Unanswered Questions From the Vaccine Injury
Content
Pace Environmental Law Review
Volume 28
Issue 2 Winter 2011
Article 6
5-10-2011
Unanswered Questions from the Vaccine Injury
Compensation Program: A Review of
Compensated Cases of Vaccine-Induced Brain
Injury
Mary Holland
NYU School of Law, [email protected]
Louis Conte
Robert Krakow
Lisa Colin
This Article is brought to you for free and open access by the School of Law at DigitalCommons@Pace. It has been accepted for inclusion in Pace
Environmental Law Review by an authorized administrator of DigitalCommons@Pace. For more information, please contact [email protected].
Recommended Citation
Mary Holland, Louis Conte, Robert Krakow, and Lisa Colin, Unanswered Questions from the Vaccine
Injury Compensation Program: A Review of Compensated Cases of Vaccine-Induced Brain Injury, 28
Pace Envtl. L. Rev. 480 (2011)
Available at: http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll ?:45 IM
480
ARTICI£
UNANSW£R£ÐQU£STIONSIROMTH£
VACCIN£INJURYCOMP£NSATION
PROGRAM:
ARevIewoICompensutedCusesoIVuccIne-
InducedBvuInInJuvy
MA!YHO!!AÞÐ,!O!ISCOÞTI,!OII!TK!AKOWAÞÐ!ISACO!IÞ
*
INTROÐUCTION
Is fho VnccIno Injury ComµonsnfIon Irogrnm (“VICI”) of
fho !.S. Courf of IodornI CInIms n fnIr forum` ThIs Is nof n
frIvInI quosfIon ns If Is fho onIy forum In whIch µnronfs mny
brIngcInImsforvnccInoInjuryfofhoIrchIIdron.!ndorfhol986
ÞnfIonnI ChIIdhood VnccIno Injury Acf (“l986 !nw”), Congross
cronfod nn ndmInIsfrnfIvo forum fhnf If monnf fo onsuro sImµIo
jusfIco for chIIdron; If gnvo fho VICI orIgInnI jurIsdIcfIon for nII
vnccIno Injury cInIms.
l
Iocnuso nImosf nII !.S. chIIdron musf
*MnryHoIInnd,!osonrchSchoInrnndÐIrocforoffhoCrndunfo!ognISkIIIs
Irogrnm, ÞY! SchooI of !nw; !ouIs Confo, Indoµondonf InvosfIgnfor; nnd
!oborf Krnkow nnd !Isn CoIIn, nffornoys In µrIvnfo µrncfIco. Inco !nw SchooI
µrovIdodsIgnIfIcnnfrosonrchsuµµorfforfhIssfudy.Thonufhorsfhnnkformor
InvIronmonfnI !nw Ðonn AIoxnndrn Ðunn nnd Inw sfudonfs JIIIInn Iofrorn,
KyIo Cnffroy, Sohnd JnmnI, AIIson KnµInn, CoorgIno IoIIs, Jonno !onquIIIo,
!Isn Hnfom, AIIIson KnzI nnd AdrIonno IorfIn. Tho nufhors nIso fhnnk
voIunfoors who workod undor fho dIrocfIon of !ouIs Confo. Ior µurµosos of
dIscIosuro, !oborf Krnkow nnd !Isn CoIIn roµrosonf cIIonfs nnd hnvo cInIms on
bohnIfoffnmIIymomborsInfhoVnccInoInjuryComµonsnfIonIrogrnm.
l. ÞnfIonnI ChIIdhood VnccIno Injury Acf of l986, 42 !.S.C. § 300nn-
ll(2)(A) (2006). “AII IndIvIdunIs Injurod by n vnccIno ndmInIsforod nffor fho
dnfoofonncfmonfoffhoIogIsInfIonnroroquIrodfogofhroughfhocomµonsnfIon
µrogrnm.” H.!. !II. ÞO. 99-908, nf 3 (l986), reprinIeJ in l986 !.S.C.C.A.Þ.
6344, 6344. Affor fIIIng In fho µrogrnm, µofIfIonors mny rojocf µrogrnm
judgmonfs or oµf ouf of If fo brIng cInIms In sfnfo or fodornI courf, buf InIfInI
cInImsovor$l,000IndnmngosmusfbomndoInfhoVICI.1J.nfl2.
1
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 48l
rocoIvovnccInnfIonsfobonbIofonffonddnycnronndschooI,
2
Tho VICI hns hnd n mIxod hIsfory In fho oyos of fho
fnmIIIos of fho vnccIno-Injurod.
IfIs
of ufmosf Imµorfnnco fhnf fhIs frIbunnI µrovIdos oquIfnbIo
fronfmonf, frnnsµnroncy, nnd jusfIco fo fhoso chIIdron who hnvo
fhogrnvomIsforfunofoboInjurodbyfhovoryvnccInosInfondod
fokooµfhomhonIfhy.
3
WhIIo somo µnronfs of vnccIno-
InjurodchIIdronsuµµorfodfhol986!nw,ovorfImomnnycnmofo
vIowIfwIfh¨bIffordIsnµµoInfmonf.¨
4
AIrondybyfhomId-l990`s,
HHS hnd roducod fho grounds for µrosumµfIvo cnusnfIon, nnd
fhus rocovory, for vnccIno Injury In wnys fhnf mnny obsorvors
found froubIIng.
5
Thnf chnIIongo bognn In 2002, whon nonrIy fIvo fhousnnd
fnmIIIosfIIodµofIfIonswIfhfhoVICIcInImIngfhnfvnccInoshnd
cnusod fhoIr chIIdron`s nouroIogIcnI dIsordor cnIIod ¨nufIsm.¨
Iuf fho VICI`s gronfosf chnIIongo yof Iny
nhond.
6
2. See SIoIe IequirenenIe, ÞATIOÞA! ÞITWO!K IO! IMM!ÞIZATIOÞ,
hffµ://www.ImmunIznfIonInfo.org/vnccInos/sfnfo-roquIromonfs (Insf vIsIfod Iob.
28, 20ll) (µrovIdIng n sonrchnbIo IIsf of vnccIno roquIromonfs for chIIdron by
sfnfo).
SfnrfIng In fho Info l980`s, fho froquoncy of nufIsm dIngnosos
3. See, e.g., IrIof for fho ÞnfIonnI VnccIno InformnfIon Confor, of nI. ns
AmIcI CurIno SuµµorfIng IofIfIonors, IruosowIfz v. Wyofh, l30 S.Cf. l?34
(20l0) (Þo. 09-l52), otoiloIle oI hffµ://www.nmorIcnnbnr.org/confonf/dnm/
nbn/µubIIshIng/µrovIow/µubIIcod_µrovIow_brIofs_µdfs_09_l0_09_l52_IofIfIonor
AmCuÞVICnnd24Orgs.nufhchockdnm.µdf.
4. 1J.nfl3(quofIngfhofosfImonyofInrbnrn!ooIIshorboforoCongrossIn
l999: ¨Thoro Is bIffor dIsnµµoInfmonf nnd µorvnsIvo unhnµµInoss nmong
µnronfs...wIfhfhocurronfsfrucfuronndndmInIsfrnfIonoffhovnccInoInjury
comµonsnfIonµrogrnm....¨).
5. HHS romovod fho µrosumµfIon of rocovory from ¨rosIdunI soIzuro
dIsordor¨ In Mnrch, l995, forcIng fnmIIIos, IIko fho IruosowIfz fnmIIy In
BrueeeuiIc t. W,eII, fo µrovo cnusnfIon. See ÞnfIonnI VnccIno Injury
ComµonsnfIonIrogrnm!ovIsIonoffhoVnccInoInjuryTnbIo,60Iod.!og.?6?8,
?680(Iob.8,l995)(codIfIodnsnmondodnf 42C.I.!.µf.l00);eee oleoAndrou
ex rel.Androuv.Soc`yofHonIfh&HumnnSorvs.,569I.3dl36?,l3?4(Iod.CIr.
2009).
6. See !oroy v. Soc`y of fho Ðoµ`f of HonIfh & Humnn Sorvs., Þo. 02-392V,
2002 W! 3l?30680, nf *l (Iod. CI. Ocf. ll, 2002), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/!oroy°20l.µdf.
2 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
482 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
bognn fo skyrockof.
?
In nn unµrocodonfod µrocoodIng, fho VICI
cronfod nnd conducfod fho OmnIbus AufIsm IrocoodIng,
consoIIdnfodhonrIngsmonnffobrIngjusfIcofofhosocInIms.Tho
VICI dIsmIssod nII fho ¨fosf cnso¨ cInIms of vnccIno-Inducod
nufIsm, nnd fho Courf of AµµonIs for fho IodornI CIrcuIf uµhoId
nIIfhodocIsIonsonrovIow.
8
ÐosµIfo nµµnronf judIcInI cInrIfy nnd fInnIIfy In fhoso
docIsIons,sIgnIfIcnnfquosfIonsromnIn.Arofhocnsosof¨nufIsm¨
fhnffhoVICIrojocfodInfhoOmnIbusAufIsmIrocoodIngronIIy
dIfforonffromfhocnsosof¨oncoµhnIoµnfhy¨nnd¨rosIdunIsoIzuro
dIsordor¨fhnffhoVICIhnscomµonsnfodboforonndsInco`IsIf
µossIbIo fho VICI rojocfod cnsos of ¨nufIsm¨ bocnuso of fho hof-
buffon InboI nnd nof bocnuso of ronI dIfforoncos In InjurIos or
ovIdonco`
ThIs µroIImInnry sfudy suggosfs fhnf fho VICI hns boon
comµonsnfIng cnsos of vnccIno-Inducod oncoµhnIoµnfhy nnd
rosIdunI soIzuro dIsordor nssocInfod wIfh nufIsm sInco fho
IncoµfIon of fho µrogrnm. Through fhIs µroIImInnry sfudy, fho
nufhors hnvo found oIghfy-fhroo cnsos of nufIsm nmong fhoso
comµonsnfod for vnccIno-Inducod brnIn dnmngo.
9
ThIs nssossmonf of comµonsnfod cnsos showIng nn
nssocInfIon bofwoon vnccInos nnd nufIsm Is nof, nnd doos nof
µurµorf fo bo, scIonco. In no wny doos If oxµInIn scIonfIfIc
cnusnfIon or ovon nocossnrIIy undormIno fho ronsonIng of fho
docIsIons In fho OmnIbus AufIsm IrocoodIng bnsod on fho
scIonfIfIc fhoorIos nnd modIcnI ovIdonco boforo fho VICI. Þor
doos fhIs nrfIcIo hnvo nnyfhIng fo sny nbouf sfnfo chIIdhood
ImmunIznfIonmnndnfosIngonornI.
ThIs fIndIng
rnIsos fundnmonfnI quosfIons nbouf fho InfogrIfy, frnnsµnroncy,
nndfnIrnossoffhIsforum.
Whnf fhIs nrfIcIo doos µoInf fo nro unnnsworod quosfIons
nbouf vnccInos nnd nufIsm, n fhorny Issuo fhnf nffocfs
?. MIchnoI I. McÐonnId & John I. InuI, Tining of 1ncreoeeJ AuIieIic
DieorJer CunuloIite 1nciJence, 44 IÞVT!. SCI. & TICH. 2ll2, 2ll2 (20l0),
otoiloIle oIhffµ://www.nII.org/µdf/McÐonnIdInuI20l0.µdf.
8. See infronofosl2?-l35.
9. See infro TnbIo of VICI-Comµonsnfod CInIms of IrnIn Injury Thnf
IncIudoAufIsmorAufIsm-IIkoSymµfoms.
3
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 483
nµµroxImnfoIy ono In ono hundrod nnd fon chIIdron.
l0
On fhIs
µoInf, fhIs sfudy sfrongIy suggosfs fho nood for furfhor
CongrossIonnI nnd scIonfIfIc InvosfIgnfIon fo oxµIoro fho
nssocInfIonbofwoonvnccIno-InducodbrnInInjurynndnufIsmnnd
fho InfogrIfy of fhIs fodornIIy-ndmInIsforod comµonsnfIon
µrogrnm.
ll
InInrfI,worovIowfhol986!nwfhnfcronfodfhoVICInnd
fho OmnIbus, bnckground InformnfIon on nufIsm, fho
Ðoµnrfmonf of HonIfh nnd Humnn SorvIcos` (¨HHS¨) concossIon
InfhoPolingcnso,nndnffomµfsfogofInformnfIonnboufnufIsm
from comµonsnfod cnsos of vnccIno Injury. Inrf II dofnIIs fho
µubIIshod cnsos In fho VICI fhnf nofo nufIsm or nufIsm-IIko
symµfoms nnd InformnfIon nbouf soffIod cnsos mnnIfosfIng
nufIsmfhnfµnronfnIcnrogIvorshnvoconfIrmod.IfdIscussosfho
cnsos nnd IncIudos roµrosonfnfIvo quosfIonnnIro rosµonsos from
µnronfs nnd cnrogIvors. Inrf III hIghIIghfs unnnsworod
quosfIons, mnkos rocommondnfIons, nnd drnws concIusIons.
AµµondIcos IncIudo dIngnosfIc InformnfIon, dofInIfIons, oxcorµfs
from n Iroodom of InformnfIon !oquosf, n IIsf of µrovIousIy
µubIIshod nrfIcIos ovnIunfIng comµonsnfod cnsos from fho VICI,
nndncoµyoffhoµnronfsfrucfurodInforvIowform.
l0. See CDC IeoIuree, CDC SIuJ,. An Ateroge of 1 in 110 CIilJren Hote on
ASD, CT!S. IO! ÐISIASI COÞT!O! & I!IVIÞTIOÞ,
hffµ://www.cdc.gov/fonfuros/counfIngnufIsm(InsfvIsIfodJnn.l8,20l0).
ll. Tho VICI Is Iocnfod In fho HHS, HonIfh !osourcos nnd SorvIcos
AdmInIsfrnfIon, HonIfhcnro Sysfoms Iuronu, ÐIvIsIon of VnccIno Injury
ComµonsnfIon. See AoIionol Voccine 1njur, ConpeneoIion Progron, AIouI
V1CP, !.S. ÐII`T OI HIA!TH & H!MAÞ SI!VS., HIA!TH !IS. & SI!VS. AÐMIÞ.,
hffµ://www.hrsn.gov/vnccInocomµonsnfIon/ (Insf vIsIfod Iob 28, 20ll). HHS,
ÐOJ,nndfhoCourfofIodornICInImsjoInfIyovorsoofhoVICI.1J.
4 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
484 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
I. TH£ VACCIN£ INJURY COMP£NSATION
PROGRAM (VICP) ANÐ TH£ OMNIBUS AUTISM
PROC££ÐING
1. TLe VICP und tLe 19B6 NutIonuI CLIIdLood VuccIne
InJuvy Act
Congross cronfod fho VICI ns µnrf of fho l986 ÞnfIonnI
ChIIdhoodVnccInoInjuryAcf(l986!nw).
l2
CongrossµnssodfhIs
IogIsInfIon fo nchIovo sovornI objocfIvos: (l) fo cronfo fho
Infrnsfrucfuro for n nnfIonnI ImmunIznfIon µrogrnm;
l3
(2) fo
InsuInfo Indusfry nnd fho modIcnI µrofossIon from IInbIIIfy;
l4
(3)
fo osfnbIIsh n µrogrnm fo comµonsnfo fho Injurod;
l5
nnd (4) fo
µromofosnforvnccInos.
l6
Tho l986 !nw oufIInod nn nmbIfIous ngondn for vnccIno
rosonrch, µroducfIon, µrocuromonf, dIsfrIbufIon, µromofIon, nnd
µurchnso of vnccInos.
l?
