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Cm Nmfiv “ I Fiflfid: May B9, 2mg $$$$$$$$$$$fl$$$$$$$$$$$$$ BS“, gs * Special Damay Pgfifimgrg ‘9? vga 33“ Entitlement; ‘llyllil'ils‘iilji papiflmmavfimg 5% WV} vminfig Gardagfilfl; Guilflaina ‘6‘ 3m Syndrome (SIRS); Millera SECRETARY @IF Niall: 6‘ Fisher Variant; Siwifimm SERVICESE *3 Agmwfimu $ $ $6 50mm Pam NJ, is: petfitfimer. USw Demimgm @f Justigeg fl. Katmaimfim an 11 12g 2m. fi, DES» (‘fpfiifimefifi filled a pefitim far mmmmmfilm mam film Mammal} Vamim Injury Cmpanwfifim (“fine Pram” m‘ “Vamfine Am”)? aflflggimg that m mffemdl mm m MHerFfigfim vafimfi 0f Gmiflllafinw mmme (“6335”) in Aprfill 2%? mg a result @fmcgivfimg mm mm 4. . @ffltm human papiflm‘mwims (“WV”) “gaming in”) (m M a 2%?“ Pafitfim at 2,, Regpmdmt mmmmdfid agaimt awm’ding m Wfimm stating that pétitfiimgr had mt W WWW that m Wham this decfisfiam wag @rfigfimflly flawed; “ma W65 were ncfifigd that Kim dmigfim woumd be WSW in mm:me with Elha Mawmmmt Am magma Pub, L. N09 MWESém § 2&5, 116 Stat 2899?; 29113 (Mfied m mmded at 44 USwa § 35m mtg (2W6); Petifim‘m m aim maimed that she mum Wk Mamba pmuam m § EMm-IZEdXAXB); Vamfim Rum mm Pefitfianer made a timely mum far redmfiim and this dmfigian i3 being reigned in age/amasz wifln 3% Manama flan“ :i' mm : Li“ mmpfims Pam: 2 9f the Nafiamafl @hfifidbmd Vamim Injury Am 9f flggég 42 USgCn§§ EQQWEM @fit mm {mm findivfiduafl Wfiifim mffimmmg Wm be m 42 UuSmC. BQQM. Rehphhdhmgs Rule 4 thhfi (“Rhaph thh JHPV Whinth chum her injurfihse filed :2: M, 2&1 L at 1, 14a Th3 hawk hhhmihhd mm hi supphh hf thhh“ whitith Phfifihhhh fiflhd Whmfl ht rephm ham Davifl Axeflmhfl, W39 an imfihhhhlhght. Phtfihhher’s Exhfihim (“Pats Em”) 23% 4% 41119 43. Phthihheh film fillhdl WWW flhm me @f hhr mfimlwmg Steven H.) Shhehhhh MD, Pet. Em 563 5% thphhdgh‘t fihfl whims fm fimmag Leigh MD”, a, hemmflhgiht ma hhmfimmmhlhgish Rasmhdhhfih @Rhmst E359”) A, Ge A hearing was hhlh hm Ahwgh 239 ZhMg dmfihg whfihh “(ha parties” Petith filhd a phshhehfihg hfih‘f 0h man 36, gm, thphhhght filed her ph hhfiihf QED 23, 2% M. Thh amen" as name him fhf adjudiehhhm Affirm a havihw hf hm hhtfiim mm; the umdmsimhd find that hammer has pmvified evidhhw that Shh devalhpeh hhh Mifliehthah variant hf 6B3 aha? her February 219 2%? h vmhwhfihhs The hhdhhsfighhd aim finds that whithth has pmvihhh mphhdemm evidmm hm the hill, aiming caused ha? ha demhp thc Mihhh—Fihhhr :1; hf GESSB whihh ShfiiSffieh hat h f pmf WE w ft“ H Human Shiva.418 F.3d 11274512% ghee?» Ch. 2&5). Amrdihgflyg pefifih @fl“ is mithd m 1; tihh. II. ha Eh Ewidefi In itchhih jhihh pmhhhfihg smhmfisgfihh fiflefi ah mhhr 1189 mm, flhh partihs pwmfi sawmfl hm hm hhphth Th dmidh the cath thh mums yygwf hm the hhdhn‘sfighhdl hm ah m whhthhh hhfitihhhr has pmmhefl pmphhdemfi @videhhh hhm Shh fin! hh ah hf thh Wharahisher Wham hf 633 ah ah humfimmhhefl’ dmyeflihhfiéhfi dismdm‘ m hm“ h Wipfl hf aha HPV thfihh hm 2L 2%?! Ammflm Jhim Shhmihsihh h’fi 29 filed Sept. 11%, 2914. Samnflg the " eh mum mm the uhdm'sflwhgfl whether phtifihher has WWW 1r 1; 31$de flhm She sufihred fihm ah idahtifihhhg hhdhhlyihg mhdiehi mhditfihh s 2L 2%?» .@ While the Whigs haw magma The hmflhmigmd hmmfim wheflmsr petith s hf (aha MifllhheFishhr whim hf GBSS” hm “wmhhmhhh dihhzhlef’ m“ an “idlm‘hfiahlhg mflerflyihg rhea] chhdfi‘tihh,” fihh uhdhhhighhdl @ hm hmfit hm“ analysis th just thhsh whdittihhs, hm aha mhsfldmhd WELth shth fhr my 3111th W &@ § 3Q®hfi~fl lihxmcmhm. ‘3 “Authfimmuhh” ms 6 m “by h hpmifih hhmhml hr whammth immune msphnhh s @Wflh fihsmm (self antigens m“ Dhrflahdlh .‘ ‘Dfiflhfldfig’fi 11831 (3261 ed. 29112). 