Opinion ID: 587397
Heading Depth: 2
Heading Rank: 3

Heading: Shock-collapse or hypotonic-hyporesponsive collapse--3 days

Text: 13 D. Residual seizure disorder in accordance with [§ 300aa-14(b)(2) ]--3 daysE. Any acute complication or sequela (including death) of an illness, disability, injury, or condition referred to above which illness, disability, injury, or condition arose within the time period prescribed.... 14 42 U.S.C. § 300aa-14(a)(I). C. Decision of the Special Master 15 i. No Encephalopathy Occurred. Under the Act, a petition for compensation is first heard by a special master, a new office created as a part of the Claims Court. In this case, the designated special master considered that Chelsea's unusual screaming and persistent crying were compatible with an encephalopathy, but, referencing § 300aa-14(b)(3)(A), concluded that these symptoms in and of themselves were not conclusive evidence of encephalopathy. Opinion of Special Master at 7. The special master noted that the presence of an encephalopathy usually can be documented by slow wave activity on an electroencephalogram [ (EEG) ], however, no EEG was performed on Chelsea. Id. The special master also determined that the autopsy did not show any brain damage. Reviewing the evidence, the special master determined that the reported symptoms, considered in the context of the full record, did not support a finding that Chelsea suffered an encephalopathy within three days following the December 1 DTP vaccination. Id. 16 ii. Hypotonia Did Occur. The special master cited § 300aa-14(b)(1) for the proposition that a 17 hypotonic-hyporesponsive collapse may be evidenced by indicia or symptoms such as decrease or loss of muscle tone, ... loss of color or turning pale white or blue, unresponsiveness to environmental stimuli, depression of consciousness, ... or cardiovascular or respiratory arrest. 18 Chelsea exhibited a decrease in muscle tone, loss of color, unresponsiveness or reduced responsiveness to environmental stimuli, depression of consciousness, and ultimately, cardiac and respiratory arrest (although this occurred beyond the 72 hour time frame). Opinion of Special Master at 7. However, while the special master also found that the hypotonia did occur on December 4, the third day following the vaccination, he concluded that it may very well have been caused by the developing pneumonia in Chelsea's lungs. Id. at 8. Likewise, the special master found that the fever, drowsiness and anorexia which Chelsea experienced during the first day or two following her vaccination are common reactions .... Id. Further, the emergency room diagnosis on December 3 specifically noted that Chelsea was not septic. Id. 19 iii. Chelsea Acquired Pneumonia Independently of the DTP Vaccination. The special master concluded that some of the symptoms Chelsea exhibited, including coughing, runny nose, diarrhea and fever, had persisted at least two weeks prior to the DTP vaccination. Petitioner's expert witness testified that Chelsea's fever, deep cough and loss of appetite were explainable by the Klebsiella pneumonia. Only the high-pitched screaming would not be fully explained by the pneumonia. On the other hand, the expert testified, only Chelsea's cough, which predated her second DTP vaccination and worsened following the vaccination, could not be explained by the vaccination. Id. 20 The special master noted that both pneumonia and pertussis can produce hypotonic-hyporesponsive reactions and that Chelsea's white blood cell count was higher than would be expected from the DTP alone. Therefore, the special master concluded, Chelsea was infected with the pneumonia prior to or at about the same time she received the second DTP vaccination and the onset of the pneumonia was independent of the administration of the DPT vaccination. Id. 21 Further, the special master considered two studies presented in support of Petitioner's contention that a DTP vaccination renders the recipient more susceptible to infection. The special master found that neither study provided a basis for concluding that the DTP vaccine made Chelsea more susceptible to the pneumonia. 22 iv. Chelsea's Death was Due to the Pneumonia. Section 300aa-14(a)(I)(E) makes compensable 23 [a]ny acute complication or sequela (including death) of an illness, disability, injury, or condition referred to [in the Table] which illness, disability, injury, or condition arose within the time period prescribed. 24 The special master determined that because Chelsea's death did in fact follow the vaccination, it was a sequela. 5 However, a preponderance of the evidence showed that her death was not caused by the hypotonic-hyporesponsive episode.... It was a sequela temporally, but not causally. Opinion of Special Master at 10. 25 Further, having concluded that Chelsea was experiencing symptoms related to the pneumonia, the special master noted that Chelsea may also have experienced a reaction to the DTP vaccination. However, even though the pneumonia might therefore be considered an acute complication to Chelsea's reaction to the vaccine, the special master held that this did not make her death compensable under the Vaccine Injury Compensation Program because [a]cute complications and sequelae of Table injuries are not compensable if they are due to factors unrelated to the administration of the vaccine. Id. Because all of the symptoms Chelsea displayed, except for the high-pitched screaming, were consistent with pneumonia, Chelsea's symptoms may reasonably be attributed to the pneumonia. Id. at 11. Based on this evidence, the special master held that Petitioner had failed to establish a nexus between the DTP vaccination and Chelsea's death. The special master accordingly denied compensation.