If osfnbIIshod fho VICI fo comµonsnfo
¨vnccIno-roInfod Injury or donfh.¨
l8
In Ifs IogIsInfIvo hIsfory,
Congross nssorfod fhnf fho µurµoso of fho µrogrnm wns ¨fo
osfnbIIsh n fodornI no-fnuIf
µrogrnm undor whIch nwnrds cnn bo
mndo fo vnccIno-Injurod µorsons quIckIy, onsIIy, nnd wIfh
corfnInfy nnd gonorosIfy.¨
l9
Congross onncfod fho sfnfufo fo
comµonsnfo chIIdron who hnd boon Injurod whIIo sorvIng fho
µubIIcgood.
20
Tho µrogrnm roquIros µnronfs of vnccIno-Injurod chIIdron fo
fIIo fIrsf In fho VICI boforo nny ofhor courf.
2l
Tho Courf of
IodornI CInIms In WnshIngfon, Ð.C. ovorsoos fho µrogrnm.
22
l2. ÞnfIonnI ChIIdhood VnccIno Injury Acf of l986, 42 !.S.C. §§ 300nn-l fo
34(2006).
l3. 1J.§300nn-2.
l4. 1J.§300nn-ll(n)(3).
l5. 1J. §300nn-l0(n).
l6. 1J.§300nn-2?(n).
l?. 1J.§300nn-2.
l8. 42!.S.C.§300nn-l0(n).
l9. H.!. !II. ÞO. 99-908, nf 3 (l986), reprinIeJ in l986 !.S.C.C.A.Þ. 6344,
6344.
20. 1J.
2l. 42!.S.C.§300nn-ll.
22. 1J.§300nn-l2.
5
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 485
Affor fIIIng In fho VICI, howovor, µofIfIonors rofnIn fho rIghf fo
go fo cIvII courf nffor wnIfIng n sµocIfIod µorIod of fImo or
rojocfIngnVICIdocIsIon.
23
CongrossInfondodfocronfonInrgoIy
ndmInIsfrnfIvo µrogrnm ns nn nIfornnfIvo fo fho cIvII forf Inw
sysfom.
24
ThoµurµosooffhoVICIwnsfoosfnbIIshnfodornI¨no-
fnuIf¨ comµonsnfIon µrogrnm. Tho CongrossIonnI CommIffoo
!oµorf nofod fhnf fho ¨sysfom Is Infondod fo bo oxµodIfIous nnd
fnIr¨ nnd fo comµonsnfo rocognIzod vnccIno InjurIos ¨wIfhouf
roquIrIng fho dIffIcuIf IndIvIdunI doformInnfIons of cnusnfIon of
Injury.¨
25
Tho µurµoso of fho sfnfufo wns fo ovorcomo fho
InndoquncIos of fho oxIsfIng forf sysfom for vnccIno-Injurod
chIIdron.¨|I]orfhoroInfIvoIyfowwhonroInjurodbyvnccInos
fhroughnofnuIfoffhoIrownfhooµµorfunIfIosforrodrossnnd
rosfIfufIon nro IImIfod, fImo-consumIng, oxµonsIvo, nnd offon
unnnsworod. . . .Yof fufuros hnvo boon dosfroyod nnd mounfIng
oxµonsosmusfbomof.¨
26
Whon Congross µnssod fho l986 !nw, fhoro woro sovornI
rocognIzod vnccIno InjurIos, IncIudIng nnnµhyInxIs,
oncoµhnIoµnfhy,µnrnIyfIcµoIIo,chronIcnrfhrIfIs,rosIdunIsoIzuro
dIsordor, nnd donfh.
2?
AII fho InjurIos on fho VnccIno Injury
TnbIo woro fo hnvo occurrod wIfhIn fhIrfy dnys of vnccInnfIon.
28
MosfInjurIosIIsfodInfhoTnbIodoscrIbodovonfsfhnfmusfoccur
wIfhIn hours or fhroo dnys of n chIId rocoIvIng n vnccIno.
29
If
µofIfIonors mof fho oxncf roquIromonfs of fho sµocIfIod InjurIos,
fhon fhoy wouId nof bo roquIrod fo IIfIgnfo nnd wouId rocoIvo
comµonsnfIon fhrough nn ndmInIsfrnfIvo ¨no-fnuIf¨ µrocoss.
30
23. 1J.§300nn-2l.
24. H.!.!II.ÞO.99-908,nfl3(¨ThoCommIffoo|onInorgynndCommorco]
nnfIcIµnfos fhnf fho sµood of fho comµonsnfIon µrogrnm, fho Iow frnnsncfIons
cosfsoffhosysfom,fhono-fnuIfnnfurooffhoroquIrodfIndIngs,nndfhoroInfIvo
corfnInfynndgonorosIfyoffhosysfom`snwnrdswIIIdIvorfnsIgnIfIcnnfnumbor
ofµofonfInIµInInfIffsfromIIfIgnfIon.¨).
25. 1J.nfl2.
26. 1J.nf6.
2?. See I.!. 99-660, l00 Sfnf. 3?43 (codIfIod ns nmondod nf 42 !.S.C. §
300nn-l4), otoiloIle oI hffµ://www.hrsn.gov/vnccInocomµonsnfIon/
nufhorIzIngIogIsInfIon.µdf.
28. 1J. InrnIyfIc µoIIo hnd n fImo µorIod of 30 dnys; mosf InjurIos woro fo
hnvooccurrodwIfhIn3dnys.1J.
29. 1J.
30. 1J.
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03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
486 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
Ior InjurIos fhnf woro nof IIsfod on fho TnbIo, howovor,
µofIfIonors wouId hnvo fo µrovo fhoso InjurIos bnsod on n
µroµondornnco of fho ovIdonco, n ¨moro IIkoIy fhnn nof¨
sfnndnrd.
3l
ThoVICIInsuInfosvnccInomnnufncfurorsfromIInbIIIfynnd
roquIrosfhnfµofIfIonorsbrIngfhoIrµofIfIonssoIoIyngnInsfHHS.
Thoy mny nof suo mnnufncfurors or honIfhcnro µrncfIfIonors.
32
ThornfIonnIoforfhIsIndusfrynndµrofossIonnIµrofocfIonwnsfo
onsuro n sfnbIo chIIdhood vnccIno suµµIy nnd fo kooµ µrIcos
nffordnbIo.
33
Tho VICI nwnrds comµonsnfIon ouf of n VnccIno
Injury Trusf Iund coIIocfod from nn oxcIso fnx of $0.?5 Imµosod
onfhosnIoofovoryvnccIno.
34
IofIfIonorsfryfhoIrcnsosInfhoVICIboforoSµocInIMnsfors
offhoCourfofIodornICInIms.IIghfSµocInIMnsforsncfnsfho
soIofIndorsoffncfnndInw.
35
ThoVICIIsmonnffoboInformnI,
wIfhouf roIInnco on fho fodornI ruIos of ovIdonco nnd cIvII
µrocoduro.
36
3l. ÞnfIonnI ChIIdhood VnccIno Injury Acf of l986, 42 !.S.C. § 300nn-
l3(n)(l)(2006).
Congross Infondod fhIs InformnIIfy fo bonofIf fho
32. 1J.§300nn-ll(n);eee oleoH.!.!II.ÞO.99-908,nfl2(l986),reprinIeJ in
l986!.S.C.C.A.Þ.6344,6353(¨|T]hobIIIroquIrosfhnfnµorsonwIfhnnInjury
rosuIfIng from n vnccIno fhnf wns ndmInIsforod nffor fho onncfmonf of fhIs
IogIsInfIon fIIo n comµonsnfIon µofIfIon nnd go fhrough fho comµonsnfIon
µrogrnm boforo µrocoodIng wIfh on, IIfIgnfIon ngnInsf n mnnufncfuror.¨
(omµhnsIsnddod)).
33. See, e.g.,SfovoI.CnInndrIIIo,VonieIing VoccinoIione. WI, Are So Mon,
Anericone OpIing OuI of VoccinoIing TIeir CIilJren:,3?!.MICH.J.!.!IIO!M
353, 408 (2004) (¨VnccIno mnnufncfurors quIckIy Ionrnod fhoIr Iosson nnd
fhronfonodfohnIfµroducfIonunIossgunrnnfoodIndomnIfIcnfIonbyfhofodornI
govornmonf. As n rosuIf, vnccIno shorfngos onsuod, µrIcos skyrockofod, nnd
CongrosswnsforcodInfoncfIon.¨).
34. AoIionol Voccine 1njur, ConpeneoIion Progron, Voccine 1njur,
ConpeneoIion TrueI IunJ,!.S.ÐII`TOIHIA!TH&H!MAÞSI!VS.,HIA!TH!IS.
& SI!VS. AÐMIÞ., hffµ://www.hrsn.gov/vnccInocomµonsnfIon/
VIC_Trusf_Iund.hfm(InsfvIsIfodJnn.ll,20ll)(¨ThoTrusfIundIsfundodby
n$0.?5oxcIsofnxononchdosoofvnccInoµurchnsod(I.o.,onchdIsonsoµrovonfod
InndosoofvnccIno).¨).Inofhorwords,nconsumorwouIdµny$2.25nsnnoxcIso
fnx on fho MM! vnccIno, or $0.?5 on onch of fho monsIos, mumµs nnd ruboIIn
nnfIgons.
35. 42!.S.C.§300nn-ll.
36. !.S. CT. IIÐ. C!AIMS VACCIÞI !. 8(b)(l) (¨In rocoIvIng ovIdonco, fho
sµocInImnsfor wIII nof bobound by common Inw or sfnfufory ruIos ofovIdonco
buf musf consIdor nII roIovnnf nnd roIInbIo ovIdonco govornod by µrIncIµIos of
fundnmonfnIfnIrnossfobofhµnrfIos.¨).
7
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 48?
µofIfIonors by mnkIng fho forum sImµIor nnd Ioss cosfIy.
3?
ÐocIsIons of fho SµocInI Mnsfors do nof sorvo ns µrocodonf In
subsoquonfµrocoodIngsInsfnfoorfodornIcourf.
38
IofIfIonors mny rocoIvo $250,000 In fho ovonf of n vnccIno-
roInfod donfh nnd n mnxImum nmounf of $250,000 for µnIn nnd
sufforIng.
39
ThosocnµshnvonofchnngodsIncol986.
40
Thol986
!nw nIso µrovIdos for ¨ronsonnbIo nffornoy`s foos nnd cosfs¨ for
brIngIngnµofIfIon,sofhnfµofIfIonorsdonofhnvofoµnyInwyors
oufofµockoforoufoffhoµrocoodsofnjudgmonf(nsfhoywouId
hnvofodoIncIvIIcourfundornconfIngoncyfoonrrnngomonf).
4l
Thol986!nwroquIrosfhnfµofIfIonsbofIIod¨|nomorofhnn]
36monfhsnfforfhodnfooffhooccurroncooffhofIrsfsymµfomor
mnnIfosfnfIon of onsof or of fho sIgnIfIcnnf nggrnvnfIon of such
Injury |nffor fho ndmInIsfrnfIon of fho vnccIno].¨
42
ThIs fhroo-
yonr sfnfufo of IImIfnfIons Is shorfor fhnn mnny sfnfo forf
sfnfufos nnd doos nof µrovIdo for foIIIng whon µInInfIffs dId nof,
or couId nof, dIscovor fho Injury wIfhIn fho fhroo-yonr sfnfufo of
IImIfnfIons.
43
InµorhnµsfhomosfsIgnIfIcnnfµnrfoffhosfnfufo,fhol986
!nwrosfrIcfsvnccInomnnufncfurors`nndvnccInondmInIsfrnfors`
IInbIIIfy In nny courf unIoss µofIfIonors fIIo fIrsf In fho VICI.
44
3?. H.!. !oµ. Þo. 99-908, nf 3 (Tho µurµoso of fho sfnfufo Is ¨fo osfnbIIsh n
IodornI 'no-fnuIf` comµonsnfIon µrogrnm undor whIch nwnrds cnn bo mndo fo
vnccIno-InjurodµorsonsquIckIy,onsIIy,nndwIfhcorfnInfynndgonorosIfy.¨)
38. 42 !.S.C. § 300nn-l2(4)(A), whIch µrovIdos fhnf ¨InformnfIon submIffod
fo n sµocInI mnsfor or fho courf In n µrocoodIng on n µofIfIon mny nof bo
dIscIosod fo n µorson who Is nof n µnrfy fo fho µrocoodIng wIfhouf fho oxµross
wrIffonconsonfoffhoµorsonwhosubmIffodfhoInformnfIon.¨Inofhorwords,
nIIrocordsnrosonIodnnddonofbocomoµnrfoffhocourfrocordInsubsoquonf
cIvIIInwsuIfs.
39. 1J.§§300nn-l5(n)(2),(4).
40. 1J. Cf. I.!. 99-660, l00 Sfnf. 3?43 (codIfIod ns nmondod nf 42 !.S.C. §§
300nn-l5(n)(2), (4)), otoiloIle oI hffµ://www.hrsn.gov/
vnccInocomµonsnfIon/nufhorIzIngIogIsInfIon.µdf.
4l. See 42!.S.C.§300nn-l5(o)(l).
42. 1J.§300nn-l6.
43. CIoorv.Soc`yof HonIfh&HumnnSorvs.,85Iod.CI.l4l,l4?(Iod.CI.,
2008). A cnso on oquIfnbIo foIIIng nnd dIscovory of Injury In vnccIno cnsos Is
curronfIy boforo fho Courf of AµµonIs for fho IodornI CIrcuIf for nn en Ionc
honrIngfobohonrdIn20ll.SeeCIoorv.Soc`yofHonIfh&HumnnSorvs.,Þo.
2009-5052,20l0W!4269396(Iod.CIr.Ocf.25,20l0).
44. See42!.S.C.§300nn-22.
8 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
488 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
SfnrfIng In l988, no vnccIno mnnufncfuror wns IInbIo for n
vnccIno-roInfod Injury or donfh from ono of fho rocommondod
vnccInos ¨If fho Injury or donfh rosuIfod from sIdo offocfs fhnf
worounnvoIdnbIoovonfhoughfhovnccInownsµroµorIyµroµnrod
nndwnsnccomµnnIodbyµroµordIrocfIonsnndwnrnIngs.¨
45
ThIs
InngungosfomsfromfhoSocond!osfnfomonfofTorfs.
46
Tho!.S.
Suµromo Courf docIdod BrueeeuiIc t. W,eII, whIch donIf
sµocIfIcnIIywIfhfhIsµrovIsIonIn Iobrunry20ll.
4?
In nddIfIon fo brond IInbIIIfy µrofocfIon, fho l986 !nw nIso
µrovIdos nnofhor shIoId fo mnnufncfurors undor fodornI Inw.
48
Thol986!nwµormIfsfhomfhorIghffonofdIscIosoknownrIsks
foµnronfsorgunrdInnsoffhosoboIngvnccInnfod.!osfIngonfho
¨Ionrnod InformodInry¨ docfrIno, mnnufncfurors bonr no IInbIIIfy
for gIvIng, or fnIIIng fo gIvo, nccurnfo or comµIofo InformnfIon fo
fhoso vnccInnfod, nnd hnvo onIy fo µrovIdo roIovnnf InformnfIon
fo docfors, who musf gIvo µnfIonfs CÐC VnccIno InformnfIon
Sfnfomonfs.
