IN THE UNITED STATES COURT OF FEDERAL CLAIMS

OFFICE OF THE SPECIAL MASTERS

No. 12-285V

Filed: October 25, 2013

Not for Publication 

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

MONTEZ PETRONELLI, *

*

Petitioner, *

* Decision on the Record; Influenza Vaccine;

v. * Guillain-Barré Syndrome; GBS

*

SECRETARY OF *

HEALTH AND HUMAN SERVICES, *

*

Respondent. *

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

Ronald Homer, Esq., Conway, Homer & Chin-Caplan, P.C., Boston, MA, for petitioner.

Michael P. Milmoe, Esq., U.S. Dept. of Justice, Washington, DC, for respondent. 

RULING ON ENTITLMENT1

Vowell, Chief Special Master:

On May 4, 2012, Montez Petronelli [“Ms. Petronelli” or “petitioner”] timely filed a 

petition for compensation under the National Vaccine Injury Compensation Program, 42 

U.S.C. § 300aa-10, et seq.

2

[the “Vaccine Act” or “Program”]. The petition alleged that, 

as a result of her influenza vaccine on September 28, 2010, Ms. Petronelli suffers from 

a neurological demyelinating injury. The amended petition, filed on December 10, 2012, 

specified that petitioner suffers from Guillain-Barré syndrome [“GBS”].

The Vaccine Act provides that a special master may not make a finding awarding 

compensation based on the claims of a petitioner alone, unsubstantiated by medical 

 

1

Because this unpublished ruling contains a reasoned explanation for the action in this case, I intend to 

post it on the United States Court of Federal Claims' website, in accordance with the E-Government Act 

of 2002, Pub. L. No. 107-347, 116 Stat. 2899, 2913 (Dec. 17, 2002). In accordance with Vaccine Rule 

18(b), petitioner has 14 days to identify and move to delete medical or other information, the disclosure of 

which would constitute an unwarranted invasion of privacy. If, upon review, I agree that the identified 

material fits within this definition, I will delete such material from public access.

2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99-660, 100 Stat. 3755. Hereinafter, for 

ease of citation, all “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 

300aa (2006).
2

records or medical opinion. See § 13(a)(1). Petitioner has proffered both medical 

records and an expert medical opinion by Dr. Thomas Morgan causally linking her GBS 

to her influenza vaccination.

For the reasons stated herein, I find that petitioner has established entitlement to 

compensation.

I. Procedural History.

Between May 4, 2012 and September 4, 2012, when this case was reassigned to 

me, Special Master Lord conducted the initial status conference and petitioner filed 

exhibits 1-7 and her Statement of Completion. See Order, issued June 13, 2012; Notice 

of Intent to file on CD, filed July 10, 2012; Statement of Completion, filed July 13, 2012. 

On September 13, 2012, I held a status conference with the parties. During the 

call, the parties expressed a desire to explore an informal resolution to this case. See

Order, issued Sept. 13, 2012. Petitioner was ordered to file (1) medical records 

requested by respondent by October 15, 2012, (2) a status report when her demand 

was conveyed to respondent, and (3) her expert report by March 13, 2013.

Petitioner filed exhibits 8 and 9 on October 9, 2012. She transmitted her demand 

to respondent on November 20, 2012. Petitioner’s Status Report, filed Nov. 30, 2012. 

Petitioner filed her affidavit and an amended petition on December 10, 2012. Although 

the parties continued to discuss settlement, petitioner filed her expert report on March 

13, 2013.

On April 8, 2013, the parties conveyed to the court that petitioner had received a 

response from respondent regarding her life care plan assessment, but that she had not 

yet received a comprehensive response to her settlement demand and therefore it was 

unclear if a settlement agreement could be reached. Joint Status Report, filed Apr. 8, 

2013, at 1. The parties requested a status conference to discuss future proceedings. 

Id.

On April 17, 2013, following the parties’ requested status conference, I ordered 

respondent to file her Rule 4(c) report, accompanied by any response to petitioner’s 

expert report she may elect to file, by no later than June 17, 2013. Order, issued Apr. 

17, 2013. 

