Guzman v. Sec'y of Health & Human Servs., 15-736V
| Decision Date | 14 May 2019 |
| Docket Number | No. 15-736V,15-736V |
| Parties | GLADYS GUZMAN, Petitioner, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. |
| Court | U.S. Claims Court |
(To be Published)
Virginia E. Anello, Douglas & London, P.C., New York, NY, for Petitioner.
Debra Filteau Begley, U.S. Dep't of Justice, Washington, DC, for Respondent.
On July 16, 2015, Ms. Gladys Guzman filed a petition seeking compensation under the National Vaccine Injury Compensation Program ("Vaccine Program").2 Petitioner alleges that she experienced cutaneous vasculitis ("CV") due to her receipt of the influenza ("flu") vaccine on February 18, 2014. An entitlement hearing was held on October 25, 2018, in New York, New York. For the reasons stated in more detail below, Petitioner has not demonstrated entitlement to compensation under the Vaccine Program.
Although Petitioner's pre-vaccination history does not bear significantly on the outcome of this case, it does reveal that she previously experienced allergies or allergic-like symptoms that could be associated with her post-vaccination condition. For example, on May 3, 2013 (the year before the vaccination at issue), Ms. Guzman sought treatment for a reported fever, loss of appetite, sneezing, a runny nose, and eye discharge, and treaters assessed her with allergic rhinitis and poor appetite. Ex. 1 at 173, 175. A few days later, on May 8, 2013, she sought treatment for a one-day history of pain on her right side and was diagnosed with post-herpetic neuralgia. Id. at 185-87. Then, at a September 2013 appointment, Petitioner reported that she had developed a rash in association with a new medication (Famotidine) she had recently started taking, although the records do not indicate that this was an ongoing concern for which additional treatment was sought. Id. at 487. Ms. Guzman also received the flu vaccine in April 2013 (over a year before the vaccination in question) without recorded incident. Id. at 21-22.
On February 18, 2014, Ms. Guzman received a flu vaccine at the walk-in clinic of New York Presbyterian Hospital after seeking treatment for possible heart palpitations. Ex. 1 at 526-27, 534. There is no immediate record evidence in the subsequent time period of any reaction. Id. Eight days later, on February 26, 2014, she went to an urgent care clinic for treatment of an itchy rash, which she stated had begun "about 48h after flu shot (2/18/14)," with more pressing symptoms developing over the prior four days. Id. at 493. She also reported a similar reaction following receipt of the flu vaccine in 2013 (although as noted above the filed records from 2013 do not memorialize such a reaction). Id. The records from this February 2014 visit describe the rash as a "diffuse[,] fine, erythematous,3 maculopapular4 rash" present everywhere on her body except for her face and lower legs. Id. at 494.
Ms. Guzman was assessed with a "recurrence of rash 48h after flu shot without other clear exposures." Ex. 1 at 494. The treating physician noted her rash was most consistent with a "systemic allergic reaction; allergen not yet known," prescribed hydrocortisone cream (topical steroids) and an allergy medication (Loratadine5), and recommended she see an allergist. Id.
Ms. Guzman sought additional treatment at the New York Presbyterian walk-in clinic less than a week later, on March 1, 2014, for the same rash which she again identified as having begunwithin two days of her receipt of the flu vaccine. Ex. 1 at 497. She was, as before, assessed with a possible allergic reaction and prescribed a short course of oral steroids. Id. at 499. She next sought treatment on March 24, 2014, because the rash remained (although her overall symptoms had subsided somewhat in severity). Id. at 501-02. The examining physician observed a "macular erythematous rash over arms and esp[ecially] trunk, blanching, improving from prior documentation." Id. at 502. Ms. Guzman was assessed with "allergic/drug rash" and directed to follow-up with an allergist. Id. The following month, on April 15, 2014, Petitioner returned to New York Presbyterian to see her internist, Dr. Amanda Westlake. Id. at 503-05. She informed Dr. Westlake that her "[r]ash ha[d] completely resolved," but that she was nevertheless "intermittently using steroid cream" and taking Loratadine. Id. at 503.
Over the next eleven months, Ms. Guzman sought medical treatment multiple times for a variety of conditions, but she did not report a rash at any such time, and no rash was ever observed on any examination. Ex. 1 at 507-52; Ex. 4 at 1. Of note, on August 29, 2014, Petitioner was treated by an ear, nose, and throat specialist, Dr. Jeffery Ahn, for allergic rhinitis and ear wax removal. Ex. 4 at 1-6. Notes from the visit indicated that Petitioner was still taking Loratadine and using hydrocortisone cream as needed (though the notes do not reveal any specific health problems related to the medication use). Id. at 1. No mention was made of a current rash at that time.