49
ThoCourfofAµµonIsforfhoIodornICIrcuIfhnsosfnbIIshod
n µofIfIonor`s burdon of µroof In n sorIos of cnsos.
50
45. 1J.§300nn-22(b)(l).
If roquIros
fhnfnµofIfIonorµrovo:
46. !osfnfomonf(Socond)ofTorfs§402(A)cmf.k(l965).
4?. In2008,fhoSuµromoCourfofCoorgInhoIdfhnfcIvIIcourfsmusfdocIdo
on n cnso-by-cnso bnsIs whofhor n vnccIno-roInfod Injury Is unnvoIdnbIo for
cInIms of vnccIno dosIgn dofocf. Am. Homo Irods. Corµ. v. IorrnrI, 668 S.I.2d
236 (Cn. 2008). Iy confrnsf, In 2009, fho ThIrd CIrcuIf Courf of AµµonIs hoId
fhnf nII vnccInoInjurIos nIIogodIy duo fo dosIgn dofocf nro ¨unnvoIdnbIo¨ undor
fho l986 !nw bocnuso of fodornI µroomµfIon. IruosowIfz v. Wyofh, Inc., 56l
I.3d233,242-46,255-56(3dCIr.2009),cerI gronIeJ,l30S.Cf.l?34(20l0).On
Iobrunry 22, 20ll, fho Suµromo Courf nffIrmod fho ThIrd CIrcuIf`s ruIIng 6-2
fhnffhol986!nwµroomµfsnIIcIvIIvnccInodosIgndofocfcInIms.JusfIcoScnIIn
wrofo fho mnjorIfy oµInIon; JusfIco Sofomnyor wrofo n dIssonf, sfrongIy
dIsngrooIng wIfh fho mnjorIfy`s InforµrofnfIon. IruosowIfz v. Wyofh, Þo. 09-
l52, 20ll W! 588?89 (Iob. 22, 20ll), otoiloIle nf
hffµ://www.suµromocourf.gov/oµInIons/l0µdf/09-l52.µdf.
48. See 42!.S.C.§300nn-22(c).
49. See iJ.; CÐC, Voccine 1nfornoIion SIoIenenIe, www.cdc.gov/vnccInos/
µub/vIs/dofnuIf.hfm(InsfvIsIfodMnr.2l,20ll).
50. SeeAIfhonv.Soc`yofHonIfh&HumnnSorvs.,4l8I.3dl2?4,l2?8(Iod.
CIr.2005);eee oleoCnµIzznnov.Soc`yofHonIfh&HumnnSorvs.,440I.3dl3l?,
l324(Iod.CIr.2006);Androuex rel.Androuv.Soc`yofHonIfh&HumnnSorvs.,
569I.3dl36?,l3?4-?5(Iod.CIr.2009).
9
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 489
(l)nmodIcnIfhoorycnusnIIyconnocfIngfhovnccInnfIonnnd
fhoInjury;
(2) n IogIcnI soquonco of cnuso nnd offocf showIng fhnf fho
vnccInnfIonwnsfhoronsonforfhoInjury;nnd
(3) n showIng of n µroxImnfo fomµornI roInfIonshIµ bofwoon
vnccInnfIonnndInjury.
5l
Tho Courf nrfIcuInfod fho ronson for fhIs Iowor burdon fhnn
fhnfnocossnryIncIvIIcourf¨fonIIowfhofIndIngofcnusnfIonInn
fIoIdboroffofcomµIofonnddIrocfµroofofhowvnccInosnffocffho
humnnbody.¨
52
IofIfIonorsnronofroquIrodfoshowfhoµrocIso
mochnnIsmofInjury
53
bufnro¨moroIyroquIrodfoshowfhnffho
vnccIno In quosfIon cnusod fhoIr Injury. . ..¨
54
2. TLe VuccIne-AutIsm Contvovevsy
ThIs burdon of
µroofnµµIIodInfhoOmnIbus,nsIfdoosInnIIVICIcnsos.
VnccInos hnvo boon confrovorsInI sInco Idwnrd Jonnor
InIfInfod fhoIr wIdosµrond uso In IngInnd In fho l?00s.
55
Somo
nrguo fhnf fho confomµornry !.S. movomonf for vnccIno snfofy
nnd choIco bognn wIfh !on Thomµson`s foIovIsIon sµocInI DPT
IouleIIe In l982.
56
5l. AlIIen,4l8I.3dnfl2?8.
Thnf fIIm doµIcfs mnny IndIvIdunIs who
sufforod from fho kInds of InjurIos fhnf fho VICI Infor
comµonsnfod. Tho IndIvIdunIs fhnf fho fIIm doµIcfod hnd
dovnsfnfIng dIsnbIIIfIos soIzuros, monfnI rofnrdnfIon, nufIsm,
µnrnIysIs, bIIndnoss, nnd donfnoss, nmong ofhors. Thnf fIIm Iod
dIrocfIy fo fho cronfIon of ÐIssnfIsfIod Inronfs Togofhor, whIch
Infor bocnmo fho ÞnfIonnI VnccIno InformnfIon Confor (¨ÞVIC¨),
52. 1J.nfl280.
53. See Knudson ex rel Knudsonv.Soc`yof HonIfh&HumnnSorvs.,35I.3d
543,549(Iod.CIr.l994).
54. KoIIoy v. Soc`y of HonIfh & Humnn Sorvs., 68 Iod. CI. 84, l00 (Iod. CI.
2005).
55. Ior hIsfory of confrovorsy nbouf vnccInos, soo !oborf Johnsfon,
ConIenporor, AnIi-VoccinoIion MotenenIe in HieIoricol PerepecIite, in THI
IO!ITICS OI HIA!IÞC: HISTO!IIS OI TWIÞTIITH-CIÞT!!Y ÞO!TH AMI!ICAÞ
A!TI!ÞATIVIMIÐICIÞI259,259-86(!oborfJohnsfonod.,2004).
56. See DPT. Voccine IouleIIe (ÞIC foIovIsIon brondcnsf Aµr. l9, l982); eee
oleo IA!! OIIIT, ÐIAÐ!Y CHOICIS: HOW THI AÞTI-VACCIÞI MOVIMIÞT
TH!IATIÞS!SA!!2-?(20l0)|horoInnfforÐIAÐ!YCHOICIS].
10 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
490 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
fho IondIng !.S. vnccIno snfofy orgnnIznfIon.
5?
Throughouf fho
Info l980`s nnd onrIy l990`s, ÞVIC µubIIcIy ndvocnfod for fho
rIghf fo Informod consonf for vnccInnfIon nnd hIghIIghfod fho
rIsksofvnccInoInjury.HnrrIsCouIfornndInrbnrn!ooIIshor`s
book, A SHOT IÞ THI ÐA!K, nbouf ndvorso roncfIons fo fho ÐIT
vnccIno, quosfIonod fho chIIdhood ImmunIznfIon µrogrnm`s
snfofy.
58
Tho !.S. vnccIno confrovorsy grow In fho Info l990`s. In
l99?, Congrossmnn Irnnk InIIono of Þow Jorsoy nffnchod nn
nmondmonf fo n Iood nnd Ðrug AdmInIsfrnfIon (¨IÐA¨)
ronufhorIznfIonbIII,roquIrIngfhoIÐAfo¨comµIIonIIsfofdrugs
nnd foods fhnf confnIn InfonfIonnIIy Infroducod morcury
comµounds, nnd . . . µrovIdo n qunnfIfnfIvo nnd qunIIfnfIvo
nnnIysIs of fho morcury comµounds In fho IIsf.¨
59
Tho bIII Infor
ovoIvodInfofhoIÐAModornIznfIonAcfofl99?(¨IÐAMA¨)nnd
wnssIgnodInfoInwonÞovombor2l,l99?.
60
In l998 nnd l999, !.S. vnccIno mnnufncfurors rosµondod fo
IÐA roquosfs by µrovIdIng dofnIIod InformnfIon nbouf fhoIr
morcury-confnInIng vnccIno µrosorvnfIvo, fhImorosnI.
6l
ThImorosnIhndboonusodnsnµrosorvnfIvoInvnccInossIncofho
l930sbocnusoofIfssfrongnnfI-bncforInIµroµorfIos.
62
Thousoof
fhImorosnI nIIowod vnccIno mnnufncfurors fo µroduco nnd
dIsfrIbufo vnccInos moro chonµIy by µnckngIng nnd dIsfrIbufIng
fhomInmuIfI-usovInIs.
63
5?. ÞAT`! VACCIÞI IÞIO. CT!., hffµ://www.nvIc.org/ (Insf vIsIfod Jnn. 20,
20ll).
SovornIoffhovnccInosonfhoroufIno
58. See generoll, HA!!IS!IVI!MO!ICO!!TI!&IA!IA!A!OIIISHI!,ÐIT:A
SHOTIÞTHIÐA!K(l985).
59. Morcury InvIronmonfnI !Isk nnd ComµrohonsIvo !fIIIznfIon !oducfIon
InIfInfIvo,H.!.29l0,l05fhCong.§9(n)(l99?).
60. Iood nnd Ðrug AdmInIsfrnfIon ModornIznfIon Acf of l99?, 2l !.S.C. §
30l(2006);eee oleoAM.ACAÐ.OIIIÐIAT!ICS,HIIATITISCOÞT!O!!IIO!T(l998),
otoiloIle oIhffµ://www.nnµsonIIno.org/vnccInos/hcr.µdf.
6l. Voccinee, BlooJ & Biologice, TIineroeol in Voccinee, !.S. IOOÐ & Ð!!C
AÐMIÞ., hffµ://www.fdn.gov/bIoIogIcsbIoodvnccInos/snfofynvnIInbIIIfy/
vnccInosnfofy/ucm096228.hfm(InsfvIsIfodIob28,20ll).
62. 1J.
63. 1J.
11
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 49l
chIIdhoodImmunIznfIonschoduIoconfnInodfhImorosnI,IncIudIng
fhodIµhfhorIn-fofnnus-µorfussIscombInnfIonvnccIno.
64
In l999, fho IubIIc HonIfh SorvIco (¨IHS¨) of HHS nnd fho
AmorIcnnAcndomyofIodInfrIcs(¨AAI¨)IssuodnjoInfsfnfomonf
onfhImorosnIInvnccInos.Ifsfnfod:
IHSnndAAIconfInuoforocommondfhnfnIIchIIdronshouIdbo
ImmunIzod ngnInsf fho dIsonsos IndIcnfod In fho rocommondod
ImmunIznfIon schoduIo. CIvon fhnf fho rIsks of nof vnccInnfIng
chIIdron fnr oufwoIgh fho unknown nnd much smnIIor rIsk, If
nny,ofoxµosurofofhImorosnI-confnInIngvnccInosovorfhofIrsf6
monfhs of IIfo, cIInIcInns nnd µnronfs nro oncourngod fo
ImmunIzo nII Infnnfs ovon If fho choIco of IndIvIdunI vnccIno
µroducfsIsIImIfodfornnyronson.
65
Affor fho joInf sfnfomonf, µnronfs of nufIsfIc chIIdron
Inforrod fho µossIbIIIfy fhnf morcury-confnInIng vnccInos mIghf
hnvo confrIbufod fo fhoIr chIIdron`s dovoIoµmonfnI rogrossIon
fhrough n unIquo form of morcury µoIsonIng. In 200l, sovornI
nufhors µubIIshod nn nrfIcIo In MIÐICA! HYIOTHISIS, onfIfIod
AuIien. o notel forn of nercur, poieoning, µosfuInfIng fhnf
nufIsm mIghf bo fho rosuIf of morcury In vnccInos.
66
Inronfs of
chIIdronwIfhnufIsmbognnfofIIoInwsuIfsnroundfhocounfryfor
comµonsnfIon from vnccIno-Inducod Injury.
6?
64. Infhol990s,fhoÐITvnccInosconfnInodfhImorosnI.MM!nofnbIydoos
nof confnIn fhImorosnI bocnuso If confnIns IIvo vIrusos fhnf fho fhImorosnI
mIghf ofhorwIso kIII. Ior n IIsf of chIIdhood vnccInos nnd fhoIr fhImorosnI
confonf,soo iJ.nfTnbIol.
SInco fho Info
l990`s, fho vnccIno-nufIsm dobnfo hns confInuod, wIfh now
65. Iub.HonIfhSorv.,!.S.Ðoµ`f.ofHonIfh&HumnnSorvs.,TIineroeol in
Voccinee. A JoinI SIoIenenI of IIe Anericon AcoJen, of PeJioIrice onJ IIe
PuIlic HeolII Sertice, 48 MO!IIÐITY & MO!TA!ITY WK!Y. !II. 563 (l999),
otoiloIle oI hffµ://www.cdc.gov/MMW!/I!IVIIW/
MMW!HTM!/mm4826n3.hfm.
66. See generoll, S. Iornnrd of nI., AuIien. o Aotel Iorn of Mercur,
Poieoning, 56 MIÐ. HYIOTHISIS 462 (200l), otoiloIle oI
hffµ://www.nnfIonnInufIsmnssocInfIon.org/IIbrnry/nnovoIform.µdf.
6?. See generoll, Cordon ShomIn, Commonf, Mercur, Iieing. TIe OnniIue
AuIien ProceeJing onJ WIoI Ioniliee SIoulJ Knou Before IueIing OuI of
Voccine CourI,58AM.!.!.!IV.459(2008).
12 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
492 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
dovoIoµmonfsInmodIcInonndscIonco,
68
nndwIfhnufhorsfnkIng
µosIfIonsbofhfornndngnInsfnµossIbIovnccIno-nufIsmIInk.
69
3. WLut Is AutIsm?
¨WhnfIsnufIsm`¨ThIsdocoµfIvoIysImµIoquosfIonIsnffho
honrf of fhIs µrobIom. Todny, ¨nufIsfIc dIsordor¨ Is consIdorod n
µsychInfrIcdIngnosIsInfhoDiognoeIic onJ SIoIieIicol Monuol of
MenIol DieorJere (¨ÐSM-IV¨), fho sfnndnrd roforonco for fho
cInssIfIcnfIon.
?0
ThodIngnosfIccrIforIn,IncIudodInAµµondIxIIn
fuII, IncIudo (l) ImµnIrmonfs In socInI InforncfIon, (2)
ImµnIrmonfs In vorbnI nnd non-vorbnI communIcnfIon, nnd (3)
sforoofyµIcnI rosfrIcfod or roµofIfIvo µnfforns of bohnvIor nnd
Inforosfs.
?l
Thoro nro no unIvorsnIIy nccoµfod bIomnrkors such
ns µhysIcnI chnrncforIsfIcs or bIood or urIno fosfs. Tho fhroo
domnIns of dIngnosfIc crIforIn for nufIsfIc dIsordor covor n wIdo
sµocfrum, from IndIvIdunIs wIfh no Inngungo, nImosf no socInI
InforncfIon nnd sovoro bohnvIornI µrobIoms, fo oxfromoIy hIgh-
funcfIonIng IndIvIdunIs wIfh Infonso Inforosfs nnd quIrky
µorsonnIIfIos. Tho rnngo of nufIsfIc dIsordors In fho ÐSM-IV
formnIIy IncIudos nufIsm, !off`s ÐIsordor, ChIIdhood
ÐIsInfogrnfIvo ÐIsordor, Asµorgor`s Syndromo, nnd IorvnsIvo
ÐovoIoµmonfÐIsordorÞofOfhorwIsoSµocIfIod(¨IÐÐ-ÞOS¨).