5 Demyhhhhhh is the “dasmfimhg remhval hr lhhs @fhhh myhhh hm hf a haw Q!” thhS.” Pethfiehet hemmed the e fettewmhp eeteehettee with De Rihtte eh thee 1159 mm, Pets Ex 2 at 11?» De Rihm meted thet whitteher hm il‘tj heeh seen at the Univeth ef me fifteenter with w, htl ;::-::;;1I‘t Bethe peley with et‘ the eeeehht emiefll nerve Gilly LA DE: Rhee else meted that Lyme dfieeeee ewelegtee had been hegeh‘eem Pet he. 2 et We 11% She teeemmehded e feltewahp fer hepeet ea: ehtdiee if heeflede IQ at 118.. Petitiehee meetwettt ehefltet“ eh tithe E95 2%? Pets Ex, 1‘? at he The MRI ettditety emete; Pet, Ex. I? et he ehewed Wehefly meted ehheheetheht efthe diemfi the Jelly 2,65 299% petttiem had eh eeeleetteh with De Rehett Be Neeehhm, eh - the: e peeefihfle Lyme 2': eeh. Pet. Ex. 4e et 5?. he Neeelmm new the pefitietter hee e eemeflee filtheee. I em m et‘ the etteteg. t em ehe meethtm whether it she he ever had Lyme a e a t tt weetd he unlikely the teeth Lyme met he have e peeitive MEG Western hiet th eh] ether tin and flegte theth a a a s Veeehhtte ef eeme sent 1 te mehe the meet eenee as e teething “ a” Pet. Ex. 46 et 5?. Petitteher it e , , ‘ Intth phhehhe eh August 99 233W» whieh ehewed heme} mete. Peta Ext 3 et 5e; Pet. Ex. 21 et wee a a hmt‘eetehe eh _ .teheh re 2 d Q ea 5:1 e: Petitiehet“ hemmed te De Ghete eh Attghet 239 20W, the e fettewahp eeheefltetteh Pet Ex 1"? at: t 114-1?” De. Genie meted thet “eh week—hp hes heeh eerie eeehtethg ehet hehmtegteet eehditiehe eliminating eeterete end etepteell GhittethsBMte eyedteme) eemettmes eteted with eeeehflt heave eehtee hhte teeeee when w ee he likely fer her eeeehth hehee pelefieee” Pet, Ex. W et the. Petitiehet seer L _ .. M Khemflee e hetthelegfiet2 et the Ctevellehd Chete eh Qetehet 23 eeee the he eeehtetfieh fer feeiefl wemm, Pets Bee M; at “A De Khehelet meted that whfiehet teeeivee eh HPV eeeethetteh h we, and thet petttieher wee \if'f" that her symptom eeete e teeetteh te the vmthea Ml et e. De Kueheflet ° “hietety fie meet eemmtihfle with e Mtflfllafiiehet‘ ef Gttiflileihahme sendt‘eme. The CSF ehdl het ehew he whim ethhmtheeytelegie di’meetetfi’ehg hht eveelfll htie ie the heet fit. I he met eee e W t h ehtthedy hehig eeht.g This eehettteh eehlldl heee been related te her eeeeihetiem thehgh this he preeeh exelheieety,” Pet Ext 12 at 83 Petitieher else see D1: Steven R hehthtte eh infeetteue theeeee eeeeiehet at the Cleveland Cilhtieg eh flee heme deg:5 @etehet 2, eeee Pet Ex. 12 at 2szV Dt. Sehmm meted hm wettehet meefie'edi the WV eeeehte in hm 20mg end thet she had theta]! heme pehy with at: eehte eheet eherwerde gig He thet the “[hfietefii and 22.3; e dtegheets ef Geifleihahehe eyhdme WherQFteflheh vetteht, Chmteefltyg [It] wehdet ehetmt. tjehmtea teetell :h diemeeie a theheh we heee tithe ehppettthg teh emit teeth the date the this emth f” at 45 Du“; Sehteitt htrther wet he “reviewed phhheehy eeetlehty the Thee am muted tS-Qh memes ef hemellegie eemeheettehe ef ELth eeeehte in adults eh the ee etteh e temtteh te eeeehte ih thte patient with e tempemhy- aerated veeeihetiehu” e eteeuge De. Kuehzllet he she he mflfi eee that the ee t e ehtihetttee Ileh ee thie teet wee etdleted ehd the results were Ex. M at eeet . M Om Qcmber M5 2am, Dr: Sghmhmr mart flag physfiaims at m Clfiwflmd minim felt m WWW? had “pmsibflfi mammaan [MiflleraFishafl vawimt” Pat. Egg 3 art 19“ A. mama @phflmflmis am by M. @9le, W5 an 225 mm a remixing WWW nerve 9am! and] @sia in ma 19$an 91? her Hefi fihfifik. Dre Calm mm that pefitfimsr hm her sympmmg in her maipt @f the HPV vaccine. Pet. Ex. 33 at Mall 5. Anaflmr m @f’ we brain was Named m pefifimm 0n Dambar 5?? 