After receiving extensions to her original deadline, respondent filed her Rule 4(c) 

report [“Res. Report”] on July 9, 2013. In the report, respondent stated that she would 

“not offer an expert report in this case,” and that “other than [the] Rule 4(c) Report, and 

the attached literature, respondent will not expend further resources to defend this 

case.” Res. Report at 9. Respondent suggested I decide entitlement based on the 

current case record. Id. Petitioner filed a responsive pleading to respondent’s Rule 4(c)

report on July 30, 2013.
3

II. Evidentiary Record.

Petitioner received an influenza vaccine on September 28, 2010. Petitioner’s 

Exhibit [“Pet. Ex.”] 2, p. 1. No medical records prior to the immunization or from the day 

of the immunization were filed by petitioner. 

On October 21, 2010, petitioner was seen by her primary care physician, Dr. 

Sraboni Banerjee. According Dr. Banerjee’s visit note, petitioner indicated she had 

been sick for six weeks, starting with a chest cold with no fever, sore throat, or cough,

before progressing to a cough with nasal congestion and post nasal drainage. 

Petitioner indicated that her cough had started to resolve after four weeks, but then 

restarted during the past two weeks. Doctor Banerjee diagnosed her with sinusitis and 

prescribed amoxicillin. Pet. Ex. 2, pp. 38-39. At this visit, petitioner also complained of 

feeling very tired and numb, having tingling in her extremities, and muscle aches. 

Doctor Banerjee attributed her tingling to her sinusitis and conveyed to petitioner that 

her symptoms should improve within a couple of days. Id. at 39.

Petitioner had a follow-up visit for her sinusitis on October 25, 2010. Her cough 

was mostly resolved, but she still complained of numbness and muscle pains and 

indicated they had gotten worse. Pet. Ex. 2, p. 43. She expressed frustration that she 

was feeling tired and was unable to read or cook. Id. Doctor Banerjee speculated that 

her tiredness and general achiness were associated with the tension and stress brought 

on by her upcoming GRE exam. Id.

In the evening of October 25, 2010, petitioner fainted and was brought to the 

emergency room [“ER”] by her husband around midnight. She indicated she had a 

cough for two weeks that was almost resolved and had been experiencing worsening 

fatigue, numbness, and weakness. Pet. Ex. 1, p. 88. The ER physician ordered routine 

blood and lab tests. Id., pp. 96-97. Because Dr. Banerjee had sent blood to the lab 

following her appointment with him, there was confusion in the lab and testing of the 

blood sample sent by the ER physician was delayed. Id., p. 95. Petitioner elected to 

leave around 4:30 AM, prior to receiving her lab results, with the understanding that she 

would return if abnormal results were found. Id. 

Petitioner spoke with Dr. Banerjee on October 26, 2010. She reported that since 

returning home from the ER she was doing worse with increased leg weakness, 

difficulty walking and climbing stairs, and a loss of balance. She also indicated that she 

was getting winded very easily and was unable to lift her arms above her head. 

Concerned that she might be describing symptoms of GBS, Dr. Banerjee advised her to 

return to the ER immediately for further evaluation. Pet. Ex. 6, p. 13.

She arrived at the Kaiser Permanente Santa Clara Medical Center [“SCMC”]

around 3:39 PM and was evaluated by emergency room physician Dr. Haydn Hok 

Leung at 4:20 PM. Pet. Ex. 1, pp. 107-08. Ms. Petronelli relayed that she had a cough 

and myalgias for a couple of weeks, and that October 19, 2010 she noticed numbness 

in her toes which had progressively gotten worse and moved up her legs and also into 
4

her arms. She also was experiencing shortness of breath. Pet. Ex. 1, p. 108. 

Petitioner was admitted to the hospital with diagnosis of possible GBS. Id., p. 112. 

A neurology resident at SCMC, Dr. Kelly Yeh, examined petitioner later that day. 

Doctor Yeh recorded that Ms. Petronelli had received a flu vaccine on September 28, 

2010, and thereafter developed a cold consisting of a cough with mucous and a sore 

throat. Doctor Yeh also noted that during the previous week on October 19th or 21st

petitioner started to develop numbness, pins and needles, and coldness in her toes. 

The numbness then ascended up her feet, into her legs, and up to petitioner’s hands. 

Doctor Yeh documented that petitioner had not had any recent medical changes except 

for starting amoxicillin the previous week as treatment for her cold. Pet. Ex. 1, p. 120. 

Upon examination, Dr. Yeh observed petitioner had decreased sensation to light touch 

and pinprick which was worse in her toes bilaterally, but also present in her feet and 

legs, normalizing around petitioner’s knees. Petitioner also demonstrated a decreased 

sensation to touch and pinprick in her hands bilaterally to her mid-proximal forearm. Id., 

p. 121.