?2
68. Ior n rovIow of scIonfIfIc sfudIos suµµorfIng n µossIbIo IInk bofwoon
vnccInos nnd nufIsm, eee CnroI Sfoff & Androw WnkofIoId, An UrgenI Coll for
More IeeeorcI, in VACCIÞI IIIÐIMIC: HOW CO!IO!ATI C!IIÐ, IIASIÐ SCIIÞCI,
AÞÐ COI!CIVI COVI!ÞMIÞT TH!IATIÞ O!! H!MAÞ !ICHTS, O!! HIA!TH, AÞÐ
O!! CHI!Ð!IÞ 49, 49 (!ouIso Kuo Hnbnkus & Mnry HoIInnd ods., 20ll). Ior
scIonfIfIcsfudIosdIsconfIrmIngnµossIbIoIInkbofwoonvnccInosnndnufIsm,soo
Voccine SofeI,, TIineroeol, CT!S. IO! ÐISIASI COÞT!O! AÞÐ I!IVIÞTIOÞ,
hffµ://www.cdc.gov/vnccInosnfofy/Concorns/ fhImorosnI/Indox.hfmI (Insf vIsIfod
Jnn.l8,20ll).
69. See, e.g., SITH MÞOOKIÞ, THI IAÞIC VI!!S: A T!!I STO!Y OI MIÐICIÞI,
SCIIÞCI, AÞÐ IIA! (20ll); ÐIAÐ!Y CHOICIS, eupro nofo 56; IA!! A. OIIIT,
A!TISM'SIA!SII!OIHITS:IAÐSCIIÞCI,!ISKYMIÐICIÞI,AÞÐTHISIA!CHIO!A
C!!I(2008);A!TH!!A!!IÞ,VACCIÞI:THICOÞT!OVI!SIA!STO!YOIMIÐICIÞI'S
C!IATIST !IIISAVI! (200?); ÐAVIÐ KI!IY, IVIÐIÞCI OI HA!M: MI!C!!Y IÞ
VACCIÞISAÞÐTHIA!TISMIIIÐIMIC:AMIÐICA!COÞT!OVI!SY(2005).
?0. AM. ISYCHIAT!IC ASS`Þ, ÐIACÞOSTIC AÞÐ STATISTICA! MAÞ!A! OI MIÞTA!
ÐISO!ÐI!S(ÐSM-IV-T!)§299.00,3??-?8(4fhod.2000).
?l. 1J.nf?5.
?2. SeeiJ.nf?6-84.
13
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 493
IocnusonufIsfIcdIsordorIsdofInodonIybynnnggrognfIonof
symµfoms, fhoro Is no monnIngfuI dIsfIncfIonbofwoon fho forms
¨nufIsm¨ nnd ¨nufIsm-IIko symµfoms.¨ ThIs nrfIcIo mnkos fho
dIsfIncfIon onIy fo nccurnfoIy rofIocf fho forms fhnf fho Courf of
IodornICInIms,cnrogIvors,nndofhorsuso.IfIsnofndIsfIncfIon
fowhIchfhonufhorsnffnchsIgnIfIcnnco.
Ono of fho mosf sfrIkIng chnrncforIsfIcs of nufIsm Is Ifs
drnmnfIc rIso sInco fho onrIy l990`s. Ior docndos, fho nufIsm
µrovnIonco wns nµµroxImnfoIy fIvo cnsos µor fon fhousnnd
chIIdron.
?3
In Ðocombor 2009, fho Confors for ÐIsonso ConfroI
(¨CÐC¨) nnnouncod fhnf fho rnfo nmong oIghf-yonr oIds wns ono
cnso µor ono hundrod nnd fon, or nµµroxImnfoIy l° of nII !.S.
chIIdron.
?4
AIfhoughforfwodocndos,HHSnnd!.S.µrofossIonnI
modIcnI nssocInfIons nrguod fhnf rIsIng rnfos of nufIsm woro
nffrIbufnbIosoIoIyfoboffordIngnosos,moroIncIusIvocnfogorIos,
nnd dIngnosfIc subsfIfufIon, In 2009 fho govornmonf
ncknowIodgod n ronI rIso duo nf Ionsf In µnrf fo onvIronmonfnI
fncfors.AsÐr.ThomnsInsoI,ÐIrocforoffhoÞnfIonnIInsfIfufoof
MonfnIHonIfhnndChnIroffhoInforngoncyAufIsmCoordInnfIng
CommIffoo, snId In IIghf of fho ono In ono hundrod nnd fon
numbors, ¨Thoro Is no quosfIon fhnf fhoro hns gof fo bo nn
onvIronmonfnIcomµononfhoro.¨
?5
AroconfsfudybyscIonfIsfsnf
fho InvIronmonfnI IrofocfIon Agoncy IdonfIfIod nufIsm`s
¨chnngoµoInf yonr¨ ns l988-89, µInµoInfIng fho sfnrf of n
drnmnfIcrIsoInµrovnIonco.
?6
?3. CnfhorIno !Ico, Pretolence of AuIien SpecIrun DieorJere - AuIien onJ
DetelopnenIol DieoIiliIiee MoniIoring AeIuorl, UniIeJ SIoIee, 2006, 58
MO!IIÐITY & MO!TA!ITY WK!Y. !II. l (2009), otoiloIle oI
hffµ://www.cdc.gov/mmwr/µrovIow/mmwrhfmI/ss58l0nl.hfm(¨Ioforofhol980s,
fho form 'nufIsm` wns usod µrImnrIIy fo rofor fo nufIsfIc dIsordor nnd wns
fhoughffobornro,nffocfIngnµµroxImnfoIyonoInovory2,000(0.5°)chIIdron,¨
I.o.5µorl0,000.).
?4. See CDC IeoIuree, CDC SIuJ,. An Ateroge of 1 in 110 CIilJren Hote on
ASD, CT!S. IO! ÐISIASI COÞT!O! AÞÐ I!IVIÞTIOÞ,
hffµ://www.cdc.gov/fonfuros/counfIngnufIsm(InsfvIsIfodJnn.l8,20l0).
?5. ÐnvId KIrby, Iieing AuIien AunIere -- IeoJing IeJerol Officiol So,e
¨Ao QueeIion¨ TIoI 1ntironnenIol 1xpoeuree Are A IocIor, H!IIIÞCTOÞ IOST
(Ðoc. 2l, 2009), otoiloIle oI hffµ://www.huffIngfonµosf.com/dnvId-kIrby/rIsIng-
nufIsm-numbors_b_39?9?8.hfmI.(ArfIcIoIsnccomµnnIodbyfrnnscrIµf).
?6. MIchnoI I. McÐonnId & John I. InuI, Tining of 1ncreoeeJ AuIieIic
DieorJer CunuloIite 1nciJence, 44 IÞVT!. SCI. & TICH. 2ll2, 2ll2 (20l0),
otoiloIle oI hffµ://www.nII.org/µdf/McÐonnIdInuI20l0.µdf; eee oleo Irvn Horfz-
14 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
494 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
AIfhough fhoro hnvo boon IsoInfod hIsforIcnI nccounfs of
IndIvIdunIs wIfh nufIsfIc qunIIfIos, µnrfIcuInrIy wIfh 'gonIus` or
'snvnnf`qunIIfIos,fhomodornµhonomononwnsfIrsfdoscrIbodby
chIId µsychInfrIsf !oo Knnnor In l943.
??
In TIe Age of AuIien. Mercur,, MeJicine onJ o MonnoJe
1piJenic,nhIsforIcnInccounfofnufIsm`srIso,ÐnnOImsfodnnd
Mnrk IInxIII frncod fho ncfunI IdonfIfIos of mosf of fho orIgInnI
chIIdron In Knnnor`s l943 cnso sorIos.
Knnnor fIrsf nofod
mnny of fho chnrncforIsfIcs fhnf form fho coro of fho syndromo:
ImµnIrod Inngungo, socInI skIIIs, nnd roµofIfIvo bohnvIors. Iuf
hIs cnrofuI cnso sorIos nnnIysIs fnIIod fo nscrIbo sIgnIfIcnnco fo
corfnIn roInfod symµfoms, IncIudIng unusunI foodIng µnfforns
nnd gnsfroInfosfInnI µrobIoms In fho chIIdron, nnd ho fnIIod fo
Iook nf µossIbIo onvIronmonfnI oxµosuros fhnf mIghf hnvo boon
cnusnI.
?8
AII of fho IdonfIfIod
chIIdron In fho cnso sorIos hnd oxµorIoncod known or µInusIbIo
oxµosuros fo ofhyI morcury, n fhon nowIy-cronfod synfhofIc
chomIcnI.
?9
IfhyImorcurywnsusodnffhnffImoInbofhvnccInos
nnd ns nn ngrIcuIfurnI fungIcIdo; fho chIIdron In fho cnso sorIos
hndµnronfsoIfhorInfhomodIcnIµrofossIonworkIngonvnccInos
or µnronfs In ngrIcuIfuro usIng fungIcIdos.
80
WhIIo fho morcury
connocfIon fo nufIsm Is nof µrovon, fhoro nro mnny sourcos,
IncIudIng fho OImsfod-IInxIII book,
8l
fhnf gIvo fho hyµofhosIs
µInusIbIIIfy.
82
IIccIoffo&!ornÐoIwIcho,TIe Iiee in AuIien onJ IIe Iole of Age oI Diognoeie,
20IIIÐIMIO!OCY84(2009).
??. See !oo Knnnor, AuIieIic DieIurIoncee of AffecIite ConIocI, 2 ÞI!VO!S
CHI!Ð 2l? (l943), otoiloIle oI hffµ://nffocf.modIn.mIf.odu/!grnds/ArfIcIos/
µdfs/Knnnor-l943-OrIgInµor.µdf.
?8. See ÐAÞ O!MSTIÐ & MA!K I!AXI!!, THI ACI OI A!TISM: MI!C!!Y,
MIÐICIÞI,AÞÐAMAÞ-MAÐIIIIÐIMIC(20l0).
?9. 1J. nf l-l6,34?-64.
80. SeeiJ.nfl63-365.
8l. See iJ.
82. Ofhor roconf sfudIos fhnf nofo corroInfIons bofwoon morcury, ofhor
onvIronmonfnI foxIns nnd nufIsm IncIudo Mnry CnfhorIno ÐoSofo & !oborf T.
HIfInn, SorIing OuI IIe Spinning of AuIien. Heot, MeIole onJ IIe QueeIion of
1nciJence, ?0 ACTA ÞI!!OIIO!OCIAI IXII!IMIÞTA!IS l65 (20l0); Mnry
CnfhorIno ÐoSofo, OclIon`e Iocor onJ AuIien. TIe Coee for DetelopnenIol
AeuroIoxine ConIriIuIing Io o Dieeoee of AeuroJetelopnenI, 30
ÞI!!OTOXICO!OCY 33l (2009); !nymond I. InImor of nI., ProxiniI, Io PoinI
Sourcee of 1ntironnenIol Mercur, Ieleoee Ae o PreJicIor of AuIien Pretolence,
15
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 495
Ono musf nofo fhnf fho ÐSM-IV dofInIfIon of ¨nufIsfIc
dIsordor¨ Is sImIInr on Ifs fnco fo fho VICI`s dofInIfIons of
¨oncoµhnIoµnfhy,soIzurosnndsoquoIn.¨
83
(l)ÐocronsodornbsonfrosµonsofoonvIronmonf(rosµonds,Ifnf
nII,onIyfoIoudvoIcoorµnInfuIsfImuII);
ThoVICI`sdoscrIµfIon
ofncufooncoµhnIoµnfhyforchIIdronoIghfoonmonfhsofngonnd
oIdor, IncIudIng ¨sIgnIfIcnnf chnngo In monfnI sfnfus¨ nnd
¨sIgnIfIcnnfIydocronsodIovoIofconscIousnoss,¨IsconsIsfonfwIfh
fho ÐSM-IV`s crIforIn for onsof boforo ngo fhroo of ¨nufIsfIc
dIsordor.¨ThodImonsIonsofnufIsfIcdIsordornroconsonnnfwIfh
fho VICI`s dofnIIod doscrIµfIon of ¨docronsod IovoI of
conscIousnoss¨:
(2)Ðocronsodornbsonfoyoconfncf(doosnoffIxgnzouµonfnmIIy
momborsorofhorIndIvIdunIs);or
(3)InconsIsfonfornbsonfrosµonsosfooxfornnIsfImuII(doosnof
rocognIzofnmIIInrµooµIoorfhIngs).
84
In ofhor words, Inck of normnI oyo gnzo, ImµnIrod socInI
roInfIons,nndnon-rosµonsIvonossfooxfornnIsfImuIInronofodIn
bofh fho ÐSM-IV nufIsm nnd VICI oncoµhnIoµnfhy
cInssIfIcnfIons ns dIngnosfIc crIforIn. To bo suro, fho ÐSM-IV
cInssIfIcnfIon dIffors from fho VICI doscrIµfIon, buf ÐSM-IV
¨nufIsfIc dIsordor¨ doos nof confrndIcf fho VICI doscrIµfIon of
oncoµhnIoµnfhy, soIzuros, nnd soquoIn. Indood, scIonfIfIc
l5HIA!TH&I!ACIl8(2009).IfIsInforosfIngfhnfKnnnorhImsoIfnofodfhnfn
bIoIogIcnI ofIoIogy of nufIsm mIghf hnvo boon ovorIookod. In fho foroword fo
II!ÞA!Ð !IM!AÞÐ, IÞIAÞTI!I A!STIM: SYÞÐ!OMI AÞÐ ITS IMI!ICATIOÞS IO! A
ÞI!!A!THIO!YOIIIHAVIO!(l964),Knnnorwrofo:
Tho concoµf of 'onrIy InfnnfIIo nufIsm` (I couId nof fhInkof n boffor nnmo) wns
dIIufod by somo fo doµrIvo If of Ifs sµocIfIcIfy, so fhnf fho form wns usod ns n
µsoudo-dIngnosfIc wnsfobnskof for n vnrIofy of unroInfod condIfIons, nnd n
nofhIng-buf µsychodynnmIc ofIoIogy wns docrood by somo ns fho onIy vnIId
oxµInnnfIon,sofhnffurfhorcurIosIfywnssfIfIodorovonscornod.
1J.nfv.
83. See infro AµµondIcosInndII.
84. Conporeinfro AµµondIxIuiII infroAµµondIxII.
16 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
496 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
IIfornfuro ncknowIodgos fhnf fho condIfIons offon cooxIsf.
85
4. TLe OmnIbus AutIsm PvoceedIng
Thoso doscrIµfIons, whon µuf sIdo by sIdo, show sIgnIfIcnnf
sImIInrIfIos.
InmIIIos nIIogIng vnccIno-Inducod nufIsm fIIod InwsuIfs
ngnInsfvnccInomnnufncfurorsInsfnfonndfodornIcourfsnround
fho counfry sfnrfIng In l999. In 2002, fho Courf of IodornI
CInIms Iero, t. HHS docIsIon InrgoIy ondod such IIfIgnfIon.
