In the United States Court of Federal Claims 

OFFICE OF SPECIAL MASTERS

No. 14-750V

Filed: November 21, 2017

Not to be Published.

*************************************

PANAGOULA E. BEKIARIS, *

 *

Petitioner, * 

 * Human papillomavirus (“HPV”)

v. * rashes; no expert report; failure 

 * to prosecute; dismissal

SECRETARY OF HEALTH *

AND HUMAN SERVICES, *

 *

 Respondent. *

*

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Anthony F. Chapekis, Chicago, IL, for petitioner.

Ann D. Martin, Washington, DC, for respondent.

MILLMAN, Special Master

DECISION1

On August 19, 2014, petitioner filed a petition under the National Childhood Vaccine 

Injury Act, 42 U.S.C. § 300aa-10-34 (2012), alleging that human papillomavirus (“HPV” or 

“Gardasil”) vaccine administered August 25, 2011 caused an intense skin reaction to her sweat, 

chlorine, and soap among other substances; hyperactivity, anxiety; skin rashes; and permanent 

disfigurement. Pet. Preamble and ¶¶ 4-7. Petitioner did not file medical records until November 

26, 2014, three months after she filed the petition. Petitioner did not file her affidavit until July 

24, 2015, eleven months after she filed her petition. She did not file additional medical records 

until July 29, 2015. Even then, petitioner had more medical records which she never filed.

 1 Because this unpublished decision contains a reasoned explanation for the special master’s action in this 

case, the special master intends to post this unpublished decision on the United States Court of Federal 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). Vaccine Rule 18(b) states that 

all decisions of the special masters will be made available to the public unless they contain trade secrets 

or commercial or financial information that is privileged and confidential, or medical or similar 

information whose disclosure would constitute a clearly unwarranted invasion of privacy. When such a 

decision is filed, petitioner has 14 days to identify and move to redact such information prior to the 

document’s disclosure. If the special master, upon review, agrees that the identified material fits within 

the banned categories listed above, the special master shall redact such material from public access.
2

On September 24, 2015, respondent filed his Rule 4(c) Report opposing compensation. 

On October 14, 2015, the undersigned issued an Order setting a deadline of July 13, 2016 

(one year later) for petitioner to file an expert report. The reason the undersigned gave petitioner 

one year to file an expert report is that the pattern of petitioner’s behavior was to delay 

constantly and not respond appropriately to orders. Petitioner did not file an expert report by the 

deadline one year later or ever. 

A year after the expert report was due, on July 7, 2017, petitioner moved for discovery 

from Merck, the manufacturer of Gardasil, of samples of the prior (2011) formula of Gardasil 

vaccine; chemical and clinical facts/notes regarding the former formulation of Gardasil and 

subsequent formulas; information regarding the changes in the formula and the reasons for the 

changes; and any further information to enable a clinician to form an opinion “theoretically 

linking the injuries” petitioner claimed the vaccine caused. Pet. Mot. at ¶ 13.

On July 10, 2017, the undersigned denied petitioner’s motion for discovery. Most of 

petitioner’s medical records refer to her having acne vulgaris, not urticarial (hives) and rashes. 

Order at 5. The undersigned regarded petitioner’s motion for discovery consistent with the 

pattern of petitioner’s numerous efforts to delay resolution of the case. Id. at 6.

On July 13, 2017, after a telephonic status conference in which petitioner’s counsel stated 

that petitioner was less than responsive, the undersigned issued an Order stating that if petitioner 

did not file medical records from her current doctor, Dr. Ioannis Moissidis, by November 17, 

2017, the undersigned would dismiss this case for failure to prosecute under Vaccine Rule 

21(b)(1).

Petitioner did not file anything by November 17, 2017. The undersigned now 

DISMISSES this case for failure to prosecute.

FACTS

Pre-Vaccination Records

On March 2, 2009, petitioner saw Dr. Patricia Stec, complaining of a runny nose, stuffy 

nose, coughing, headache, dizziness for 10 days, and anxiety. Med. recs. Ex. 3, at 24.

On July 5, 2010, petitioner saw her doctor because she noticed she was unable fully to 

extend her arms past 170 degrees bilaterally in cheerleading. Id. She received her first Gardasil 

vaccination. Id.