Doctor Yeh assessed petitioner as having “ascending numbness/paresthesisas 

with absent reflexes, severe back pain and tenderness of face/extremities, also with 

weakness primarily of hip flexors/hamstrings, suggestive of Guillain-Barre Syndrome.” 

Pet. Ex. 1, p. 122. Doctor Yeh recommended frequent and serial pulmonary function 

tests, a lumbar puncture, and IVIG3treatment. Id. Doctor Jai Hee Cho, a physician at 

SCMC, also briefly saw and examined petitioner. Doctor Cho “agree[d] with the findings 

and the plan of care as documented in [Dr. Yeh’s] note.” However, in recounting 

petitioner’s history of presenting illness in her consult note, Dr. Cho indicated that 

petitioner had a mild upper respiratory infection [“uri”] prior to receiving her influenza 

shot and that the symptoms worsened after the vaccination. Pet. Ex. 1, p. 123. 

Petitioner’s lumbar puncture showed elevated protein levels and normal white 

blood count and glucose, confirming the diagnosis of GBS. Pet. Ex. 1, p. 195. She 

received five days of IVIG treatments at SCMC before being discharged to another 

Kaiser Permanente facility for rehabilitation. Id., pp. 229-232, 236-37. Petitioner was 

discharged from the rehabilitation facility on December 1, 2010. Pet. Ex. 5, pp. 6-7. 

She received home health care, which included physical and occupational therapy until 

January 24, 2011, when she was transitioned to out-patient therapy. See Pet. Ex. 7, pp. 

7-18. 

An EMG/NCV4study was performed in May 2011. The study showed that 

petitioner still had “evidence of a demyelinating sensorimotor polyneuropathy in the 

 

3

“IVIG” stands for intravenous immunoglobulin. Neil M. Davis, MEDICAL ABBREVIATIONS, 15th Edition, at 

178 (2011). 

4

EMG (electromyography) studies look at the electrical activity within muscles and NCV (nerve 

conduction or electroneurography) studies examine the integrity of the peripheral nerves. Kathleen D. 

Pagona & Timothy J. Pagona, MOSBY’S MANUAL OF DIAGNOSTIC AND LABORATORY TESTS [“MOSBY’S LABS”]

at 571-77 (3d. ed. 2006). The two studies are commonly performed at the same time in patients 

complaining of weakness. 
5

upper and lower extremities.” Pet. Ex. 3, pp. 38-39. When compared with the study 

conducted in December 2010, Pet. Ex. 1, pp. 256-57, the study showed significant 

improvement. Pet. Ex. 3, pp. 38-39. In September 2011, petitioner was seen by 

neurologist Dr. Cho and reported that she still required a cane to walk through large 

stores, such as Costco, and could not go to parks without her wheelchair. Id., p. 64. 

Doctor Cho noted that although the “lack of functional improvement is a concern, there 

is no objective evidence that there has been a relapse,” and thus she was not 

concerned about CIDP.5 Pet. Ex. 3, p. 65. 

 

III. Discussion.

A. Legal Standards to Establish Entitlement to Compensation. 

In order to prevail under the Program, a petitioner must prove either a “Table” 

injury6or that a vaccine listed on the Table was the cause in fact of an injury (an “offTable” injury). Because GBS is not a Table injury for any vaccine appearing on the 

Vaccine Injury Table, petitioner must produce preponderant evidence that a covered 

vaccine is responsible for her injury. 

When a petitioner alleges an off-Table injury, eligibility for compensation–the 

prima facie case–is established when the petitioner demonstrates, by a preponderance 

of the evidence, that: (1) she received a vaccine set forth on the Vaccine Injury Table; 

(2) that she received the vaccine in the United States; (3) that she sustained or had 

significantly aggravated an illness, disease, disability, or condition caused by the 

vaccine; and (4) that the condition has persisted for more than six months.7 To satisfy 

her burden of proving causation in fact, petitioner must establish each of the three 

Althen factors 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 proximate temporal relationship 

between vaccination and injury. Althen v. Sec’y, HHS, 418 F.3d 1274, 1278 (Fed. Cir. 

2005); see de Bazan v. Sec’y, HHS, 539 F.3d 1347, 1351-52 (Fed. Cir. 2008); Caves v. 