86
ÞonofhoIoss, fIvo fhousnnd µofIfIonors fIIod cInIms In fho
VICI of vnccIno-Inducod nufIsm on fhImorosnI nnd MM!
cnusnfIon fhoorIos. Tho VICI docIdod IfwouId hoId honrIngson
fhosofwofosffhoorIoswIfhfhroo¨fosfcnsos¨foronchfhoory,fo
docIdo ¨gonornI cnusnfIon,¨ fhnf wouId nµµIy fo nII cnsos wIfh
sImIInr cInIms, nnd ¨sµocIfIc cnusnfIon,¨ for fho IndIvIdunI
chIIdron`scInIms.Mnnyfhousnndsmorocnsosworobnrrodfrom
fIIIng bocnuso fho sfrIcf fhroo-yonr sfnfufo of IImIfnfIons hnd
oxµIrod.InnddIfIon,somoµofIfIonorsfIIodInfhoVICInndfhon
movod fhoIr cnsos fo sfnfo nnd fodornI courfs nffor fho roquIrod
wnIfIng µorIod fo brIng InwsuIfs ngnInsf vnccIno mnnufncfurors
onfhofhooryofvnccInodosIgndofocf.
IIndIng fhnf fho morcury-confnInIng µrosorvnfIvo wns ¨vnccIno-
roInfod¨undorfhol986!nw,fhoChIofSµocInIMnsforruIodfhnf
nII fhImorosnI cnsos woro roquIrod fo bo consoIIdnfod nnd fIIod
fIrsfInfhoVICI,nsnIIofhorvnccIno-roInfodInjurIos.IofonfInI
µofIfIonorsvIowodfhImorosnInsnµrosorvnfIvo,nndnofnsfruIy
vnccIno-roInfod. Iurfhormoro, fhoywnnfod fo IIfIgnfo In roguInr
cIvII courfs, whoro fhoy wouId onjoy rIghfs fo dIscovory,
µofonfInIIyhIghcomµonsnforynndµunIfIvodnmngos,nndjurIos.
ÞonooffhosodImonsIonsnronvnIInbIoInfhoVICI.
8?
85. See,e.g.,S.I.IrysonofnI.,Pretolence of AuIien Anong AJoleecenIe uiII
1nIellecIuol DieoIiliIiee,53CAÞ. J. ISYCHIAT!Y 449, 449 (2008);!.Tuchmnn&
I.!nµIn,1pilepe, in AuIien,l!AÞCITÞI!!O!OCY352,353(2002).
86. See !oroy v. Soc`y of fho Ðoµ`f of HonIfh & Humnn Sorvs., Þo. 02-392V,
2002 W! 3l?30680 (Iod. CI. Ocf. ll, 2002), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/!oroy°20l.µdf.
8?. See, e.g., Am.HomoIrods.Corµ.v.IorrnrI,668S.I.2d236,236-38(Cn.
2008).
17
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 49?
On Iobrunry l2, 2009,SµocInI Mnsfors of fhoIodornI Courf
of CInIms roIonsod Iong-nwnIfod docIsIons In fho fIrsf OmnIbus
AufIsmIrocoodIngfosfcnsos.ThoSµocInIMnsforsruIodfhnf(l)
fhoro wns no µInusIbIo IInk bofwoon fho MM! vnccIno nnd
nufIsm, nnd fhnf (2) fho fhroo ¨fosf cnso¨ µofIfIonors for fhIs
cnusnfIon fhooryMIchoIIo CodIIIo, CoIfon Snydor, nnd Ynfos
HnzIohursfdosorvodnocomµonsnfIon.ThoSµocInIMnsforsdId
nofsImµIyconcIudofhnffhoscIoncodIsfnvorodµofIfIonors.Thoy
IssuodscnfhIng oµInIons fhnf rojocfod nnd domonnod µofIfIonors`
scIonfIfIcfhoorIos,oxµorfwIfnossosnndfronfIngµhysIcInns.
SµocInI Mnsfor HnsfIngs µrocInImod fhnf fho CodIIIo cnso
wns ¨ono-sIdod,¨ fhnf fho docfors who ndvIsod MIchoIIo CodIIIo
woro ¨ter, urong,¨ (omµhnsIs In orIgInnI).
88
Ho wrofo fhnf fho
µhysIcInns who found n IInk bofwoon MIchoIIo`s sovoro mnIndIos
nndhorvnccInos¨mIsIod¨fhoCodIIIosnnd¨nroguIIfy...ofgross
modIcnI mIsjudgmonf.¨
89
SµocInI Mnsfor VowoII, In fho Snydor
cnso, sImIInrIy chnrncforIzod fho µofIfIonors ns ¨vIcfIms of bnd
scIonco,¨nndsuggosfodfhnf¨nnobjocfIvoobsorvorwouIdhnvofo
omuInfo !owIs CnrroII`s WhIfo Quoon nnd bo nbIo fo boIIovo sIx
ImµossIbIo (or, nf Ionsf, hIghIy ImµrobnbIo) fhIngs boforo
bronkfnsf¨ fo docIdo In µofIfIonors` fnvor.
90
In shorf, fho SµocInI
MnsforsdocIdodfhnf(l)fhorownsnoroIInbIoscIoncosuµµorfIng
nn MM!-fhImorosnI-nufIsm IInk, (2) fho µofIfIonors` µhysIcInns
woro ¨guIIfy of gross modIcnI mIsjudgmonf,¨ nnd (3) fho µnronfs
whoµursuodunµrovonvnccInoInjuryfronfmonfsworo¨mIsIodby
µhysIcInns.¨
9l
Tho noxf yonr, In 20l0, fho snmo SµocInI Mnsfors roIonsod
fhoIr docIsIons In fho WIIIInm Mond, Jordnn KIng, nnd CoIIn
Ðwyor fosf cnsos on fho socond fhoory of morcury-Inducod
88. CodIIIo v. Soc`y of HonIfh & Humnn Sorvs., Þo. 98-9l6V, 2009 W!
33l968, nf *l34 (Iod. CI. Iob. l2, 2009), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/vnccIno_fIIos/HnsfIngs-
CodIIIo.µdf.
89. 1J. nf*l35.
90. Snydor v. Soc`y of HonIfh & Humnn Sorvs., Þo. 0l-l62V, 2009 W!
332044, nf *l98 (Iod. CI. Iob. l2, 2009), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/vnccIno_fIIos/VowoII.Snydor.µdf.
9l. See CeJillo,2009W!33l968,nf*l35.
18 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
498 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
nufIsm, ngnIn fIndIng no bnsIs for comµonsnfIon.
92
Thoso fhroo
fosfcnsoµofIfIonorsoIocfodnoffonµµonIfhoIrdocIsIons.Among
fhoso nrguIng MM!-Inducod nufIsm In fhofIrsfsof offosf cnsos,
bofhCodIIIonndHnzIohursfIosfonnµµonI
93
nndSnydordIdnof
nµµonI.
94
Tho Courf of AµµonIs for fho IodornI CIrcuIf dId nof nffIrm
nufomnfIcnIIy fho CeJillo nnd HocleIureI docIsIons. In fho
HocleIureI t. HHS ornI nrgumonf, fho judgos wnnfod fo know
whnf wouId hnµµon If Infor scIonco confIrms fho fhImorosnI-
nufIsmfhoory`
95
WhnfwIIIhnµµonfofhochIIdron`scInIms`Tho
judgonnsworodhIsownquosfIon,snyIngfhnfCongrosscouIdndd
fhImorosnI-InducodnufIsmfofhoTnbIoofInjurIosnndsfnfofhnf
fhoso who hnd µrovIousIy boon donIod comµonsnfIon wouId sfIII
bo oIIgIbIo.
96
SImIInrIy, fho µnnoI of nµµoIInfo judgos In CeJillo t. HHS
nskodfhoÐoµnrfmonfofJusfIco(¨ÐOJ¨)foughquosfIons.
Tho nµµoIInfo courf judgos soomod nof fo fInd fho
vnccIno-nufIsmfhoorynsImµInusIbIonshndfhoSµocInIMnsfors.
9?
92. See Mond v. Soc`y of HonIfh & Humnn Sorvs., Þo. 03-2l5V, 20l0 W!
3584449(Iod.CI.Aug.20,20l0);KIngv.Soc`yofHonIfh&HumnnSorvs.,Þo.
03-584V,20l0W!892296(Iod.CI.Mnr.l2,20l0);Ðwyorv.Soc`yofHonIfh&
Humnn Sorvs., Þo. 03-l202V, 20l0 W! 892250 (Iod. CI. Mnr. l2, 20l0). AII
fhroo cnsos nro nvnIInbIo onIIno. See AuIien Decieione onJ BoclgrounJ
1nfornoIion, !.S. IIÐ. CO!!T OI C!AIMS,
hffµ://www.uscfc.uscourfs.gov/nodo/5026(InsfvIsIfodMnr.l,20ll).
Two
offhofhroojudgosworocIonrIyfroubIodfhnfÐOJhndInfroducod
nn oxµorf roµorf fo robuf koy µofIfIonor bIoIogIcnI ovIdonco
wIfhouf InfroducIng fho undorIyIng Inb rosuIfs or books,
somofhIng fhnf nII µnrfIos ngrood wouId hnvo boon ImµossIbIo
93. CodIIIov.Soc`yofHonIfh&HumnnSorvs.,6l?I.3dl328,l349-50(Iod.
CIr. 20l0), otoiloIle oI hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/
fIIos/codIIIo.fodcIr.µdf; HnzIohursf v. Soc`y of HonIfh & Humnn Sorvs., 604 I.3d
l343, l354 (Iod. CIr. 20l0), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/HnzIohursf_AffIrmnnco.µdf.
94. SeeSn,Jer,2009W!332044,nf*l98.
95. TrnnscrIµf of OrnI Argumonf, HnzIohursf v. Soc`y of HonIfh & Humnn
Sorvs., 604 I.3d l343 (Iod. CIr. 20l0), otoiloIle oI
hffµ://www.cnfc.uscourfs.gov/ornI-nrgumonf-rocordIngs/2009-5l28/nII.
96. 1J.
9?. TrnnscrIµfofOrnInrgumonf,CodIIIov.Soc`yofHonIfh&HumnnSorvs.,
Þo. 98-9l6V, 2009 W! 33l968 (Iod. CI. Iob. l2, 2009), otoiloIle oI
hffµ://www.cnfc.uscourfs.gov/ornI-nrgumonf-rocordIngs/20l0/nII/codIIIo.hfmI.
19
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 499
undor fho IodornI !uIos of CIvII Irocoduro.
98
Thoy µrobod
whofhorÐOJ hnd nskod forfho Inb books (fhoy hndn`f)
99
or how
ÐOJcouIdbosurofhnffhooxµorfroµorfwnsroIInbIowhonÐOJ
dIdn`f hnvo fho undorIyIng dnfn (whon fho ÐOJ Inwyor nssurod
fho judgo fhnf fho dnfn wouId hnvo roInforcod fho oxµorf`s
concIusIons, fho judgo Inughod, ns dId obsorvors In fho
courfroom).
l00
Tho judgos woro sImIInrIy froubIod fhnf ÐOJ
fnIIod fo nofIfy µofIfIonors fhnf fhoy woro sookIng fho oxµorf
roµorf In fho fIrsf µInco, ns suroIy ÐOJ shouId hnvo boon woII
nwnro fhnf surµrIso wns nn onfIroIy InnµµroµrInfo fncfIc In fho
VICI, whIch Congross monnf fo bo µofIfIonor-frIondIy nnd non-
ndvorsnrInI.
l0l
WhIIo fho nµµoIInfo judgos In bofh HocleIureI
nndCeJillo docIdodInfnvorofHHSnndngnInsfµofIfIonors,fhoy
dId so nffor confonfIous ornI nrgumonf, nnd fho judgos nofod In
CeJillo t. HHSfhnfÐOJ`sconducffroubIodfhom.
l02
AfforfhofInnIOmnIbusnµµonIsworodocIdodInfhosummor
of20l0,bynIInµµonrnncos,fhovnccIno-nufIsmcnsoInfhoVICI
wns cIosod. Tho Courf of IodornI CInIms sonf ouf Ioffors fo nII
µofIfIonorsfoIIIngfhom,Insomnnywords,fhnfunIossfhoycouId
nIIogo dIfforonf fhoorIos nnd µrovIdo comµoIIIng oxµorfs nnd
ovIdonco, fhoIr cnsos wouId bo dIsmIssod wIfhouf honrIng on fho
bnsIsoffhoOmnIbusgonornIcnusnfIonfosfcnsos.
l03
98. 1J.
99. 1J.
l00. 1J.
l0l. 1J.
l02. CodIIIov.Soc`yofHonIfh&HumnnSorvs.,6l?I.3dl328,l342(Iod.CIr.
20l0), otoiloIle oI hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/
fIIos/codIIIo.fodcIr.µdf; HnzIohursf v. Soc`y of HonIfh & Humnn Sorvs., 604 I.3d
l343, l354 (Iod. CIr. 20l0), otoiloIle oI hffµ://www.uscfc.uscourfs.gov/
sIfos/dofnuIf/fIIos/HnzIohursf_AffIrmnnco.µdf (¨Wo ngroo wIfh µofIfIonors fhnf
fho govornmonf's fnIIuro fo µroduco or ovon fo roquosf fho documonfnfIon
undorIyIng Ðr. IusfIn's roµorfs Is froubIIng, buf wo fhInk fhnf In fho
cIrcumsfnncosoffhIscnso,fhnffnIIurodoosnofjusfIfyrovorsnI.¨).
l03. SeeAufIsm!µdnfo-Soµfombor29,20l0,1n reCInImsforVnccInoInjurIos
!osuIfIng In AufIsm Sµocfrum ÐIsordor or n SImIInr ÞourodovoIoµmonfnI
ÐIsordor, 2002 W! 3l696?85 (Iod. CI. JuIy 3, 2002), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/nufIsm°
20uµdnfo°209°2029°20l0.µdf; CO!!T OI IIÐ. C!AIMS, C!IÐAÞCI TO
IITITIOÞI!S OÞ HOW TO IXIT THI VACCIÞI I!OC!AM l (20l0), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/IXITIÞC_C!IÐAÞCI_
TO_I!O_SIS.µdf.
20 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
500 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
5. TLe PoIIng ConcessIon
ÐurIngfhoµroµnrnfIonforfhosocondsofoffosfcnsosInfho
OmnIbus fhnf wouId consIdor whofhor fhImorosnI-confnInIng
vnccInos cnuso nufIsm, n mnjor, unnnfIcIµnfod ovonf occurrod:
HHS concodod ono of fho sInfod fosf cnsos. In n roµorf roquIrod
by Courf !uIo 4(c), Ionkod fo fho µross, HHS concodod fhnf
vnccInos, IncIudIng fho MM!, hnd frIggorod Hnnnnh IoIIng`s
oncoµhnIoµnfhy nnd subsoquonf dovoIoµmonfnI rogrossIon.
l04
HHS`s doscrIµfIon of fho chIId`s condIfIon ImµIIod n dIsfIncfIon
bofwoon ¨nufIsm-IIko symµfoms¨ nnd ¨nufIsm,¨ nIfhough fhoro
wnsnonmbIguIfyfhnfHnnnnhIoIIngInfncfhndnufIsm.
l05
Tho
concossIon documonf ¨concIudod fhnf fho fncfs of fhIs cnso moof
fho sfnfufory crIforIn for domonsfrnfIng fhnf fho vnccInnfIons
CHI!Ð rocoIvod on JuIy l9, 2000, sIgnIfIcnnfIy nggrnvnfod nn
undorIyIng mIfochondrInI dIsordor, whIch µrodIsµosod hor fo
dofIcIfs In coIIuInr onorgy mofnboIIsm, nnd mnnIfosfod ns n
rogrossIvo oncoµhnIoµnfhy wIfh fonfuros of nufIsm sµocfrum
dIsordor.¨
l06
ThIsconcossIonIodfosomoInforosfInfhoµrosson
fho vnccIno-nufIsm IInk nnd fho roIo of mIfochondrInI
condIfIons.
l0?
l04. See ÐnvId KIrby, TIe Voccine-AuIien CourI DocunenI 1ter, Anericon
SIoulJ IeoJ, H!IIIÞCTOÞ IOST (Iob. 26, 2008), otoiloIle oI
hffµ://www.huffIngfonµosf.com/dnvId-kIrby/fho-vnccInonufIsm-courf-
d_b_88558.hfmI; eee oleo !.S. CT. IIÐ. C!AIMS VACCIÞI !. 4(c), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/courf_Info/VnccInoruIos_
20l00lll_v4.µdf.