On October 16, 2010, petitioner returned to her doctor for her second Gardasil 

vaccination. Id. She said she felt dizzy after her last vaccination but recovered quickly and felt 

good afterwards.
3

Post-Vaccination Records

On August 25, 2011, petitioner received her third Gardasil vaccination. Med. recs. Ex. 3, 

at 20.

On August 26, 2011, petitioner telephoned Dr. Frank Roemisch and said she had transient 

urticaria (hives) the prior night, which was eight hours after Gardasil and when petitioner was 

very stressed regarding time constraints to do her homework. Med. recs. Ex. 5, at 36. 

Petitioner’s urticaria was resolved with Benadryl taken the prior night and repeated that morning. 

She did not have systemic symptoms. Id.

On August 27, 2011, petitioner telephoned Dr. Roemisch and said her hives relapsed 

without systemic symptoms. Id. Dr. Roemisch said to take a cool shower and use Benadryl. 

She was to call on August 29, 2011 or as needed if she had any new or increased symptoms. She 

was to start a trigger diary. Id.

On October 8, 2011, petitioner saw Dr. Roemisch, complaining of a body rash and severe 

pruritis (itching) since August 26, 2011, especially on her upper body and arms. Med. recs. Ex. 

3, at 25. Benadryl helped, but made her drowsy. She had an increase in pruritis after a gym 

class. Id. On a physical examination, petitioner had generalized urticaria with some minor 

excoriations. Med. recs. Ex. 5, at 37. Dr. Roemisch prescribed Prednisone 20 mg. If 

petitioner’s symptoms increased or persisted, she was to use Xyzal2 5 mg. and see an allergist. 

Id.

On October 15, 2011, petitioner telephoned Dr. Roemisch and said her pruritis decreased, 

she was off Prednisone, and she did not use Xyzal. Id. 

On November 1, 2011, petitioner saw LPN Reyna Garcia, who works with Dr. Stec. Id.

at 33. Petitioner thought she might have scratched her eye. On examination, petitioner was 

noted to have moderate inflammatory acne on her face for which LPN Garcia prescribed Atralin 

0.05% gel. Id. 

On April 19, 2012, petitioner telephoned Dr. Roemisch, complaining of pruritus and 

rashes with multiple lotions and exercise. Id. at 37. She told Dr. Roemisch that Xyzal was too 

strong. Benadryl was effective but did not last six hours. Petitioner had not seen an allergist 

because she had not found a Greek allergist and did not have insurance. Dr. Roemisch 

prescribed Claritin 5 mg. If that did not work, she should try Singulair, and if that failed, she 

should consider adding a H2 blocker. He said not to use the gym for two months. Id.

On April 17, 2013, petitioner saw Dr. Vassilios Dimitropoulos, a dermatologist, who 

 2

 Xyzal is “trademark for a preparation of levocetirizine dihydrochloride.” Dorland’s Illustrated Medical 

Dictionary 2088 (32nd ed. 2012) (hereinafter, “Dorland’s”). Levocetirizine dihydrochloride is “a 

histamine H1-receptor antagonist used in treatment of allergic rhinitis and chronic idiopathic urticaria....” 

Dorland’s at 1032.
4

diagnosed her with acne vulgaris on her face, chest, and back, post-inflammatory 

hyperpigmentation, and xerosis (abnormally dry skin). Med. recs. Ex. 2, at 14. Petitioner had 

had acne for six years. Id. (This would put onset of her acne in 2007, four years before her third 

HPV vaccination.) On a physical examination, petitioner had numerous erythematous papules, 

rare pustules, multiple excoriations, and numerous open and closed comedones.3 Id. at 15. She 

had many erythematous inflammatory stains. Id. Dr. Dimitropoulos prescribed Minocycline4

100mg and Tretinoin5 0.025% cream. Id. at 16. 

On June 19, 2013, petitioner returned to Dr. Dimitropoulos. Id. at 10. Her acne was not 

itching, painful, or burning. It was localized to her face. Id.

On August 14, 2013, petitioner returned to Dr. Dimitropoulos. Id. at 1. He diagnosed her 

with improving acne vulgaris and post-inflammatory hyperpigmentation. Id. at 5. Petitioner had 

an allergic reaction to Cefuroxime6 in the form of a rash. Id. at 2.