230% ahawi‘mg smblg Mammal the maxim Ingram gimme tha Jam 1% 2%? My, but the alga what vi“ N‘ m a. My Mmed am May 3%, 209?. Pet. Ex. 2 at $8; Pat. Ex. 3 at 34. smatmar umdle a; a SPECT mm scam 0n 23, mm: film did mt Shaw gignifiwm: interval dfimgeg when r m a study pfirfmmgd m1 BMW 1155‘ 29%. Pain Ex; I? at 6% Hm a, mm; by Era. Rim flaked 2h 2m& ShE mated that (1mm wnflifimm suggafiive @f an immmmifitemt fimmmg @mditiem mast mmisfifim wifl’m @hmnic infi dmysiimtfimg my 217% Pat, Ex» 2 at 11391115, During flm game visit, yin: mgr inquimd as m hm” initfiafl diagmgis @fi‘ @wifllafimafiamé gymdrmm Di: Rim mm 1m mg 6B8 ” 5: by Dr” Laban whifle mimime was bagpimflizwl, and M @116 may ° ° 3’] by Dim Rim wem mansigmm wifih NEW cmial game VII E m 14. Pefififiamer aim whefiha‘ ha mmdfitiam walla [kg '1 m 1131? I-EPV vamfimfiim that she waived 42 days pfim ta her hmpfi'tafl mmm in April fiflflfi M; Di: Mum; ‘éss‘fl mat pafifimmgg pmggmmflmm mat the ataxia fm an immmm m vmmmadfiamd @ (Em March 1% 2m, patifimer gaw Dr; Sahechm in a f®£fl®waup Wig-13m Pet, Ex“ 3 at 15“ Dan Meghtw mmd that ’ , i’ has mmw 3mm @f’ her sympmmgg” but 31mm that her mptmms “@9de ha 2mm m hm prim" higtmfy 0f Lying d Shfi i3 an ma, which is helping? Mgbig and Lyfim” @ fl Pfififimergg @mgyaflng aw Magnum 0m Apfifl 20,, 2m 19 pafim’m pregmoed m Rahal-t Cg Efickgzm, MD” an @phthflmehgigtg Whfl mm that mtfiiamer Wmimnad m have facial paraflysfis grime having GESB Pat F“ , 38 at 3., Ha mm mm left Emiafl weakness; dmnbfle visiam vmaafll diplapfia, and mum: hypertgmgim. 11g Paflifiamr wag mmfimd by Steven Aw Teflim, MED; a mumbgist, an May 245 m E. Pet” Ex! 33 at 1L Dr. Tfifliflm mm mm: petitier had a mmal ear 6mm and that Em fagfial nerve fumme was mammal m we might and} Mg 356 an flm Raft wifin mfiduafl and symmkimsisa @ It was mm that petitime rmeiwd the; HPV vmma 209% and firm Wig flmmpy had ham in mm» m Dr. Taliam Lin Emit he ii};-:§;11§zfl m ’: 519m Gf 11mg» jig @m May 8, EMS; Warm“ a: v‘ waakms an m left sfida @f Em axmafl [@gfiw @fi‘ihe Rafi fmiall mews wiflm @hmfic demawatflobm @351 4. 112 fin July 3% 2m 33 D12 thmhtm inflated n EMGiNCV hf mtitlnnnt’n hilntnrnl thetnl mntnt nntvas whtnh shnwnd nmln “ “ elm lntnnctnt and lnw ntnnlltndlen wanna nn thn lath @nnsintnnt with facial mummthya Pet. Ex. 55 at 5—60 At thn tnntittnd I“ : is We at fin SEN 3mm with nnn slide nt‘ hnt mnnth ‘ Pntltinnnt nlnn and nyen Lt. Shn explntnnn that hat eyes “tn that the has pnttnnnnnt nerve 9f he? nnt hath in tandem nnytnnnns” 133; at ?, Pntttlnnnt thm the ring hing her andfitnty names ndt it; at h. ln 5; nntn hntn her twin nlnginh Dam Efiflkmm hated April 29% 2M3? he s that mtttfinnnr hm had an, inmmplntn tat;an ftnm hen Mtllnnh’lnhnn nt‘ GBS and tlmt lint tetldnnl injuring tnnlndle thctnl (hill f. wntnn cm the lntt ninth delnyntl nynfltn tlnsunn an the lam nhtnnln eye htttntlnn (wnm nn the lnh}, dnlnynd nyn maven“:an institth dnuhln visim and reduced 1554.. by her tnjntinng pantinnnr twttt‘intt thnt the Mutated t‘tntn law nthnnl in Mny Zhlh, and thnlt the hm in July 2MB at 22“ V. Emrt Ttimnny and Annflynh As Stnnnnt‘ds nt’ Adjttfltnnttnn tan a Cnnsnfinn Claim tunnel” flan Vacating Ant pntinnnt mutt pmvn ether {11) that that =- in; an itth talth within thn Stamina htjnry Tnhln == nnnnmndlng lly mnnn by n tnnntnn (a Tn fictive chm nnfthtenl n “Tabla fining: tn we nfthn tanninntinnn in nth n2? {2} that het tnjnty was “nnna’l‘nhln lnjntywts §§ Shhnaelhfinttltthh llictilj; § 3 Min) an amnnttw by 42 (ERR § lthm; it lltnttlxctfitm; sen nigh Mnhmlyfie hwy fifflfilflt & Human Snttn, £92 End 1315; 11321 (End. Cit. mm}; ,. l. , n I r 440 F.3d Eli l32© (Fed. Ch: 2M6}. 