks about the the court asking the question of hepatitis b vaccine could cause a serum sickness like condition could fibromyalgia follow a serum sickness like condition he says oh that's a whole other question the answer is that if you say to me that it caused the final injury illness  to this and the answer has got to be yes i can say no so now what we do with that we go back to a five thirty eight on a five thirty eight we had dr kennedy's a valuation or dr carey and looking at all this happened says while it is conceivable that he could be a rare serum sickness like reactor to hepatitis b vaccination the duration magnitude of his symptoms seem while out of proportion he saying that the reaction seemed of proportion to what he doesn't understand what dr brenner said is if you have a severe much sickness like reaction that can trigger the long chronic condition which is fib a genetically susceptible individual from the leak case we already know the back scene is one of those triggers which is a potential trigger other triggers dr bonnie what's going to explain allergic reactions can trigger it infections can trigger scenes can trigger it all these things can trigger when i went through a talk with dr brenner and i asked him all these questions is there any evidence of an infection known was there any evidence of an allergic reaction you know well there wasn't evidence of all aggression effect there are all kinds of immune mediated reactions allergic reaction is an immune mediated reaction there are other reactions take longer like an auto immune type reaction dr bloody never claimed this was on he was explaining how the vaccine affects their her logical system a headache for instance and leak case the vaccine can cause a headache that's a neurological system which can trigger fiber ballenger it can affect the immune system like an allergy or serum sickness like reaction it can affect the hormonal system  several months for the inciting event to trigger fibromyalgia that's his testimony we know that was in several months before the summer of ninety ninety eight he had to have to be that sometimes so that timing even according to dr brenner is appropriate what dr bloddy was saying he didn't he didn't rest his theory on this he just said that i have a theory of causation there's a logical sequence of cause and effect of the appropriate to her relationship and he said also it looks to me like this was a case of positive reach challenge because he reacted after that first or second vaccine whichever way you want to cut it and then he added more severe reaction after the third which is documented in medical records so clearly he was made worse dr what he testified that there are things that can make fib called far out we didn't say how far he's he testified the few days that we're talking about was appropriate dr brenner gives us the outside of us because dr brenner testifies it can take several months so we go from there clear in the record that the timing can be they were from a few days or hours two months that's the time for using our age group using their expert dr bloody didn't discuss whether it could take several months because that wasn't his view of the evidence when actually last week yeah i believe it was last week on investigated a lot of different vaccines to see if the risk causal relationship between lots of different conditions in the vaccine that report came out that is something that the secretary of health and human services will look to in determining whether or not there is sufficient evidence to establish a table injury and causal relationship between a vaccine and a particular condition the condition we are talking about here report honestly i haven't had a chance to go through it with a fine tooth comb i believe they addressed all of the childhood vaccines is that the one that was done in conjunction with the national i mean science yes it was actually just focused on autism and diabetes  i don't believe so i know there was an investigation into cambray syndrome and all sorts of other conditions and i do know that it several inches thick because i have seen it but i have not had an opportunity to read through it i just while there might it may be true that there is a genetic predisposition that there has to be a trigger of some sort to create this condition if we're going to assume that the person is susceptible that occur around the time that he received the vaccine there is no evidence in the medical record that evidence came from the testimony of mister get the first vaccine there is nothing and he did not go to any doctors for a month he up which was almost one year later in march of one thousand nine hundred nine mr rickman said i have had direct diarrhea since the previous summer marches not summer and march is when he says the keep developed diarrhea so i don't see how there is any factual basis in the record for his recollection today that he developed diarrhea within twenty four hours regarding the third vaccination he went to his doctor to get aids we were common colds and aches and pains in the in the months before that it would be consistent with how he acted if he had this serious problem and didn't complain to his doctor about it but regarding the third vaccination he went to his doctor for its work and test in relation to his i q patient therapy internship that he was undergoing he went two days after receiving the vaccine which is when he said he was just manifesting all of these symptoms there is nothing in dr moses records to reflect that it reflects that he has generalized anxiety he was prescribed xanax he had  that he had had shoulder pain for believe two months which would preceded the third vaccine and burning neck pain of one month which as mr shoemaker said would be september twenty eighth however i