On February 5, 2014, petitioner returned to Dr. Dimitropoulos. Id. at 6. Her acne was 

mild, localized to her face, and characterized by blackheads. It did not itch, and was not painful 

or burning. Id. 

On January 7, 2015, petitioner returned to Dr. Dimitropoulos. Med. recs. Ex. 4, at 27. 

She had facial acne, dermatographism7 on her arms, post-inflammatory hyperpigmentation, 

photodamage, and lentigos.8 Id. Dr. Dimitropoulos discussed petitioner seeing an immunologist 

and allergist. Id.

DISCUSSION

To satisfy her burden of proving causation in fact, petitioner must prove by preponderant 

evidence: “(1) a medical theory causally connecting the vaccination and the injury; (2) a logical 

sequence of cause and effect showing that the vaccination was the reason for the injury; and (3) a 

showing of a proximate temporal relationship between vaccination and injury.” Althen v. Sec’y 

of HHS, 418 F.3d 1274, 1278 (Fed. Cir. 2005). In Althen, the Federal Circuit quoted its opinion 

 3

 Comedones are the plural of “comedo.” A comedo is a “noninflammatory lesion of acne vulgaris and a 

few other conditions, consisting of a plug of keratin and sebum within the dilated orifice of a hair follicle; 

it usually contains bacteria . . . .” Dorland’s at 390.

4

 Minocycline is “a semisynthetic broad-spectrum antibiotic of the tetracycline group.” Dorland’s at 

1168. 

5

 Tretinoin is “all-trans-retinoic acid, applied topically in the treatment of acne vulgaris . . . .” Dorland’s

at 1959. 

6

 Cefuroxime is “a synthetic, broad-spectrum ß-lactase-resistant, second-generation cephalosporin 

effective against a wide range of gram-positive and gram-negative bacteria.” Dorland’s at 312.

7

 Dermatographism also known as dermographism is “a type of physical urticaria in which moderately 

firm stroking or scratching of the skin with a dull instrument produces a wheal with a red flare on each 

side.” Dorland’s at 499.

8

 Lentigo is “a small, flat, tan to dark brown or black, macular melanosis on the skin; it resembles a 

freckle clinically but is histologically distinct . . . .” Dorland’s at 1022.
5

in Grant v. Secretary of Health and Human Services, 956 F.2d 1144, 1148 (Fed. Cir. 1992):

A persuasive medical theory is demonstrated by “proof of a logical 

sequence of cause of and effect showing that the vaccination was 

the reason for the injury [,]” the logical sequence being supported 

by a “reputable medical or scientific explanation[,]” i.e., “evidence 

in the form of scientific studies or expert medical testimony[.]”

418 F.3d at 1278.

Without more, “evidence showing an absence of other causes does not meet petitioner’s 

affirmative duty to show actual or legal causation.” Grant, 956 F.2d at 1149. Mere temporal 

association is not sufficient to prove causation in fact. Id. at 1148.

Petitioner must show not only that but for Gardasil vaccine, she would not have had 

rashes and other alleged injuries, but also that Gardasil vaccine was a substantial factor in 

causing her rashes and other alleged injuries. Shyface v. Sec’y of HHS, 165 F.3d 1344, 1352 

(Fed. Cir. 1999). 

The Vaccine Act, 42 U.S.C. § 300aa-13(a)(1), prohibits the undersigned from ruling for 

petitioner based solely on her allegations unsubstantiated by medical records or medical opinion. 

The medical records do not support petitioner’s allegations. She has not filed a medical expert 

opinion in support of her allegations.

The undersigned DISMISSES this petition for failure to prosecute under Vaccine Rule 

21(b)(1). 

CONCLUSION

The petition is DISMISSED. In the absence of a motion for review filed pursuant to 

RCFC Appendix B, the Clerk of Court is directed to enter judgment herewith.9

IT IS SO ORDERED.

Dated: November 21, 2017 /s/ Laura D. Millman 

 Laura D. Millman

 Special Master

 9 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by each party, either separately or 

jointly, filing a notice renouncing the right to seek review.