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Thn nndnmgtnd mnnt @nnntdnt thn man “an n Whnln” and may nnt rule ln nnthinnnth thvnr nnlely htttntl on Whitinnnntn nwn nlnitnn tinth lay medical tnnnttln nt mntllnnl npfintonu” § l3993 F.2d 1152591528 (Fad, Cirallggfi). 1m additfimmg the mini,ng @fmfifimer’s 'Mfiffim physiciéms m “gum pmbmive” as Mug physfisians am firm the “15mm Wsifim” t0 gfliagmae ma dammim Em mm afpgfifimgflg mmdlifiame 443 RM at 132$; Hewevm, madicafi wards "“ fm‘fih a, “ " physicimk mews gm mt m ,& bind. me v master m @th the wmcllusims @f smh an indivfidmk awn ifthey mm be amuside and filmy svaflmfied. § 3011mm] 3mm); 88 Fed. CB. at 39% phygfigimg shamfld aim ha weighed aghast when "' " mmflfictfing apfimimm ammg Elm flaming physicamg mama]va f a, 11.00 Fed” C11. mg $49 (Fad, Cl. mm fig 69% Ffid 1 v» SW3? @f‘ '5 Selma 11m Fed. CL M9a 336 (Fed; {2}], 2m 1% m 463 E. App‘x 932 {Fm mm, mm; $4. I . , 2&11 WI; lgfifigwg at $11? @gdlu C11, 8pm mm film @fpe’ti’timam rmdfmfl mm the landming was that Wfimefs Mating physfigfim @1161 mi: mam & mmmms in gambling a diagmsfi far Wiflimem Hawwm Em umdfirsigmd fimdg mm mg medieafl remmls and flag tit-*vtnuxm @fthe :: @xpafis suggegt that patfitfioner 1mm Mikelfly than mt smfiamd fimm 1m mnmmsm variant @f GBSD (it) Gmifllaimafiamé Symmmg and the MMEE’EFEW Vafiam A brief ' 5 (G'ng iS hgflpflnl m (2517:". m3 MfilflfireFfishm van ~' by me mute m“ Submuta m mflaxiaa and a ‘t Em N at 4a Pafifimg typimfly in @ legs and mg m {the WW @fvawying " is: pmfifla m 73% wmbrfigpimfl fluids. Si 1- ‘ mm pmgasgfivg limb mast @fim begfii ,. am and bulbar mmllegm “The _ V. _ is mmiawd WI 6:: gd GE @3ng dew madam reflexes, and wads m ha mlfiiveflly gmmfic. Id The 3 . in an mate it; Wing its @flifiifiml madfir @f * 5;; n Wm 19 mm mm. althmgm in 5mm SW3 mpiaflly wakmws maan nadir mflim several Mum may be mg mg Cmiall mama pauses, fimlmdfimg immivemmi @fif’flm facial HW@ remflicifimg fafifia’fl mam name immlvwmt m buflbar palsy may bfi $811.. In a; mall ,, H Lil. fif may pafligwflmly if CS}? is @bmfimed emfly in ting mm 9:? films9 CSF mmin may be mammal, 2% The hiiiihraFihher varihhi hi” GEE is h “clinith Mdmmh hy a triad hi" hm hphihahhhpiegihg and arei‘iexih a a a a” 9 . i t Ex“ N at i Whiie fihh ‘imic hihh ih hfim hiimimliy and xi: in ihh hhhhhhe hf iimh w _ h them i5 hiihichi merihp with GBSQ wiih iimh ' “ th'he GBSlEMiiihia Fihhhlf Smdnmhhj Whi'ihp Symmmssfi Ch MllithiShhh swimming” imihdihg hm me hf humihhihgih .iawwfilfi findings are hhhhhh 0f gmmhl immimi might and alihihhi Mir d digmeflafimgm m gimiihr Eh thm for GBS‘. in general? hie .- hhhhhmliiiieh m iimiihd to nerves, (2) Phiiiimmh Evidhhhh A haview hfphiiiihhei’h hammghaieh hm ihh mge hf 1" chmidlemd by hhr heating physihiam inc 5, thh hiliiihraFihhhr w hhihhih demyhiihhting phi phihys and a viral heuriiiha Wile .. ,. hhi WWI with ihh himic hind hf i‘hr the Milwahihher vaiihhh hit five his“ Mfimfii’as mating physihihm gamith her hihihi'y and hiihihai hf sympihmh hhd either ihh Miiieiahishgh Vhrihhi hf GBS as h dihghhsih hi: hhhhaiiy dihghhmi phhhhhhr with ihm hhhdiiihh, ha a cansuitaiihh an April 1119 2mm Dr. h hemihghi, hangith a Whihie hf MiiflthiShhfi‘ hr as h flwwisg Phi. Ex. m hi ifiafiéa Oh Apiifl ifig 2W9 Di; Wham Mahdi ihhi Wiitihher 11% a “hihssih thiihh hf GuiliamuBmé mimme hf hi ihhihi Whigs” Phi Ex. 4 hi 3%. hi Qhwhhr Nah after mvi '° pefiiihheris medihai .. ,. fdh amid histhryfi Di; Khhhzihi hi ihh Cihmihhi Ciihih ‘ “hisimy i3 magi mmmfihih with a. Milihrufihhm variant of