urge you to look at dr moses's records he actually dr moses in august a month prior to the vaccine for that exact complaint burning neck pain so there is no there's no factual basis that there was any type of believe this court has been very clear in the current case that when there is a conflict between medical records particularly companies contemporaneous medical records and current and life testimony significant weight should be given to the medical records what about them the athens case in the three prong test them one of the problems the testimony well that by minimizing the testimony of the special master say that medical trump sure we're testimony he did not use any extremes he did not say always and i know from firsthand experience sometimes testimony does trump the contemporaneous medical records that was not the case here in the special master evaluated the evidence as a whole he sought mr rickett testifying he saw how he looked through all of the records and he made a determination that he was going to credit the contemporaneous medical records over his testimony that determination is entitled to significant deference by this court and any reviewing court as this court actually said in the case which issued yesterday a review in court is not at liberty to second guess the special masters fact conclusions and that is what is being challenged here especially masters factual conclusions on appeal judge miller at the court of federal claims to review these finding he could not discern any error to the contrary he concluded that the special masters findings and analysis were not only rational and supported by substantial evidence of in the record but they were eminently reasonable if the court has no further you we don't need to go in to tell us that fibromyalgia can be triggered by hepatitis b vaccine the leak case already shows that in the leak case the same special master found that the vaccine triggered caused a headache which triggered the informal non adversarial generous and speedy and it's none of those things this is a program work that titian or should not be treated like this the special master said that his testimony was credible that's what the special master  they tried to make dr block you write a report using only the medical records i've represented these cases for over thirty years you can't do that if you look at your medical records of i look at my medical records it does not tell the story of our lives and what happened to us no one knows better what happened to them than the person that lived through it you can also look however exhibit sixteen in this case which is the description of the symptoms and a confirmation by a friend of this of robert testified exactly to the same thing he did the first vaccination nothing was reported the medical records he had some diarrhea some pain but it resolved he had no insurance he didn't go to the doctor so it's not there doesn't mean it didn't happen and dr bodies is ok i can't rely on that because it really is speculation the second vaccination there clearly is evidence of a reaction and i already pointed out that if you look at the four twenty four ninety eight record on a two zero six it it complains of right arm and shoulder pain for two to three weeks left arm and shoulder began yesterday clearly those are symptoms that he's describing to a doctor that occurred after the second vaccination so you're absolutely right the timing is in the medical records it confirms what he says happened that went on and that pain did not stop it continued throughout the summer as matter of fact dr brenner believes that throughout that summer sometime during th summer he didn't say when he says in the summer of ninety eight on that's when he think that he had by a mile because the symptoms were constant thereafter and if you look at dr moses record eighty eight ninety four and six twelve ninety eight he's complaining of pain eight twenty tonight he's  ning of pain the visit on nine twenty four ninety eight is two days after the vaccination and two days after the vaccination against sematic complaints but then if you look at the october twenty eighth one thousand ninety eight visit a one seventy three he complains of a one month history of burning neck with some extension to his interest regular reason as well as proximal shoulders so clearly this fits perfectly with what he said happened after the third vaccination he said that he was able to plug on go dr this is this is right if we talk about that october twenty eighth visit and how that one month before with the symptoms four days after the vaccination i got him to admit that so i said no doctor would you agree that he did have these reactions and if you accept his testimony today in court you heard correctly say yes i did that he did have reactions involving both arms shoulders the neck to scatter region after both the second vaccination and more severely after the third action nation would you agree that there is evidence of challenge challenge answer i would agree that would be were it true and i'm not saying that it is that would be evidence of recurring reaction yes so he's agreeing if you accept the testimony of the titian which is not contradicted by the medical records than in fact is is confirmed by the medical records and if you accept dr moneys testimony the evidence and challenge the challenge detrimentally is not the theory of causation it is further evidence it's like further corroborating evidence you don't need that in the in the lead case there was no challenge we challenge it was a simple that scene caused a headache because triggered by the amount of what we have here is even stronger than the case and what dr wanted was trying to point out was there all these ways the vaccine can trigger fibromyalgia but in this case it's