The following year, in March 2015, Petitioner saw an allergist, Dr. Stephen Canfield, at New York Presbyterian. Ex. 1 at 555-57. She repeated her prior assertion that she had developed a rash within two days of the February 2014 flu vaccine, but now added as well that she had also experienced a "fever, burning sensation, headaches, weak[ness], + nausea, swelling of breasts." Id. at 555. Significantly, however, although she complained of a number of symptoms she had purportedly experienced since that time (and which she associated with exposure to deodorant, detergents, perfumes, lipstick, and Clorox), she made no mention of a persisting rash over the intervening period, and did not display one on exam. Id. at 555-56. Based upon the history provided above, Dr. Canfield concluded that it was "unlikely" that Ms. Guzman had experienced an allergic reaction to the flu vaccine. Id. at 556. He also offered to test Petitioner's possible vaccine allergy with a challenge test to the flu vaccine next year. Id.
Over the next four months, Ms. Guzman sought care many times for a myriad of complaints, but she did not mention to any treaters that she had a rash. Ex. 1 at 557-67. Later that summer, in July 2015 she returned to Dr. Canfield, again reporting a one-year history of myalgias and fatigue following her February 2014 flu vaccine, but not mentioning an ongoing rash. Id. at 576. Her exam did, however, reveal that she had a rash on her inner elbow that was described as "erythema" or "erythematous rash with papules, not itchy." Id. at 576-77. Dr. Canfield assessed Ms. Guzman with "unclear etiology for diffuse myalgias and fatigue" and determined it was "unlikely for symptoms to be secondary to previous flu vaccine . . . due to [the] persistence of symptoms." Id. at 577. He recommended that Ms. Guzman be tested for Lyme disease and a vitamin D deficiency. Id. Testing thereafter revealed a negative Lyme's disease titer, as well as a normal IgE level, and normal inflammatory markers. Id. at 593-95.
Since the middle of 2015, the record establishes several instances in which Petitioner has sought medical care but has not complained of a persistent or concerning rash - nor do medical treaters seem to have observed one. Ex. 2 at 1-20. At most, at a visit to Dr. Canfield on April 7, 2016 (after this action had been initiated), Petitioner again complained of a history of an "erythematous rash with papules, not itchy," adding that the rash improved when she applied hydrocortisone cream or other over-the-counter lotions or ointments. Id. at 27. Her exam, however, did not reveal a rash, and Dr. Canfield maintained his view that Ms. Guzman's ongoing, intermittent symptoms were probably not related to her 2014 flu vaccination. Id. at 28. Petitioner saw Dr. Canfield the following month, at which time she again reported a history of a "erythematous rash with papules[.]" Id. at 42. She did not, however, display any rash on exam, and a skin test for allergens produced results termed "equivocal." Id. at 43. Petitioner has not filed any medical records for subsequent time periods.6
Petitioner testified at hearing via Spanish translator and filed an affidavit in support of her claim. Tr. at 6-56; see also Affidavit, filed as Ex. 3 (ECF No. 20-1). Her testimony largely consisted of her own recollection of her overall health history post-vaccination, with some additional explanation of disputed issues relevant to certain medical records.
Consistent the with medical record detailed above, Ms. Guzman testified that she received the flu vaccine on February 18, 2014, at the New York Presbyterian office of her primary care treaters. Tr. at 8. She did not recall experiencing any adverse reaction or symptoms immediately following vaccine administration. Id. at 9.
Within forty-eight hours thereafter, however, Ms. Guzman represented, she began to experience weakness, nausea, headaches, a burning sensation, and a rash extending to the back, thighs, upper torso, and arms. Tr. at 9, 11, 37. The skin on her back appeared red and she began to put water on it in hopes it would help alleviate her symptoms. Id. at 10.
Due to the above concerns, Ms. Guzman presented to the hospital at New York Presbyterian on February 26, 2014 (roughly one week following her receipt of the vaccine). Tr. at 11. She recalled being examined by multiple physicians. Id. She represented that one such treater advised her that she had experienced an adverse reaction to the flu vaccine, and prescribed Loratadine and hydrocortisone cream to treat her symptoms (two medications she had not taken prior to that date). Id. Ibuprofen was recommended for her headaches. Id. at 12. Ms. Guzman also recalled that hospital treaters advised her to schedule an...
To continue reading
Request your trial