Ghiiihihafimé syhdmmhy” Pa: Ex. 12 at he Aim in Gemher 2am Di: Schmiii hhihd hm Mfihharih “[Ehjihtm'y am ihsting dim suggth a dimhsis hf“ @hilihihuihmé syhdmma Miiihquiflher variant” Pet Ex. 12 at 255! @111 acmth 159 Efifi’h Di: hhihd that ihh phyihiahh hi high Cihwiahd Ciihih fhit: that Wiifimei‘ had “phwihlle Ghiilmihshmé [MiiifieFiShfiifll variant” Phi. Ex; 3 at 190 Eh addi‘iihh m ihh medical x and mmhig hemihgish Di Shhmhifig tfihfifihd at the hwihg and «z :: - @f ihh mhsi " wiih phiiiihhhiis swipimms was ihe Miii aFih hi varith hf 6385. Th at m. in humming his is, Dirw that peiitihher had mhrdihhiihh hifiihhhihh Visihn wmpihihih mid. iimihie visihh, whim houid hh mlh‘ihd ih him mm hut he that petitith did mi ham hmhhm Th hi We‘i’h“ DES Shhehhm high hidhrhd Mg hammth ihr hhhhhhhr hm ham that She had Shim with the Shimth mtifihd that “m@ impmvmmt she had wag mmifim‘i with the Miinishhr] dimhih; hiharwish why Whhid hhe impth fihh‘u i W Th hi: Maize 1—7 7 ‘ ah “ah hihwiiihh hf CSF pmiein Ileveig {ahth w Cyihhilhuhiihhlggih dimhihiihh is hhm'mai wafeth Vfliilfih ihr ihh dhihg ihh fishing) in thh reihiivg hhsmch hf pie (elevaiihh hf CS? “W3C [[Whiig hflhhd mil mummy thhd hphh the hast whith whimth ihs Warming @mhp has Jihad a CSF hhthif’mime @f<§@ WBC ! hi ihr what “ ' “H a Sh @iihihhilly iypihhi Whhld he @hhhisihhi with GEES it ih that in game @533 ©f© @333 CS? may hh °hhmiaifi paiiiwiai'ig if hhihihhd Within the first Whek hi” iiiflfifigim prii EKG Na‘i 9a 25 Oh cums @hhmhmhm Dr. Selmth “hat Mona did mt wfiflh all @f the @hsgic features hf hm Miflflerahihher variant. Tm at $6., thevms ha ham mummde that pathihhgr summed h new inhuh has fill vmfihhhhh and feh that th@ dz @h‘ih fer pathfihherh wmdfih’iah was Mfiflflehuhisher “* ‘ ° @fmfifihher and heir cam“ & at 60; 66,, d ahhha Dun Axehhd mfififid that ha was hat a magazth and relying an " ° physihiam m aging hhg “3.. @his @fthe Miners» . T3“, at 115:3?» As thh mhdlfichfl mamas hfpafifihham’ “In 1: Fihher variant hf GBS whhh Whiting his @ph’mhms in thfih hm {3) Rfispfifldmt’ Evidehhh Dr. heist @pilfi‘md that pathfith dial mt hhff‘er fmm 633% a variant M” @389 or a demyehnahmg injuryg hand fihhh an hppmprfihhe diagrams was never mmfirmw in her mag Tr. at 1&35659 DE; Leigh Shah hm he reflihd ah the medlimfl mam m yeahh thh opihfimg ihhflhdihg thh mmfiemhhmry mhmds ham That; Shhhhhthr that hmumam findings uhdhmimfihg a diagmhhh @f thh MilleraFihhm Wham of GES. Th at M64; D1; Leigh mm that pefifihher had mgahfiva huh?— gamghhgfide mhhhdies and unhhppemive CSF findings She him m1 Widem‘sfi hf hmmhll dew tehdm mfilexw and him hhhhmce 0f hmihg @phfihhflmhplegfih wad mfiexfih. DE: Lfiihfi mags hm hi5 WU”: hm Dr S©h®®hh$f hm saw Whitith am May My mm; at me mhmh fhfilll wihg hat“ W‘BH At that whit, Dr. Shhth made m mehfihh hf hympthms hf {fiiI‘V‘FiLVI‘iI'Vi -a He mm thm Wififimm’ mammal whammy huh} mama Ha ifhh hm hm facial wealmm was hashith max?th or filmed m L;me ‘ the Bach hf evfidm “Eh summt a hwyhhhmihg fihjm'yg Dr: heist mfihdl that militiamth W films dfifi mt Shaw datum hf h demyhflhhhhg h1qu phhtvahchmhhh, and that the pm; and stmihhtihn fihhg he he? t, , r I"; _| hehasmific fihdhflgh During the ham-huge, hewevhrfi Dun, heist :21; I that Eightith did thW @viflhhhe hf " mm hmjmy m her fmhfl harm (a 11mg @f name Wills) and hemyehhhhgm ahmfi the he 9 2m? wagging as ShQWh by DH; Sehmhfimh ENG. Tm at lhhhh DE: heist gem ah ha mat? hm “hhvihhgfly thaw s and that itth wag ah hhhthhh hr Whh h hf ihh fhhfihl hm there is no way $6 date whhh that hnjury 'i'Z! hi? thh facial fame itiqu ii‘n April Ehh'h @fi 11935949 (4) Evaflhatim