Sec’y, HHS, 100 Fed. Cl. 119, 132 (2011), aff. per curiam, 463 Fed. Appx. 932, 2012 

WL 858402 (Fed. Cir. 2012) (specifying that each Althen factor must be established by 

preponderant evidence).

 

5

By definition, GBS is monophasic, meaning it occurs only once. In contrast, CIDP reoccurs. In initial 

presentation, patients with CIDP are often difficult to distinguish from patients with GBS, as the initial 

symptoms are very similar. However, GBS typically responds to either plasma exchange or IVIG; patients 

with GBS who receive steroids typically do not improve or may get worse. Patients with CIDP generally 

improve on steroids. A. Ropper & M. Samuels, ADAMS AND VICTOR’S PRINCIPLES OF NEUROLOGY, McGrawHill Companies (9th ed. 2009) at 1292-93. 

6

A “Table” injury is an injury listed on the Vaccine Injury Table, 42 C.F.R. § 100.3 (2011), corresponding

to the vaccine received within the time frame specified. 

7

Section 13(a)(1)(A). This section provides that petitioner must demonstrate by a preponderance of the 

evidence the matters required in the petition by section 300aa–11(c)(1)....” Section 11(c)(1) contains the 

four factors listed above, along with others not relevant in this case.
6

Once petitioner establishes each of the Althen factors by preponderant evidence, 

case, the burden of persuasion shifts and respondent must show that the alleged injury 

was caused by a factor unrelated to the vaccination. See de Bazan, 539 F.3d at 1354 

(citing Knudsen v. Sec’y, HHS, 35 F.3d 543, 548 (Fed. Cir. 1994)); § 13(a)(1)(B). 

Respondent must demonstrate that “the factor unrelated to the vaccination is the more 

likely or principal cause of the injury alleged. Such a showing establishes that the factor 

unrelated, not the vaccination, was ‘principally responsible’ for the injury.” Deribeaux v. 

Sec’y, HHS, 717 F.3d 1363, 1369 (Fed. Cir. 2013). Section 13(a)(2) specifies that 

factors unrelated do “not include any idiopathic, unexplained, unknown, hypothetical, or 

undocumented cause factor, injury, illness, or condition.” Close calls regarding 

causation must be resolved in favor of the petitioner. Althen, 418 F.3d at 1280; but see 

Knudsen, 35 F.3d at 550 (when evidence is in equipoise, the party with the burden of 

proof fails to meet that burden).

By specifying petitioners’ burden of proof in off-Table cases as the 

preponderance of the evidence, directing special masters to consider the evidence as a 

whole, and stating that special masters are not bound by any “diagnosis, conclusion, 

judgment, test result, report, or summary” contained in the record (§13(b)(1)), Congress 

contemplated that special masters would weigh and evaluate expert opinions in 

determining whether petitioners have met their burden of proof. 

In weighing and evaluating expert opinions in Vaccine Act cases, the same 

factors the Supreme Court has considered important in determining their admissibility 

provide the weights and counterweights. See Kumho Tire Co. v. Carmichael, 526 U.S. 

137, 149-50 (1999); Terran v. Sec’y, HHS, 195 F.3d 1302, 1316 (Fed. Cir. 1999). As 

the Supreme Court has noted, a trial court is not required to accept the ipse dixit of any 

expert’s medical or scientific opinion, because the “court may conclude that there is 

simply too great an analytical gap between the data and the opinion proffered.” Gen. 

Elec. Co. v. Joiner, 522 U.S. 136, 146 (1997).

B. Parties’ Contentions Regarding Entitlement.

There is no dispute that petitioner received a covered vaccine administered in the 

United States. It is also clear from the medical records that approximately four weeks 

after receiving a flu vaccine, Ms. Petronelli was diagnosed with GBS and has 

experienced sequelae of GBS for longer than six months. Therefore, the only issue left 

to resolve is whether the influenza vaccine administered on September 28, 2010, was 

the cause-in-fact of petitioner’s GBS.

1. Petitioner’s Expert Report.

In support of petitioner’s claim that her September 28, 2010 influenza vaccination 

caused her GBS, petitioner filed an expert report from Dr. Thomas Morgan. Doctor 

Morgan is a board certified neurologist who has been an assistant professor with the 

Department of Clinical Neuroscience at Brown University’s School of Medicine since 

1978. Pet. Ex. 13 at 1, 3. His report identifies a theory of causation, molecular mimicry, 
7

and indicates that the timing of petitioner’s vaccination and onset of symptoms is 

consistent with the immune mechanism he identified. Pet. Ex. 12 at 5 (explaining that 

“the influenza immunization generated an immune response that cross reacted with 

antigen targets shared by the normal elements of nerve fibers to cause” petitioner’s 

GBS). 

