The opinion
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-1239V
ABRAHAM KLEIN and SHIFRA Chief Special Master Corcoran
KAHAN, parents and natural guardians
of C.K., a minor, Filed: February 17, 2026
Petitioners,
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Robert Joel Krakow, Law Office of Robert J. Krakow, P.C. New York, NY, for Petitioner.
Katherine Edwards, U.S. Department of Justice, Washington, DC, for Respondent.
FINDINGS OF FACT AND CONCLUSIONS OF LAW DISMISSING
TABLE CLAIM AND TRANSFER ORDER 1
On April 19, 2021, Petitioners initiated this action on behalf of their minor child,
C.K, for compensation under the National Vaccine Injury Compensation Program, 42
U.S.C. §300aa-10, et seq. 2 (the “Vaccine Act”). Petitioners allege that C.K. developed
immune thrombocytopenic purpura (“ITP”) – a Table injury – after receiving measles-
mumps-rubella (“MMR”), influenza, and varicella vaccines on October 17, 2018. Pet. at
1, ECF No. 1. Petitioners alternatively allege (as an off-Table claim) that C.K.’s
vaccinations were the cause-in-fact of C.K.’s ITP. Id. The claim was assigned to the
“Special Processing Unit” (the “SPU”).
1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required
to post it 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). This means the Ruling will be available to anyone with access to the internet. In accordance
with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact 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 redact 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2018).
Respondent filed his Rule 4(c) Report in defense of this case on October 22, 2024.
Respondent’s Report, ECF No. 44. In it, he argued that the onset of C.K.’s injury did not
occur within seven to thirty days of vaccination (as required for a Table ITP claim). Id. at
11. Rather, the medical records establish “the onset of C.K.’s ITP occurred no earlier than
late December 2018 which was [75] days after her MMR vaccination,” and thus well
outside the Table’s window. Id. (citing Ex. 1 at 17, 21; Ex. 2 at 29, 35, 39) (emphasis in
original). And, even Petitioners’ affidavits support an onset that occurred in early
December (approximately 47 days post vaccination) - still outside the Table timeframe.
Id. at 11-12 (citing Ex. 8 at 1; Ex. 9 at 2-3; Ex. 10 at 2).
Because Respondent’s objections appeared to have some basis, I issued an Order
to Show Cause identifying the critical deficiencies apparent from the filed record related
to the onset of C.K.’s ITP and noting that dismissal of the Table claim is likely for this
reason unless Petitioners can better substantiate it. ECF No. 45. I also noted that a
second issue exists related to Petitioners’ Table ITP claim, as the filed record shows C.K.
had an intervening viral infection (evidenced by a fever) between the MMR vaccine and
onset of her ITP, which is likewise an exclusionary criterion for a Table ITP claim. See id.
at 1, n.2 (citing Ex. 2 at 29; Ex. 10 at 2). In reaction, Petitioners confirmed that no
outstanding relevant medical evidence exists, and requested the opportunity to retain an
expert to support “a causation-in-fact claim that the MMR vaccination administered to
C.K. caused her [ITP].” ECF No. 47 at 2.
The existing medical record supports Respondent’s onset objection. C.K. received
the subject MMR vaccine on October 17, 2018. Ex. 1 at 21. Approximately 77 days post
vaccination, on January 2, 2019, Petitioners brought C.K. to her pediatrician with reports
of bruising over the left lower quadrant. Id. at 17. At that time, Petitioners stated that C.K.
had been “having bruising over the past few days” – meaning since no later than the last
days of December 2018. Id. (emphasis added). A physical examination revealed
scattered petechiae, a hematoma on the lower left quadrant, and other scattered bruises
including on the chin and lower extremities. Id. The pediatrician suspected C.K. had ITP
(though a complete blood count was within normal limits). Id. at 18.
Petitioners then took C.K. to the emergency room (“ER”) the same day, reporting
that they “first noticed bruising to lower left [abdomen] yesterday[,]” January 1, 2019 (thus
76 days post vaccination); C.K. was admitted that day. Ex. 2 at 29, 35. The attending
physician noted that C.K. “had a fever to 100.4, 3 weeks ago but no other recent illness.”
Id. at 29. A subsequent note from January 3, 2019, states that Petitioners “noted bruising
[on the] day prior to admission” – on January 1, 2019. Id. at 39. C.K. was assessed with
ITP and discharged on January 3, 2019. Ex. 2 at 37-38, 42, 49, 56-57.
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On January 4, 2019, Petitioners brought C.K. back to her pediatrician for ongoing
complaints of bruises, bleeding from her mouth, crankiness, inability to sleep, and poor
appetite. Ex. 1 at 15. The pediatrician noted the “onset” as “3-7 days[,]” thus around late
December 2018 – early January 2019. See id.
During a hematology follow-up visit on February 5, 2019, C.K.’s treater’s
assessment noted that C.K. had “severe isolated thrombocytopenia since 1/2/19
[consistent with] acute ITP[.]” See Ex. 1 at 101; see also id. at 96 (a note from February
26, 2019, reiterating the same note regarding onset on January 2, 2019); id. at 92
(carrying this notation over into C.K.’s follow-up visit on March 19, 2019); id. at 88
(repeating the note again on April 16, 2019). Finally, during a hematology visit on
September 24, 2019 (wherein her recent treatment with IVIG was discussed), C.K.’s
treater noted that she “[i]nitially began with symptoms in 12/2018[.]” Ex. 13 at 2.
In order to qualify for a Table presumption of causation for ITP for an MMR vaccine,
a petitioner must establish that onset occurs between seven and thirty days after
vaccination. 42 C.F.R. Section 100.3(V)(A). The Qualifications and Aids to Interpretation
(“QAI”) criteria for thrombocytopenic purpura require clinical manifestations such as
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Section 100.3(c)(7). The QAI also specifies that an intervening viral infection between the
MMR vaccine and onset is an exclusionary criterion. Id.
As articulated in my Order to Show Cause and confirmed above, the
contemporaneous medical records do not provide support for an onset of ITP within the
defined Table period. The Petitioners appear to accept this finding, but request the
opportunity to obtain expert report for the claim that ITP onset could begin 47 days, or
several months post vaccination. ECF No. 47 at 2. The case will accordingly be
transferred to permit them that opportunity.
Conclusion
Petitioners cannot proceed with a Table ITP claim in this matter, and therefore any
such claim is hereby DISMISSED. Petitioners’ non-Table and/or significant aggravation
claim, however, may proceed – although this will occur outside of SPU.
Pursuant to Vaccine Rule 3(d), the above-captioned case is hereby
transferred out of SPU and reassigned randomly to a Special Master by the Clerk’s
Office. Further proceedings will be determined by the assigned Special Master.
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IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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