hf Ehfi Evidth The midwing mush wmsidlm‘ the mam am a whale in evaflhating Wflhfif’s injuryy § flfiflhm), Here, the mmrd and sh parts ntha mmflhgifim that Whitimnfi” mam hkefly iflhm mt gufihmd ham Mithishhh hyhdmme :3 x; '- 2119 2%? Thih finding is mmeh by hm mgdihhl words and ihh @phfims afpetihhhhr’s hhafihg physfihfiahh a 11th hit“ whhm diagmhhd pafifihhm with the MifleE=Ffihh©f variant 0? GBS, E Mh Ffid ah 1326. It is aha 1mm Mama by he mhdficall hmmm summed by h ,h Mth mppem pefifihhefh dihgmsisu hm hue 11mm mamflh the mm that hhhhhgh m hhgflhsh was u,an at the timeg thhm h m qwegfihh hm pefifihher sufimed a Signfifimt Emmy whim hm“ 26 9! fit vmfim‘tim which test to a 12-day haspttafltzatime The mm mm doc-umemttd 90mpth @f pattttomgm vigilant dfi'iwtttetg tmtdimatim difftgmlttegg and twig]! Eiiiitt‘ii‘fl attat her 7, vmtmtim. Pet, Eggs 3 at 25; Pet Etta m at 58; Pet EX. M at 6; Pét. Etta “E? m 1566?; Pet. Ext 19 at 64?? 11%] 8E Petitimtet” W diagmtad with fatiafl nerve; affine Seventh @nmfiall mammal whim temfltad it: fatiafl weaflmass. Peta Ex; m at Etta At least five at“ ptttttmtt’g 'th her history and elimiml presentatiam t“ symptmmg phyttctams and tithtt sawtde tht MmfibFfigfilfit’ variant at“ GBS as a at gammy diagmttd thttmtet wttl ttmt mmditimt, fiflt ©t" thew factt, in additim ta titt Mummy and tepmts @f tits WW '1". Suppm‘t a finding that petitimngt mm fmm the MilletaFtttmt variant at $33» Pet Ex! I? at $2536. BEWG flue mdmstgned has famd that tflm evidetme St;me the canelmgfimm that mattith stfiemdl tmm fiat Mittem-Ffishm variant @f GES 7 1:; 219 mm the gamma mg in disputes wmeflm petitimtet Sufi“ ’ "I an aumaimmtmc demyel t dfimtfim Gmdattl vmmatim is ' m the @ The pantie ask the spam mattet m fiatermime Whether patitfimet sufiettd fimn an “identifiabltg mdttlying mfidiml mmditfitm befm 21% 2M???” Rated m the a mvfiew @f tht mama film in thfig cm, the ‘ finds thm petitfiamr did sufi‘et tram smut Symptfimfi and imij prim“ ta Ftbmaty 219 Ema aflthwgt the amt dtagmsts ttf he? mnditim was mater d mm by aflt 9f Mfith’S m physittm and WES mataatt Hmwetttg the mdemignedl 3 mt required ta diagmfie petttimer’s mnditimne Itt Lmrttbatdfi tbs Fedgmfl Circuit Stated “Witt fimctfifim @f a metal! m i3 mt t9 sfliagmmg vmfimwtfiflattd injm'iggg but ta fittermitm ‘ mt tht extitfltmt as a whale and tht tattltty (3f the tam whettmr tt 111% t $11?me by a premmdemm @f ttm @vfidetttt tram a timing ,. the [Wtititmetfig] mm? 99 hard r: 656 Ffid 1343g ESE wade Cit: 2m II.) {fitting Andwu 1?, S6333 @fHetflth Hum Sawsga 569 RM 11365?S MS? {Pfitflu Cit; await; the Atttlan is mulld be applied even ifMfiQflfif did mt have a " " ., them is tt Vt 1b zit! mt pattttmttt m a specific . t. . 7 E r gill” "tr 63 Fad. CL 34, mm (mm) (“The Vamtme Att flats mt mum “timers wmmg under tint mtmsTtbflt intij pmvistm m catagtttize their injury; they am memfly tequimdl t0 SEQ“? that the timim in Wm L1 " ' ltss mt“ the uttth diagmsifl) Em twitm petttitmgtgs medical mamas just prim“ "it he? vmttmatimt @t’ Febmry 211es WW, the mdfimfigmd mm that petfittmm’ m ht thing watt wtflt wily mttmt meted. at": an exam mutde at the Michigan Em Intfittm mt % 2®®6Q it W n that pttfitfiemt did haw same flight twig]! . t at her right Stats Pat. III? at t6. Petittamtsg physfitai am wag @tht mammal} wiflt the emepttm Qt“ smite slight inmthtty now an bet Mamet teat, . g, m ' titan @fpttittmttt‘t eyes wetlad G‘gflabts maximal; @mmmflm‘ muttkt imam." An “in, mm @mbet 3% mm at ttjfi Mittttg Eat“ Imam mated ttm iii; tiafl a “team _ ca,” that the was “alert and Mama? and that hat thaw fitmtictn was fifimlfls M3, at 