Acknowledging the discrepancy in the medical records regarding whether 

petitioner had an infection prior to her vaccination, which could be the cause of her 

GBS, Dr. Morgan asserts that the notation of a six week history of cold contained in Dr. 

Banerjee’s October 21, 2010 consult note must be in error because petitioner would not 

have been administered a nasal flu vaccine at a time when she was sick with 

congestion and a cough. Pet. Ex. 12 at 5. He also notes that Dr. Banerjee’s consult 

note contradicts the history provided to several physicians while petitioner was 

hospitalized at SCMC and the timeline of events contained in petitioner’s affidavit. 

Additionally, Dr. Morgan addresses petitioner’s sinusitis, diagnosed by Dr. 

Banerjee at the October 21, 2012 visit. He remarked that if that diagnosis was proper, it 

came after petitioner’s flu vaccine and was not the cause of her GBS. Pet. Ex. 12 at 5. 

Doctor Morgan distinguished upper respiratory infections from sinusitis and noted that 

sinusitis “is not causally associated with [GBS].” Id. at 6 (citing Duntz, M., Sinus 

headache and nasal disease, HEADACHES IN CLINICAL PRACTICE, 2d. at 235). 

2. Respondent’s Rule 4(c) Report.

Respondent declined the opportunity I afforded her to file an expert report. In 

response to petitioner’s expert report, respondent only filed her Rule 4(c) report and 

three medical journal articles. In her report, respondent criticizes Dr. Morgan’s report 

because he did “not address a number of references in the record that refer to an 

antecedent cold with no mucus or fever that was treated with amoxicillin connected to a 

vaccination and resolved by October 26, 2010.” Res. Report at 7. Respondent also 

complains that Dr. Morgan did not specifically address the October 26, 2010 note of Dr. 

Cho and its reference to petitioner having an upper respiratory infection prior to her 

influenza vaccination. Res. Report at 7.8 

Because two-thirds of patients diagnosed with GBS suffer from an antecedent

infectious illness and some of petitioner’s records, particularly Dr. Cho’s, suggest that 

Ms. Petronelli had an infection prior to her influenza vaccination, respondent argues that

“it is exceedingly unlikely that her GBS was caused by a flu vaccine.” Res. Report at 8 

(citing Haber et al., Vaccines and Guillain-Barre Syndrome, DRUG SAFETY, 34(4): 309-

323 (2009) at 311). Respondent also questions the likelihood of vaccine causation 

based on the findings contained in the 2011 IOM Report. After reviewing the available 

epidemiologic and mechanistic evidence surrounding the influenza vaccine and GBS, 

 

8 Respondent indicated that “Dr. Kelly Yeh, an internst [sic], related to Dr. Cho ‘that the patient had a mild 

URI, then got flu shot on 9/28 . . . .’” I interpret the record (Pet. Ex. 1, p. 123) as attributing the comment 

about Ms. Petronelli’s potential URI solely to Dr. Cho. Doctor Yeh’s own note concerning her evaluation 

of petitioner states “flu vaccine on 9/28/10, thereafter developed a cold.” Pet. Ex. 1, p. 120.
8

the report concluded there was insufficient evidence to support a causal association

between the influenza vaccine and GBS. Res. Report at 8 (citing K. Stratton, et al., 

ADVERSE EVENTS ASSOCIATED WITH CHILDHOOD VACCINES: EVIDENCE BEARING ON 

CAUSALITY (2011) at 321-34).

3. Petitioner’s Response to Respondent’s Rule 4(c) Report.

In her response to respondent’s Rule 4(c) report, petitioner highlights the 

applicable evidence and discusses how she has satisfied the three Althen prongs. She 

notes that her theory of causation (molecular mimicry) “has consistently been 

recognized as a biologically plausible mechanism for the onset of neurologically 

demyelinating disease, including GBS.” Response at 4. Petitioner also stresses that 

her treating physicians linked her vaccination to her GBS, and that the timing of 

approximately four weeks between her vaccination and onset of symptoms is consistent 

with her causation theory. See Response at 4-7. 