In 20l0, fho IoIIng fInnncInI comµonsnfIon
docIsIon wns µubIIshod nnd showod fhnf HHS µnId ovor $l.5
l05. Jon S. IoIIng of nI, DetelopnenIol Iegreeeion onJ MiIocIonJriol
D,efuncIion in o CIilJ WiII AuIien,2lJ.OICHI!ÐÞI!!O!OCYl?0,l?l(2006).
l06. SeeKIrby,eupro nofol04.AbrIofoxcorµffromfhIsconcossIonroµorfIs
nIsonvnIInbIonfIoIIngv.Soc`yofHonIfh&HumnnSorvs.,Þo.02-l466V,2008
W! l883059 (Iod. CI. Aµr. l0, 2008). If Is nofnbIo fhnf fhIs InIfInI concossIon
roµorf moroIy monfIons fho MM! vnccIno ns 3 of 9 nnfIgons ndmInIsforod fo
Hnnnnh IoIIng In ono offIco vIsIf, whorons fho fInnI comµonsnfIon docIsIon,
nofod boIow In fho IubIIshod Cnso Chnrf ns Cnso 2l, sµocIfIos MM! ns fho
µrIncIµnIcnusoofhorInjury.
l0?. See CIngor TnyIor, TIe Iole of GoternnenI onJ MeJio, in VACCIÞI
IIIÐIMIC: HOW CO!IO!ATI C!IIÐ, IIASIÐ SCIIÞCI, AÞÐ COI!CIVI COVI!ÞMIÞT
TH!IATIÞ O!! H!MAÞ !ICHTS, O!! HIA!TH, AÞÐ O!! CHI!Ð!IÞ l50, l56-5?
(!ouIsoKuoHnbnkus&MnryHoIInndods.,20ll).
21
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 50l
mIIIIon In dnmngos.
l08
Tho roIovnnf VICI wobsIfo nofos
cnrofuIIy, howovor, fhnf whIIo ono cnso rocoIvod comµonsnfIon
from fho OmnIbus, ¨HHS hns novor concIudod In nny cnso fhnf
nufIsmwnscnusodbyvnccInnfIon.¨
l09
Tho IoIIng concossIon Ioff uncIonr jusf how Hnnnnh IoIIng
mIghf dIffor from fho ofhor fIvo fhousnnd cInIms of vnccIno-
Inducod nufIsm In fho OmnIbus. Indood, whnf mndo fho mnffor
µnrfIcuInrIy ncufo wns fhnf HHS nnd ÐOJ roIIod on fho vory
snmomodIcnIoxµorf,mnkIngfhovorysnmomodIcnIdIngnosIs,fo
bofh comµonsnfo fho Poling cnso nnd fo dIsmIss ono of fho fosf
cnsos,wIfhouffhnfoxµorfovorboIngcross-oxnmInodorfosfIfyIng
In µorson In fho OmnIbus nbouf fhIs nµµnronf confrndIcfIon.
ll0
In Info 20l0, TIe 1cononieI nofod fhnf fnr from soffIIng fho
mnffor of mIfochondrInI dysfuncfIon nnd n µossIbIo vnccIno-
nufIsm IInk, fho HHS concossIon Ioff fho mnffor unrosoIvod.
lll
6. Attempts to GuIn InIovmutIon About AutIsm In
Compensuted Cuses
Tho Poling concossIon rnIsod koy quosfIons nbouf fho VICI`s
frnnsµnroncy nnd oquIfnbIo fronfmonf of µofIfIonors. Jusf how
dIfforonfwnsHnnnnhIoIIng`scnso`
Affor fho IoIIng concossIon, journnIIsfs bognn IookIng for
µossIbIo ovIdonco of ofhor cnsos of nufIsm nmong VICI-
comµonsnfod cnsos. !oborf I. Konnody, Jr. nnd ÐnvId KIrby
roµorfod on fho cnso of InIIoy Innks, n boy whom fho VICI
l08. ChIIdÐoo/??v.Soc`yofHonIfh&HumnnSorvs.,20l0W!3395654nf*4
(Iod. CI. JuIy 2l, 20l0), otoiloIle oI hffµ://www.uscfc.uscourfs.gov/
sIfos/dofnuIf/fIIos/CAMIII!!SMITH.°20ÐOI??082?l0.µdf.
l09. AoIionol Voccine 1njur, ConpeneoIion Progron, SIoIieIice IeporI,
IeIruor, S, 2011,!.S.ÐII`TOIHIA!TH&H!MAÞSI!VS.,HIA!TH!IS.&SI!VS.
AÐMIÞ., hffµ://www.hrsn.gov/vnccInocomµonsnfIon/ sfnfIsfIcs_roµorf.hfm (Insf
vIsIfod Mnr. 3, 20ll). Tho comµonsnfIon docIsIon for fho IoIIng cnso, IncIudod
boIow nf Cnso 2l, Is bnsod on ¨nn MM! vnccIno TnbIo µrosumµfIvo Injury of
oncoµhnIoµnfhy.¨CIilJ Doe/77,20l0W!3395654,nf*l.
ll0. See Mnry HoIInnd & !oborf Krnkow, TIe IigII Io Iegol IeJreee, in
VACCIÞI IIIÐIMIC: HOW CO!IO!ATI C!IIÐ, IIASIÐ SCIIÞCI, AÞÐ COI!CIVI
COVI!ÞMIÞT TH!IATIÞ O!! H!MAÞ !ICHTS, O!! HIA!TH, AÞÐ O!! CHI!Ð!IÞ
39,42(!ouIsoKuoHnbnkus&MnryHoIInndods.,20ll).
lll. 1nerg, Droin. TIe Coee of AuIien Mo, Ie IoulI, MiIocIonJrio,
ICOÞOMIST (Ðoc. l, 20l0), otoiloIle oI hffµ://www.oconomIsf.com/nodo/
l?6266??.
22 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
502 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
comµonsnfod for vnccIno-Inducod ncufo domyoIInnfIng
oncoµhnIomyoIIfIs (¨AÐIM¨), IondIng fo IorvnsIvo ÐovoIoµmonf
ÐIsordor Þof OfhorwIso SµocIfIod, nn nufIsfIcdIsordor.
ll2
KIrby
nIsoµubIIshodnrosµonsohorocoIvodfromHHSnboufnufIsmns
n fonfuro of VICI-comµonsnfod cnsos. Ho onfIfIod If
¨CommunIcnfIon from Humnn !osourcos nnd SorvIcos
AdmInIsfrnfIon of HHS fhnf If Ðoos nof Trnck AufIsm.¨ In If,
HHSwrofo:
Irom:Iowmnn,ÐnvId(H!SA)|mnIIfo:ÐIowmnn¸hrsn.gov]
Sonf:IrIdny,Iobrunry20,20095:22IM
To:'dkIrby¸nyc.rr.com`
Subjocf:H!SASfnfomonf
ÐnvId,
InrosµonsofoyourmosfroconfInquIry,H!SAhnsfhofoIIowIng
sfnfomonf:
Thogovornmonfhnsnovorcomµonsnfod,norhnsIfovorboon
ordorodfocomµonsnfo,nnycnsobnsodonndoformInnfIonfhnf
nufIsmwnsncfunIIycnusodbyvnccInos.Wohnvocomµonsnfod
cnsosInwhIchchIIdronoxhIbIfodnnoncoµhnIoµnfhy,orgonornI
brnIndIsonso.IncoµhnIoµnfhymnybonccomµnnIodbyn
modIcnIµrogrossIonofnnnrrnyofsymµfomsIncIudIngnufIsfIc
bohnvIor,nufIsm,orsoIzuros.
Sone cIilJren uIo Iote Ieen conpeneoIeJ for toccine injuriee
no, Iote eIoun eigne of ouIien Iefore IIe Jecieion Io
conpeneoIe, or no, ulIinoIel, enJ up uiII ouIien or ouIieIic
e,npIone, IuI ue Jo noI Irocl coeee on IIie Ioeie.
!ognrds,
ll2. See generoll, !oborf I. Konnody, Jr. & ÐnvId KIrby, Voccine CourI.
AuIien DeIoIe ConIinuee, H!IIIÞCTOÞ IOST (Iob. 24, 2009), otoiloIle oI
hffµ://www.huffIngfonµosf.com/roborf-f-konnody-jr-nnd-dnvId-kIrby/vnccIno-
courf-nufIsm-dobn_b_l696?3.hfmI; Innks v. Soc`y of HonIfh & Humnn Sorvs.,
Þo.02-0?38V,200?!.S.CInIms!IXIS254(Iod.CI.JuIy29,200?),otoiloIle
oI hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/ AboII.IAÞKS.02-0?38V.µdf;
eee oleo infroIubIIshodCnsoChnrf.
23
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 503
ÐnvIdIowmnn
OffIcoofCommunIcnfIons
HonIfh!osourcosnndSorvIcosAdmInIsfrnfIon
30l-443-33?6
ll3
Tho nufhors, µorµIoxod by HHS`s nµµnronf dIsInforosf In nn
nssocInfIon of vnccIno Injury wIfh nufIsm, docIdod fo µrobo fho
Issuofurfhor.Co-nufhor!oborfKrnkownddrossodnIroodomof
InformnfIon Acf (¨IOIA¨) roquosf fo HHS nskIng whofhor If
wouId bo µossIbIo fo obfnIn InformnfIon
ll4
II. IURTH£R INV£STIGATION
nnd documonfs
rognrdIng comµonsnfod vnccIno Injury cInIms. Affor rocoIvIng n
rosµonso fhnf such nnundorfnkIng wouId fnko four fo fIvo yonrs
nnd wouId cosf nµµroxImnfoIy $?50,000, fho nufhors furnod fo
Inco!nIvorsIfySchooIof!nwfonssIsfInfhoIrInquIry.
1. Compensuted Cuses oI VuccIne InJuvy
Tho nufhors bognn n rosonrch µrojocf wIfh Inco !nw SchooI
sfudonfsfoIocnfonndnnnIyzoVICIcnsosnssossIngwhofhorfho
VICI hnd In fncf comµonsnfod vnccIno-Inducod brnIn dnmngo,
IncIudIngnufIsm,whIIoµorhnµsnofusIngfhnfformsµocIfIcnIIy.
Ioor-rovIowod modIcnInnd IognI journnIs nndµromInonf vnccIno
rosonrchors hnvo ncknowIodgod fho vnIuo of ovnIunfIng
comµonsnfod cInIms In fho µnsf.
ll5
ll3. SeeCIngorTnyIor,Voccinee Don`I CAUS1 AuIien, TIe, JueI I1SUIT in
AuIien, AÐVIÞT!!IS IÞ A!TISM I!OC (Soµf. 9, 20l0, 4:l3 IM),
hffµ://ndvonfurosInnufIsm.bIogsµof.com/20l0/09/vnccInos-donf-cnuso-nufIsm-
fhoy-jusf.hfmI(omµhnsIsnddod).IornnoxcorµfoffhoomnII,soonIso Konnody
&KIrby,eupronofoll2.
WhIIo rocognIzIng fhnf fho
IognIsfnndnrdofcnusnfIonIsnoffhosnmonsscIonfIfIccnusnfIon
(nIso cnIIod ¨cnusnIIfy¨), sovornI nufhors hnvo µubIIshod nrfIcIos
on vnccIno Injury bnsod on rovIow of comµonsnfod cInIms for
µorfussIs,µoIIo,monsIos,ruboIIn,nndMM!vnccInoInjurIos.Tho
ll4. See infro AµµondIxIII.
ll5. See infro AµµondIxIV,whIchhIghIIghfsfhogovornmonfnInndschoInrIy
uso of fho VICI-comµonsnfod cnsos ns n sourco of vnIunbIo InformnfIon on
vnccInoInjury.
24 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
504 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
nufhors hnvo IncIudod scIonfIsfs nf fho CÐC, fho InsfIfufo of
ModIcIno,nndfhoVICI.
u. VICP PubIIsLed Cuses CompensutIng
£ncepLuIoputLy und ResIduuI SeIzuve ÐIsovdev,
NotIng ov SuggestIng AutIsm ov AutIsm-IIke
Symptoms
Tho nufhors, wIfh fho nssIsfnnco of Inco !nw sfudonfs,
cronfod n dnfnbnso of VICI µubIIshod docIsIons fhnf usod
roIovnnf forms roInfod fo nufIsm. Through fhIs sonrch of fInnI
VICI docIsIons or cnso sfIµuInfIons, wo found fwonfy-ono
docIsIons fhnf ncknowIodgod nufIsm or nufIsm-IIko symµfoms
nssocInfod wIfh vnccIno-Inducod oncoµhnIoµnfhy nnd soIzuro
dIsordor. Tho foIIowIng fnbIo summnrIzos fho cnsos nnd
sfIµuInfIons wIfh Inngungo fhnf sfrongIy suggosfs nufIsfIc
fonfuros:
25
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 505
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03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 5ll
Sovonfoonoffhofwonfy-onocnsosnofodnbovomonfIonfho
word ¨nufIsm,¨ ¨nufIsfIc,¨ or ono of fho nufIsfIc dIsordors, !off`s
ÐIsordor or IorvnsIvo ÐovoIoµmonfnI ÐIsordor.
ll6
Iour cnsos
doscrIbo dovoIoµmonfnI rogrossIon nnd soIf-InjurIous bohnvIors
hIghIy consIsfonfwIfhdoscrIµfIons of sovoro nufIsm.
ll?
Somo of
fho cnsos ruIo fhnf n vnccIno cnusod brnIn Injury, IncIudIng
nufIsm. Ior Insfnnco, In fho Bonle t. HHS cnso, fho SµocInI
Mnsfor wrofo fhnf fho brnIn dnmngo Iod ¨InoxornbIy from
vnccInnfIon fo IorvnsIvo ÐovoIoµmonfnI ÐoIny.¨
ll8
CIilJ Doe/77
t. HHS concodos fhnf vnccInos nggrnvnfod n µro-oxIsfIng
mIfochondrInIdIsordor¨whIchovonfunIIymnnIfosfodnsnchronIc
oncoµhnIoµnfhywIfhfonfurosofnufIsmsµocfrumdIsordor.¨
ll9
OfhorcnsosdonyfhnffhonufIsmInfhochIIdIsInnnywny
roInfod fo fho vnccInos or comµonsnfod brnIn InjurIos. Ior
Insfnnco, In UnJeruooJ t. HHS, fho govornmonf`s µosIfIon wns
fhnffhochIId`smonfnIrofnrdnfIonnndnufIsm¨nronofroInfodfo
fho rosIdunI soIzuro dIsordor.¨
l20
SImIInrIy, In KoeIon t. HHS,
fho govornmonf nssorfod fhnf fho ¨soIzuros woro cnusod by !off
Syndromo nnd nof by fho ÐIT vnccInnfIon.¨
l2l
ll6. ThofourcnsosnbovonofusIngnsµocIfIcnufIsm-roInfodformnroCnsol,
AIgorv.Soc`yofHonIfh&HumnnSorvs.,Þo.89-3lV,l990W!29340?(CI.Cf.