16,, Same alt ., EQSS in bath m wag alga matadg and tfimet wewtng t, hmtimg mid mm mm tidttg Peta Ex £9 at 16; Pet Ext 1@ at 223-24” 2‘? "l‘ht hm madlital teem-d iilhd prim ta pthitimttlg 2h 20m VfiQSfilflfllQflg is a mfi~Mm he: gynmlagitt clattti Nwemhtt Elia 20%., me Ext ll LIME tth Although thh uhdmigmd finds that Willimml' did titfi’et hmh shim sympwms hind ihjtities prim“ ta th 219 mm the:- tmdtrsigmd it mt attigtihg a specific ta that chmditihm a reg heeatite the mdmiwfid that that petitimtet mfimd ham a $3 am What @f the Millet-Fer Vttihht hf afier her Fehmhty 2h 2%? Gmthsil thetimtihm petitimtet has suhficimtly pmth a camahhhaihmfhm @lhima and the malysis iht flit altematith tigttificaht thmty plml by petitihhef itt her g htihi" l3 mammye dim am withth Demyhlitthtihg Dim pmttg @htg mtitimet must pmvidh h Wimblre mhdichl thmt‘y” that the vattihe me typfi hf injury illegal, 451 PM at l35§= 56 ititttihm Ta sati‘fy this gift petitihhhrh meaty mutt he " @h a “WC! and reliable matiiml Qt" itimtiiis mphhhtiah.” i1; 35 FQSd ht MSW Th6 mtditai thtmy min mead b6 “1 pmhhhlyg mt mmiwlly m» mitifimlly lie, at $49,, A petitimm my Satisfy ' ' 1!, gang me wiflmmt ta am epidemihlhgical Wiles, ‘ m it: fit@ medital m“ 44G Ffid at HZSEZfiit it 0f a sptttfic mhthmnsm, Qt” a. thth that has gmem 56? F.3d at Wig??? flitting mimtifit whimmitya As dimmed abmFfig phtitimet mentgdl a them? @fmalmtltr mimitry ta explain haw that ill taming maid muse 63S iimludihg flit Millersiiishat v t @f GES). Petitieher’s @xptrt, Dr“ Axthm explained thm file 1 ‘ " vamhme maintain structung 1th whish tint human immum , t g Wdihgifflflfllgq Ag Dr. Mlmd @Xplfilnfitlg the ptflllhmms and the Whit wit;th ._ .:_;n m whith thg human immmt mpmtsg system If"??? ; t9 pmtgtt vast individual , ingltltliimg Ll captd withing limit individual develhpt ahtthhdieh ham the twine t9 thwh tame shuttttmesfi that may he Wage ta hit mammal within tint system» Peta Ex 23 at 39 Dr, Sthtthtet pmtenthtl a lilflm gmmi 1tth smihg that “with a mfiithl mimhg Milena] m;- ;; m immum mediawfl typt at that WhiGh hat lefi her with hugging mammal fmal nemlagital dfiififli‘lg.” Peta Ext 54 at 2; Ptt Ex. 56 at 2.1 EDI: Mitt ditl mt tpmihcally my; : fine malhmilht mimifity themy at a plausihlh thmty hthtt thm m that hm math is m @tidme t6 TEL that mlmmlht mimicry plhyg a title iii @xpltihihg haw the stamina Wifitaliy hm mm GES til" Millatahishtt mitigates Din Leih‘i explained that althhugh that may its hfimhlhgy Lt:- the mmhentt hi“ the vamim and W at the human . theta it m altitth t9 diam that an mimimmime thmditith is highly th mam; 28 The undmfigmd finds that pfififiimfifi” has pmvided .. 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Bags 54 at 2., 3% @xpflaimd that petitimar had a mmplfix madical mm: and @Efinfimfll and that “there was a mmmfl m3 mm where shag had a dam 0m @f W Emng in m ©fflni’1 He afllm mfified film W ‘ m @fenhmmammt 6m pfimflmer’s W and EGM sflmdigs past vmafinatfim is emsfigfimt wifln his minim mat there was an 9mm j 52-17" V ,. the vmhafim. TE. at 8% 9 . Dr, Sfihmhmr also manning fa . tasfifiefl that them W m pmfiwflm amide 9? W y that lad him m his @pfimtim ma caman aft. M pagisvamim maimed GBS, in this m@,, but rather “fiwra is evidence in the imlmdimg £1] Tm at 6@. In @ddiflime Dr“, Meghmf mgfified firm pefiitiamgg cfliflmicall came and symmmm maid mt: ha explained by any @thfir mmhmim Tm: at 39. “,1; Dr: Amhafi, whm migfid by th@ mmflmigmd haw, by Em 9f mglgcwflm mimfimyg fihfi vmim mum mse mm]! m film myeflimfi DEG Axalmfi expliained film ma ways > wanna mm mfigems film am hamflmgamg mad men attan