Petitioner argues that she has made a prima facie case, and that respondent has 

failed to meet her burden of showing a factor unrelated to petitioner’s vaccination 

caused her GBS. Petitioner counters respondent’s reliance on the 2011 IOM Report by 

noting its conclusion of no causal relationship between influenza vaccines and GBS was 

based on a requirement of scientific certainty and not the preponderant evidence 

standard applied in the Vaccine Program. Response at 8. Additionally, petitioner notes

that the Haber article filed by respondent supports her theory of causation. Response 

at 7-8. Because respondent did not file an expert report and indicated she would not 

expend additional resources defending this case, petitioner posits that respondent will 

be unable to meet her burden. Response at 9.

C. Analysis.

This case presents the issue of whether an expert report satisfying each of the 

Althen prongs regarding vaccine causation of GBS can be countered successfully by 

medical literature alone. Under the circumstances present here, I conclude that 

literature alone, unexplained by an expert report, does not tip the balance back to 

respondent. 

Petitioner’s expert, Dr. Morgan is a board certified neurologist and an assistant 

professor at Brown University’s School of Medicine. His curriculum vita (Pet. Ex. 13) 

demonstrates that he is qualified to opine in this case. As petitioner noted in her 

response, Dr. Morgan’s causation theory is supported by medical literature filed by 

respondent. See e.g., Haber, Res. Ex. A, at 312 (discussing molecular mimicry as a 

possible biological mechanism for GBS). Although other decisions involving this 

vaccine and this injury do not constitute binding authority,

9

 Dr. Morgan’s opinion is also 

buttressed by other decisions in the Vaccine Program awarding entitlement for GBS 

associated with an influenza vaccine. See e.g., Figueroa v. Sec’y, HHS, 715 F.3d 1314, 

 

9

See Hanlon v. Sec’y, HHS, 40 Fed. Cl. 625 (1998).
9

2013 WL 1811018 at *1 (Fed. Cir. May 1, 2013) (citing Torday v. Sec’y, HHS, No. 07-

372V, 2009 U.S. Claims LEXIS 745 (Fed. Cl. Spec. Mstr. Dec. 10, 2009; Griglock v. 

Sec’y, HHS, 99 Fed. Cl. 373 (2011), aff’d, 687 F.3d 1371 (Fed. Cir. 2012); Stewart v. 

Sec’y, HHS, No. 06-777, 2011 WL 3241585 (Fed. Cl. Spec. Mstr. July 8, 2011)). 

Respondent argues that it was not the influenza vaccine but petitioner’s 

infectious illness that caused her GBS.10 The onset of petitioner’s illness is not 

concretely established. Some records place onset prior to her influenza vaccination and 

others afterwards. Compare Pet. Ex. 1, p. 123; Pet. Ex. 2, pp. 38-39 with Pet. Ex. 1, pp. 

88-89, 112, 126-27; Pet. Ex. 5, pp. 6-7. Additionally, the evidence in the case record 

does not establish what infectious illness petitioner had. It is unclear whether petitioner 

was suffering from an upper respiratory infection or sinusitis; the former being a viral 

infection and the latter a bacterial infection and typically treated with antibiotics.

11

 

Considering the facts contained in the medical records and petitioner’s affidavit, 

the medical journal articles cited, and the sole medical expert opinion offered, I 

conclude that the weight of the evidence in this case favors a finding that petitioner is 

entitled to compensation. 

IV. CONCLUSION

Based on the record before me, I find that there is preponderant evidence that 

petitioner’s September 28, 2010 influenza vaccination was a substantial cause of her 

GBS and that sequelae from petitioner’s GBS persisted for more than six months. I 

further find that respondent did not meet her burden of establishing a factor unrelated 

was responsible for petitioner’s injury. I therefore hold that petitioner has 

established the statutory requirements for entitlement. A damages order will follow. 

IT IS SO ORDERED.

s/ Denise K. Vowell 

Denise K. Vowell

Chief Special Master 

 

10 Respondent’s decision not to file an expert report prevents me from engaging in a comparison of expert 

qualifications and the rationales behind competing causation theories. 

11 Sinusitis Fact Sheet, National Institute of Allergy and Infectious Diseases [“NIAID”] (January 2012) at 3, 

available at http://www.niaid.nih.gov/topics/sinusitis/Documents/sinusitis.pdf.