JuIy l3, l990); Cnso 5, Mossnor v. Soc`y of HonIfh & Humnn Sorvs., Þo. 90-
552V, l99l W! ?4l45 (CI. Cf. Aµr. 22, l99l); Cnso 8, Shnrµnnck v. Soc`y of
HonIfh&HumnnSorvs.,Þo.90-983V,l992W!l6?255(CI.Cf.Juno29,l992);
Cnso l4 !oIfz v. Soc`y of HonIfh & Humnn Sorvs., Þo. 90-l344V, l998 W!
22842l(Iod.CI.Aµr.2l,l998).
Whofhor or nof
vnccInos ¨cnusod¨ or ¨rosuIfod In¨ nufIsm Is nof docIdod In nII
cnsos, nIfhough If Is In somo. Whnf Is cIonr, howovor, Is fhnf
nufIsm Is somofImos nssocInfod wIfh comµonsnfod vnccIno-
InducodbrnInInjury.
ll?. See Cnso l, Alger, l990 W! 29340?, nf *4; Cnso 5, Meeener, l99l W!
?4l45, nf *4; nnd Cnso 8, SIorpnocl, l992 W! l6?255 nf *8; nnd, Cnso l4,
IeiIc,l998W!22842l,nf*l,*4,*5.
ll8. Cnsol9,Innksv.Soc`yofHonIfh&HumnnSorvs.,Þo.02-0?38V,200?
!.S.CInIms!IXIS254,nf*54(Iod.CI.JuIy29,200?).
ll9. Cnso 20, ChIId Ðoo/?? v. Soc`y of HonIfh & Humnn Sorvs., 20l0 W!
3395654,nf*l(Iod.CI.JuIy2l,20l0).
l20. Cnso ?, !ndorwood v. Soc`y of HonIfh & Humnn Sorvs., Þo. 90-?l9V,
l99lW!l56659,nf*l(CI.Cf.JuIy3l,l99l).
l2l. Cnso 9, Kosfon v. Soc`y of HonIfh & Humnn Sorvs., 9?4 I.2d l5?, l59
(Iod.CIr.l992).
32 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
5l2 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
b. SettIed Cuses SuggestIng AutIsm
Tho nufhors fhon docIdod fo oxµIoro soffIod cnsos, IIko fho
Poling concossIon, fo soo If fhoro mIghf bo moro comµonsnfIon
docIsIons of vnccIno-Inducod brnIn Injury fhnf IncIudod nufIsm.
!sIng fho IodornI IubIIc Accoss fo Courf IIocfronIc !ocords
(¨IACI!¨) dnfnbnso of fodornI courf dockofs, fho nufhors
oxnmInod dockof roµorfs fIIod wIfh fho VICI fhnf HHS hnd
comµonsnfod wIfhouf honrIng.
l22
WhIIo fhoso fnmIIIos` nnmos nnd dockof numbors nro In fho
µubIIcdomnIn,nndfhnfIshowfhonufhorsrofrIovodInformnfIon
nbouf fhom, fho nufhors sook nof fo subjocf fhoso fnmIIIos fo
unnocossnry InvnsIon of fhoIr µrIvncy. Thoy hnvo nII sufforod
oxfromo hnrdshIµ In coµIng wIfh fhoIr chIIdron`s InjurIos, or In
somo cnsos, donfhs, nnd wo sook fo shIoId fhom from unwnnfod
nffonfIon.ThonufhorsnroconfIdonffhnfbofhHHSnndÐOJcnn
onsIIy confIrm fho nccurncy of fhoso comµonsnfod fnmIIIos,
nmounfs, nnd vnccIno Injury codos. Tho onIy InformnfIon fho
govornmonfngoncIosmnynofbonbIofoconfIrmnrofhoµnronfnI
Tho nufhors IdonfIfIod
comµonsnfod cnsos of brnIn Injury fhnf fhoy boIIovod mIghf
IncIudonufIsmdIngnosos.ThonfhoyusodfoIoµhononndInfornof
dnfnbnsos fo IdonfIfy foIoµhono numbors nnd nddrossos for fho
comµonsnfod fnmIIIos. !ndor fho dIrocfIon of co-nufhor !ouIs
Confo, frnInod voIunfoors confncfod comµonsnfod fnmIIIos nnd
conducfod foIoµhono InforvIows usIng fho quosfIonnnIro In
AµµondIxVnbouffhoInjurodchIIdnndfhofnmIIy`soxµorIoncoIn
fho VICI. Tho voIunfoors rocoIvod InsfrucfIon on mnkIng cnIIs
nnd,InµnrfIcuInr,woroInsfrucfodnovorfoIondµnronfsInfhoIr
nnswors. If n µnronf snId fhnf n chIId dId nof hnvo nufIsm or
nufIsm-IIko symµfoms, fho voIunfoor nccoµfod fhnf doscrIµfIon
wIfh no furfhor quosfIons. Insod on fhoso foIoµhono
convorsnfIons, fho voIunfoors ronchod ovor sIxfy fnmIIIos of
IndIvIdunIs comµonsnfod for oncoµhnIoµnfhy or rosIdunI soIzuro
dIsordor, or bofh, who concomIfnnfIy hnvo or hnd nufIsm or
nufIsm-IIkosymµfoms.
l22. Pocer, I!I. ACCISS TO CO!!T I!IC. !ICO!ÐS, hffµ://www.µncor.gov (Insf
vIsIfodMnr.3,20ll).
33
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 5l3
roµorfs of nufIsm, buf fhoy cnn onsIIy do fhIs fhrough dIrocf
confncfIffhoysookfovorIfyfhIsInformnfIon.
l23
2. TLe SocIuI CommunIcutIon QuestIonnuIve
!ocognIzIngfhnfsomorondorsmIghfboskoµfIcnIofµnronfnI
roµorfsofnufIsmwIfhouffurfhorsubsfnnfInfIon,fhonufhorshnd
fwonfy-fwo comµonsnfod fnmIIIos comµIofo n wrIffon, woII-
rocognIzodnufIsmscroonIngquosfIonnnIro.ThIsquosfIonnnIroIn
nowny¨µrovos¨fhnffhosoIndIvIdunIshnvonnnufIsmdIngnosIs.
Tho comµIofod quosfIonnnIros do, howovor, gIvo furfhor
crodIbIIIfy fo fho µnronfnI roµorfs of nufIsm. OnIy comµIofo
modIcnIIy suµorvIsod dIngnosos couId fuIIy confIrm nufIsm
dIngnosos. Such dIngnosos woro boyond fho scoµo of fhIs sfudy,
buf fho nufhors hoµo fhnf fufuro InquIry wIII IncIudo fuII
ovnIunfIon of comµonsnfod IndIvIdunIs nnd fhoIr modIcnI
comµIIcnfIons.
Tho SocInI CommunIcnfIon QuosfIonnnIro (¨SCQ¨) Is n forfy-
Ifom µnronfnI roµorf scroonIng monsuro fhnf ¨fnµs fho
symµfomoIogy nssocInfod wIfh fho nufIsm sµocfrum dIsordor.¨
l24
Tho quosfIonnnIro, drnffod by Ðrs. !uffor, InIIoy, nnd !ord,
confnIns forfy yos/no quosfIons soIocfod fo hnvo ¨dIscrImInnfIvo
dIngnosfIc vnIIdIfy.¨
l25
ThIs sImµIo Insfrumonf Is monnf fo
corroInfo fo fho comµIofo nInofy fhroo-Ifom AufIsm ÐIngnosfIc
InforvIow-!ovIsod (¨AÐI-!¨), nIso wrIffon by !uffor nnd !ord,
who nro InfornnfIonnIIy ronownod nufIsm oxµorfs.
l26
(Thoso
scIonfIsfs fIIod oxµorf roµorfs In fho OmnIbus on bohnIf of HHS,
rojocfIng fho fhoory of n vnccIno-nufIsm IInk.)
l2?
l23. See!offorfromThomnsIInvIn,IroodomofInfo.OffIcor,Ðoµ`fofHonIfh
& Humnn Sorvs., fo !oborf Krnkow (JuIy 9, 2009) (on fIIo wIfh nufhors); eee
infroAµµondIxIII.
Tho SCQ
l24. M. !!TTI! IT A!., SCQ: THI SOCIA! COMM!ÞICATIOÞ Q!ISTIOÞÞAI!I
MAÞ!A!l(2003).
l25. 1J.
l26. 1J.
l2?. See MICHAI! !!TTI!, THIMI!OSA! VACCIÞI !ITICATIOÞ (2008), otoiloIle
oI hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/Ixµorf°20!oµorfs/
KIng_03-584V/IxCC_!uffor_!oµorf_03-584.µdf; eee oleo CATHI!IÞI !O!Ð,
THIMI!OSA! VACCIÞI !ITICATIOÞ (2008), otoiloIle oI
hffµ://www.uscfc.uscourfs.gov/sIfos/dofnuIf/fIIos/nufIsm/Ixµorf°20!oµorfs/KIng
_03-584V/Ix_W_!ord_!oµorf_03-584.µdf.584.µdf.
34 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
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5l4 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
focusosonbohnvIorsfhnfnro¨rnroInnonnffocfodIndIvIdunIs.¨
l28
Tho nufhors wnrn fhnf whIIo fho scroonIng quosfIonnnIro ¨Is nof
suIfnbIoforIndIvIdunIdIngnosIs,¨fhoSCQquosfIonsnrobnsodon
fho AÐI-!, whIch Is In furn usod ns fho µrImnry dIngnosfIc
Insfrumonf for fho InfornnfIonnI CInssIfIcnfIon of ÐIsonsos-l0
(WorId HonIfh OrgnnIznfIon, l992) nnd fho ÐSM-IV (AmorIcnn
IsychInfrIc AssocInfIon, l994) dIngnosIs of nufIsm. ¨Thoso
µrovIdo nn oµornfIonnI dIngnosIs fhnf Is bnsod on fho bohnvIornI
Ifom scoros In fhroo nrons of funcfIonIng: !ocIµrocnI SocInI
InforncfIon; CommunIcnfIon; nnd !osfrIcfod, !oµofIfIvo, nnd
SforoofyµodInffornsofIohnvIor.¨
l29
Tho quosfIonnnIro rocommonds n cufoff scoro of fIffoon or
gronfor ns nn IndIcnfIon of n µossIbIo nufIsm sµocfrum dIsordor.
Ifnofosfhnf,¨fhomonnscoroforchIIdronwIfhnufIsmwns24.2,
whIch Is woII nbovo fho cufoff.¨
l30
|T]ho ngroomonf bofwoon fho SCQ nnd fho AÐI-! nf bofh fho
TofnI Scoro nnd domnIn scoro IovoIs Is hIgh, wIfh ngroomonfs
boIng subsfnnfInIIy unnffocfod by ngo, gondor, Inngungo IovoI,
nnd µorformnnco IQ. Tho fIndIngs vnIIdnfo fho SCQ ns n
scroonIng quosfIonnnIro nnd show fhnf If µrovIdos n ronsonnbIo
IndoxofsymµfomsovorIfy.
!uffor, InIIoy, nnd !ord
furfhorcInrIfy:
l3l
TyµIcnIIy, cnrogIvors rocoIvod fho SCQ quosfIonnnIros by
omnII nnd rofurnod fho comµIofod, scnnnod quosfIonnnIros by
rofurnomnII.WhIIoIfwnsnofµossIbIofondmInIsforfhoSCQfo
nII fho fnmIIIos, fho voIunfoors dId ndmInIsfor If fo fwonfy-fwo
µnronfs or cnrogIvors, roµrosonfIng 2?° of fho fofnI numbor of
cnsos.
l32
AII SCQ scoros woro nf or nbovo fho cufoff µoInf of
fIffoon, wIfh mosf subsfnnfInIIy nbovo If.
l33
l28. !!TTI!ITA!.,eupro nofol24,nfl.
Tho monn scoro of
fho fwonfy-fwo SCQ vnIuos Is 24.4, or sIIghfIy hIghor fhnn fho
l29. 1J.nf9.
l30. 1J.nf3.
l3l. 1J.nf22.
l32. See infro TnbIo of VICI-Comµonsnfod CInIms of IrnIn Injury Thnf
IncIudo AufIsm or AufIsm-IIko Symµfoms, IncIudIng 22 SCQ scoros,
roµrosonfIng2?°offhofofnIof83cnsosroµorfod.
l33. 1J.
35
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 5l5
monn scoro of 24.2 fhnf !uffor, InIIoy, nnd !ord doscrIbo.
l34
Whon cnrogIvors roµorfod fhnf chIIdron woro roInfIvoIy hIgh
funcfIonIng,fhoIrchIIdron`sscorosworoInfncfcIosorfofhocufoff
µoInf,suggosfIngfhonccurnfonnfurooffhoscroonIngdovIconnd
of µnronfnI roµorfs.
l35
AII SCQ scoros on fho fnbIo boIow foII
bofwoonfIffoonnndfhIrfyfhroo,wIfhbofhondsoffhIssµocfrum
Infho¨nufIsfIcdIsordor¨rnngo.
l36
3. TubIe oI VICP-Compensuted CIuIms oI BvuIn InJuvy
TLut IncIude AutIsm ov AutIsm-IIke Symptoms
l34. M.!!TTI!ITA!.,eupronofol24,nf3.
l35. Inforonco bnsod on cnso hIsforIos on fIIo wIfh nufhors nnd vnIIdnfod by
!uffor of nI.`s fIndIngs fhnf fho SCQ ¨µrovIdos n ronsonnbIo Indox of symµfom
sovorIfy.¨1J. nf22.
l36. See infro TnbIo of VICI-Comµonsnfod CInIms of IrnIn Injury Thnf
IncIudoAufIsmorAufIsm-IIkoSymµfoms(forSCQscoros).
36 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
5l6 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
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03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 5l?