Em W393 myelim Waugh fihg antigens @fi‘ amfibamflas¢ DEB Amflmd figstfified 111W t wag the firm interval the weeimfim and fig dewbpmmt @fpctitfiamergs ii that fimhm led him 39 his @pmmm that flag 9mimtim was mam Hikefly than mt file x @f petitimefis Tm at 11495508 6:111, my maker expflamfiim @f Emw the vmim Gould have camd ‘ pafimelfis myeilfim Dr. mm stamd flmfi [hm wmfld have m defer m the 29 mammgigg but he expflafimed 13m peflfimgfis mating phygficflans flanked Em @fl’m passable wuseg @fher symptom ma! we Wig ta find ma. 3% m E55,, s 7 physimiamw fig m 369mm Dun Sefiimhftw wag ens @f pefiifiamer’s i 44@ RE at 11326 (mating given Dim Swmhwg @pimfim mm mmfidefins phygiciam “am Efiflwfly m be in the best whim m Wham? ‘a lfig’mfil sequeme 9f gauge and @fimfl shawls] that the vmfinatfim was film far fine injury? “:3 (gaming Althfl 41$ E32361 m 12?? mg md®migned find, pmumsfive the @pimiem @fmtitimer’s Dre Sehefihfler and IDES Axeflmdg that flw Gardmil vamimte 8am pefifimm‘ t9 devalap flhe Ming? Fisher varimu: @f @339 and findg that mar has gamfiedl her Baum-den mm m Wang Twm. '99 The third pmmg mgmfims mfibflishfimg a “pmximate tempmmll relatfimmsflim flfim vmimatim and] the infirm: aflilegedm 4118 F.3d at £2810 "Hm mm Em ,V . ,, “' ’ mmpm-afl mflafiamhip.” g A WEQEEE mum @fim 139:; ‘ u pme the 0m @f WWW Wiflfiin a mefiieafl mdemsmndmg @‘f flag dismdew @fiamggyy it fig medically amepmbflg m infer dfi Em v S@@ 0.7V ,__ 539 REM 134‘?% 11352 Wad“ Cir, mm). The; expflmafiim 1%!“ what fig a WWW}; .. bflfi must aim mimidg wfi‘flh firm W 9f knew the relevant vmfim can mum an 111111qu film pmng amass Wimmt) Lois; Kmhm g; 3mg @3me & Human Saws” W3 F.3d B2393 £243 (Fng Cim 20M} ° ' ' EM Fed. C11“ 532, 542 (Feds Cl. 2m 1].),S ad CL 353 (2911235 am mm? 2313 WL 11mm {Fm Cir; 2mg} r '\‘l' mm; that an appmpfia’fie tempgmfl mmiafiimm , anywhm fmm mm m six wwkga Dr. Schwhfifir @pfimed 12m file mm @fpétitimam hiqu 9mm during an appmprfim time pefim, “that hang beiwsm m wmk m 6 wmksa” Pet Ex. 5? @112 Ill. Dry Melted @pimd that 633 “may meme“ up 129 at Beast 6 Wm ffifllawing aémfimfliqm Wm Waging” Pets Ex, 23 at 2., Dr. Law @965 mm dispm: that a vmime mfim can mm“ as far as six wmks afier vmimfim. Thw, film fimdg film 6} Bmmuae petitimer has embfisw a prim We cm; ska is emiflad m campgmaiim mflgss mpmdmt mm put m pm = w @vfidgme “mm [111%] injury was in fact camd by l' . .ealth & I? ma 3%” 3% (Fm Gigs 1199433, men an 9th mm m mmng :22: (119%); m a? 2am. _ 3Q was entemd @nt Nmmter t6, 2m. Eat Nat E» This dietsi thflt mm mt January tt 203,39 Tht tundmtgmad tpmtal mattat mnde a mutt L ’ 12,, 2&13. 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M2“ tram ptttttetttt’t munsell’t tt‘fitt x ‘ = ttw mutt t3 Emmett that tilfi 19520g 2&14 htmtmg be wnttmwde Ramdmt Pm m @tjtttm EC]? 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Pattttgmw alga titttt t1 tttttt remit an Septemba 22, NM smiling mat t tittde had tam teat tat mmndetmt ECF N0» BESS Mtttmrgs mutttt @tl 93; mt mmmidem titled a mitt ttating that mmmdmt wautd not ht fitfimg a tmppltmtmtal emit WW, fifim Dr. Lefist at mtmmdemt belliewdl that Dre Ltfittgt prim reparts and taming mflittmny tint tssu mittd in Eta Mttmdgt August 2mg Emma 1m big Dun Lafisfi @pimfl “dim; the gympmmfi and the pmss thm flfid m pafitfimmefs facfiafl maknms after Em meary 2m? Gardmi 11 wading was mg same Emma that lad m Bier facial] Wm M the vaccimaflmme Tm at m. 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Document Info
Docket Number： 10-77
Judges： Nora Beth Dorsey
Filed Date： 12/9/2015
Precedential Status： Precedential
Modified Date： 9/5/2016