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03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 52l
Key to CLuvt:
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42 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
522 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
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onIyfoInforµroffhosubgrouµofoIghfy-fhroocomµonsnfodcnsos
fhnfwohnvoIocnfod.OufofnfofnInumborofnµµroxImnfoIyfwo
fhousnndfIvo hundrodcomµonsnfod vnccIno Injury cInIms,
l3?
wo
rocognIzo fhnf fhIs Is n smnII subsof.
l38
ÐosµIfoIfsIImIfnfIons,fhIssfudysuggosfsfhnfcomµonsnfod
cnsos of vnccIno-Inducod oncoµhnIoµnfhy nssocInfod wIfh nufIsm
sfnrfod from fho IncoµfIon of fho VICI In l989 nnd hnvo
confInuod nf Ionsf fhrough 20l0. Of fhoso oIghfy-fhroo
comµonsnfod cnsos IncIudIng nufIsm, sovonfoon nofo nn nufIsfIc
dIsordor In n µubIIshod docIsIon of fho Courf of IodornI CInIms
nnd fwonfy-fwo hnvo SCQ quosfIonnnIros confIrmIng cnrogIvor
roµorfsofnufIsm.Inofhorwords,fhIrfy-nInooffhooIghfy-fhroo
cnsos,or4?°offhIssnmµIo,hnvoconfIrmnfIonofnufIsmboyond
µnronfnI roµorf nIono. Tho ovIdonco of nn nssocInfIon In fhoso
If Is our hoµo fhnf fhIs
µroIImInnrysfudywIIIIondfomorocomµIofosfudyofnIIcnsosof
comµonsnfod vnccIno Injury. Such n sfudy mIghf µrovIdo n fnr
morocomµrohonsIvoundorsfnndIngofvnccInoInjury.
l3?. AoIionol Voccine 1njur, ConpeneoIion Progron, Cloine IileJ onJ
ConpeneoIeJ or DienieeeJ I, Voccine, OcIoIer 12, 2010,!.S. ÐII`T OI HIA!TH
& H!MAÞ SI!VS., HIA!TH !IS. & SI!VS. AÐMIÞ.,
hffµ://www.hrsn.gov/vnccInocomµonsnfIon/sfnfIsfIcs_roµorf.hfm (Insf vIsIfod
Mnr.3,20ll).
l38. WhIIoboyondfhoscoµooffhIsµroIImInnrysfudy,IfIsworfhnofIngfhnf
InnddIfIonfofhosocInImsforcomµonsnfIonfromvnccInoInjury,mnnyµnronfs
nnd docfors hnvo fIIod roµorfs of nufIsm ns n vnccIno Injury In fho fodornIIy-
fundod VnccIno Advorso Ivonf !oµorfIng Sysfom (VAI!S). Thoso roµorfs of
nufIsm ns nn ndvorso vnccIno ovonf cnn bo rofrIovod nf www.modnIorfs.org by
InµuffIng¨nufIsm¨nsnsymµfom.Thoronro83roµorfsofnufIsmnsnnndvorso
ovonffhnfworofIIodbofwoonJuIyl,l990nndJuno30,l999.
43
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 523
cnsos bofwoon rocognIzod vnccIno InjurIos (oncoµhnIoµnfhy nnd
rosIdunIsoIzurodIsordor)nndnufIsmoxIsfs.
IfIsnofnbIofhnfovornfwonfy-yonrµorIodfhoVICIdIdnof
µubIIcIy ncknowIodgo nn nµµnronf vnccIno-oncoµhnIoµnfhy-
nufIsmIInk.WhIIoInfhoonrIyyonrsoffhoµrogrnmfhoromIghf
hnvoboonnoµnrfIcuInrnffonfIonfofhIsnssocInfIon,corfnInIyby
fhoInfol990`s,fhoquosfIonofvnccInoInjurynndnufIsmwnsono
ofgonornIµubIIcInforosf.ThofIndIngofsomnnycnsosofnufIsm
nmongcomµonsnfodcnsoscnIIsInfoquosfIonHHS`snssorfIonson
fhofoµIc.
SovornI of fho dnmngo nwnrds fhnf HHS comµonsnfod
IncIudodoxµonsosunIquoIyroInfodfonufIsm.IoroxnmµIo,such
oxµonsos IncIudod AµµIIod IohnvIor AnnIysIs (¨AIA¨), n form of
oducnfIonnI InforvonfIon cronfod nnd usod for IndIvIdunIs on fho
nufIsmsµocfrum.
l39
Inofhorcnsos,VICI-nµµoInfodIIfoµInnnors
rocommondod fhnf fnmIIIos InsfnII n fonco ns fho chIId wouId bo
IIkoIy fo wnndor Infor In IIfo. WnndorIng Is n woII-rocognIzod
chnrncforIsfIcnnddnngorforchIIdronwIfhnufIsm.
l40
In nddIfIon fo fho corrobornfIon from fho SCQs, fho nufhors
hnvo nowsµnµor, mngnzIno, nnd bIog nrfIcIos on fIIo, dIscussIng
fho chIIdron`s nufIsfIc symµfoms nnd chnIIongos. Tho nufhors
nIso rocoIvod modIcnI nnd oducnfIonnI rocords confIrmIng fho
chIIdron`s nufIsm dIngnosos for somo of fho comµonsnfod
IndIvIdunIs.
AIIoffhocnsosofvnccIno-InducodoncoµhnIoµnfhynssocInfod
wIfh nufIsm nofod In fho TnbIo of VICI-Comµonsnfod CInIms
nbovo woro fho rosuIf of combInnfIon vnccInos MM!, ÐTI or
ÐTnI.Thol998WoIboI,ofnI.sfudyofVICI-comµonsnfodcnsos
of ncufo oncoµhnIoµnfhy nssocInfod wIfh fho monsIos vnccIno,
nIono or In combInnfIon, IdonfIfIod no cnsos of oncoµhnIoµnfhy
nffor ndmInIsfrnfIon of monovnIonf mumµs nnd ruboIIn vnccInos
l39. MenIol HeolII, A IeporI of IIe Surgeon Generol,OIIer MenIol DieorJere
in CIilJren onJ AJoleecenIe, AuIien, S!!CIOÞ CIÞ.,
hffµ://www.surgoongonornI.gov/IIbrnry/monfnIhonIfh/chnµfor3/soc6.hfmI#nufIsm
(InsfvIsIfodMnr.3,20ll)(¨ThIrfyyonrsofrosonrchdomonsfrnfodfhooffIcncyof
nµµIIod bohnvIornI mofhods In roducIng InnµµroµrInfo bohnvIor nnd In
IncronsIngcommunIcnfIon,IonrnIng,nndnµµroµrInfosocInIbohnvIor.¨).
l40. See e.g., A!TISM & WAÞÐI!IÞC, ÞAT`! A!TISM ASS`Þ (20l0), otoiloIle oI
hffµ://www.nnfIonnInufIsmnssocInfIon.org/µdf/nufIsm_wnndorIng_I!!!°20SH
IIT°20I!OCH!!I.µdf.
44 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
524 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
nnd fowor cnsos of oncoµhnIoµnfhy nffor ndmInIsfrnfIon of
monovnIonf monsIos vnccInos fhnn of combInnfIon vnccInos.
l4l
Cooffroy Ivnns, M.Ð., ÐIrocfor of fho ÐIvIsIon of VnccIno Injury
ComµonsnfIon of HonIfh !osourcos nnd SorvIcos AdmInIsfrnfIon
(¨H!SA¨),wnsnco-nufhoroffhosfudy.
l42
Abouf hnIf of fho oIghfy-fhroo rovIowod cnsos hnvo
oncoµhnIoµnfhy,rosIdunIsoIzurodIsordor,nndnufIsm.Thoofhor
hnIf of fho rovIowod cnsos hnvo rosIdunI soIzuro dIsordor nnd
nufIsm.ThoroIsnoobvIousdIsfIncfIonInsymµfomsorgrnvIfyof
Injury nmongfhoso cnsos. In nddIfIon, oIghf of fho comµonsnfod
chIIdron,orl0°offhogrouµwoIdonfIfIod,dIodboforongofhIrfy
ono. Sovon of fho oIghf dIod from soIzuros; ono dIod from
IIghfnIng. A shorfor IIfosµnn Is nssocInfod wIfh soIzuro
dIsordor.
l43
5. CuvegIvev Responses
Wo IncIudo n fow roµrosonfnfIvo rosµonsos from fnmIIIos
nbouf fhoIr chIIdron nnd oxµorIoncos In fho VICI fhnf fnmIIIos
µrovIdod In foIoµhono InforvIows. If bonrs romomborIng fhnf
fhoso nro fho fnmIIIos who ¨won¨ In fho VICI. On bnInnco, If Is
IogIcnI fo ImngIno fhnf fho ¨wInnIng¨ fnmIIIos` vIows nro nf Ionsf
l4l. !oborf I. WoIboI of nI., AcuIe 1ncepIolopoII, IolloueJ I, PernonenI
Broin 1njur, or DeoII AeeocioIeJ uiII IurIIer AIIenuoIeJ Meoelee Voccinee. A
Ietieu of Cloine SuIniIIeJ Io IIe AoIionol Voccine 1njur, ConpeneoIion
Progron, l0l IIÐIAT!ICS 383, 383 (l998) (¨Þo cnsos woro IdonfIfIod nffor fho
ndmInIsfrnfIonofmonovnIonfmumµsorruboIInvnccIno.¨)In48cnsosofncufo
oncoµhnIoµnfhy nffor monsIos vnccIno, nIono or In combInnfIon, 8 chIIdron
rocoIvod monovnIonf monsIos vnccInos; 40 rocoIvod muIfIµIo vnccInos,IncIudIng
ruboIIn, mumµs, dIµhfhorIn, fofnnus, µorfussIs, ornI µoIIo, nnd HoenopIilue
influencoTyµoI,fogofhorwIfhmonsIosvnccIno.1J. nf384-85.
l42. Ðr. Ivnn`s µosIfIon Is nofod nf AoIionol Voccine 1njur, ConpeneoIion
Progron, AJtieor, Connieeion on CIilJIooJ Voccinee ACCV IoeIer, !.S.
ÐII`T OI HIA!TH & H!MAÞ SI!VS., HIA!TH !IS. & SI!VS. AÐMIÞ.,
hffµ://www.hrsn.gov/vnccInocomµonsnfIon/rosfor.hfm(InsfvIsIfodJnn.l9,20ll).
l43. Seicuree onJ 1pilepe,. Hope TIrougI IeeeorcI, ÞAT`! IÞST. OI
ÞI!!O!OCICA! ÐISO!ÐI!S & ST!OKI, ÞAT`! IÞSTS. OI HIA!TH,
hffµ://www.nInds.nIh.gov/dIsordors/oµIIoµsy/dofnII_oµIIoµsy.hfm (Insf vIsIfod
Mnr. 3, 20ll) (¨IooµIo wIfh sovoro soIzuros fhnf rosIsf fronfmonf hnvo, on
nvorngo,nshorforIIfooxµocfnncynndnnIncronsodrIskofcognIfIvoImµnIrmonf,
µnrfIcuInrIyIffhosoIzurosdovoIoµodInonrIychIIdhood.¨).
45
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 525
somowhnfmorofnvornbIofhnnfhovIowsoffnmIIIoswhorocoIvod
nofInnncInIcomµonsnfIon.
Horo nro n fow roµrosonfnfIvo nnswors from fnmIIIos who
µnrfIcIµnfodInfoIoµhonoInforvIows:
QuestIon: How Is youv cLIId's IIIe toduy?
(A) A. Is µrofoundIy nufIsfIc. Sho Is non-vorbnI, hns mnjor
bohnvIornI Issuos, Is soIf-InjurIous. . .cInssIc nnd vory sovoro
nufIsm. . ..Sho cnnnof bo Ioff nIono ovor. . ..A. wns n bonufIfuI
bnby, who wns dovoIoµIng normnIIy, buf who hnd obvIous
roncfIonsfohorfIrsffwoÐITvnccInos.OnoIoffhorIogswoIIon
nnd rod, nnd sho dovoIoµod n hIgh fovor nnd scronmod nffor fho
ofhor.IuffhodocforsdIdnofhosIfnfo fogIvoA.horfhIrdÐIT
shof whon sho wns 5 monfhs oId, nnd sho wonf ovor fho odgo.
Shohndfhoshofnf4:00µ.m.,nndby6:00µ.m.shohndnfovorof
l05 fo l06 dogroos. . ..Affor fhnf dny, sho wns gono. Ovor fho
yonrs, wo hnvo Iosf mnny frIonds nnd nro dIsfnnf from mnny
fnmIIymomborsbocnusoA.IssohnrdfoIovonndbonround.IfIs
vory honrfbronkIng fo soo µooµIo rojocf hor, nnd fo hnvo fhom
suggosffhnfwoshouIdhnvoInsfIfufIonnIIzodhor.
l44
(I) I. (ngod 44) hns no sµooch, no funcfIonnI uso of hIs hnnds,
nndwIIInoIongorsfnnd....HohnsncouµIoofsoIzurosovorydny.
...I.`sfoofhhndfoboµuIIodbocnusohowouIdnofnIIownnyono
nonr hIs moufh fo brush fhom. Ho Is nof µoffy frnInod. Ho Is
vory sonsory dofonsIvo, fInµs hIs hnnds, nnd mnkos monnIng
noIsos.
l45
(C)C.Isn¨gInnfbnby¨bocnusonIfhoughshoIsnnovorwoIghfl8-
yonr-oId,shofuncfIonsnffhoIovoIofn2-yonroId.ShohnsnoIIfo
ronIIy, comµnrod fo hor µoors. Sho hns vory IIffIo funcfIonnI
communIcnfIon,nndcnnonIysnynfowwords,IIko¨onf¨orshorf
µhrnsos fhnf sho roµonfs IncossnnfIy. . ..Sho Is sfIII In dInµors,
wIfhnoµrobnbIIIfyfhnfshowIIIovorboµoffyfrnInod....C.now
l44. ToIoµhono InforvIow wIfh M.M. nnd C.M., Inronfs of VnccIno CInImnnf
(Soµf.30,20l0)(onfIIowIfhnufhorsnsCnsol3).
l45. ToIoµhono InforvIow wIfh I.!. nnd !.!., Inronfs of VnccIno CInImnnf
(JuIy22,20l0)(onfIIowIfhnufhorsnsCnso30).
46 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
526 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
hnsfroquonfµorIods(ovory4fo6monfhs)offrusfrnfIon,oxfromo
rngo,nndsoIf-InjurIousbohnvIor.
l46
QuestIon: WLut wus tLe Impuct oI tLe vuccIne InJuvy on
youv IumIIy?
ÐovnsfnfIng.
l4?
QuestIon: Wus youv cLIId's cIuIm vesoIved IuIvIy?
(A)Þo,Ifwnsnwnr.
l48
(I) ÐOJ nffornoys woro dIsrosµocffuI nnd combnfIvo. . ..Tho
ComµonsnfIon Irogrnm shouId bo nbouf comµonsnfIon nnd nof
nboufdofonsooffhovnccInoµrogrnm.
l49
(C) Tho nffornoy for fho govornmonf wns nbsoIufoIy horrIbIo.
Sho wns coId, InsuIfIng, nnd dId whnfovor sho couId fo kooµ us
fromboIngcomµonsnfod.ShoµushodforC.foboµufInngrouµ
homobocnusoIfwouIdbochonµorfhnnnIIowInghorfoIIvowIfh
hor fnmIIy, nnd sho nrguod ngnInsf vory bnsIc homo snfofy
dovIcos, IIko Infchos on cuµbonrds, n fonco for fho ynrd, nnd n
sµocInIswIngwhoroC.wouIdnoffnIIoufwhonnsoIzurohIf.
l50
QuestIon: WLut wouId you vecommend In tevms oI
cLunges Iov tLe VICP?
(A)ThocourfsµondsfnrfoomuchfImoIookIngforwnysÞOTfo
comµonsnfofnmIIIos.
l5l
(I)IfshouIdboovorhnuIod.
l52
l46. ToIoµhono InforvIow wIfh K.Þ. nnd S.Þ., Inronfs of VnccIno CInImnnf
(Aug.l8,20l0)(onfIIowIfhnufhorsnsCnso59).
l4?. ToIoµhono InforvIow wIfh J.A. nnd I.A., Inronfs of VnccIno CInImnnf
(Aµr.ll,20l0)(onfIIowIfhnufhorsnsCnsol);ToIoµhonoInforvIowwIfhS.C.,
Inronf of VnccIno CInImnnf (JuIy l5, 20l0) (on fIIo wIfh nufhors ns Cnso 54);
InforvIow wIfh I.Z. nnd I.Z., Inronfs of VnccIno CInImnnf (20l0) (on fIIo wIfh
nufhorsnsCnso8l).
l48. ToIoµhonoInforvIowwIfhI.Z.nndI.Z.,eupronofol4?.
l49. ToIoµhono InforvIow wIfh J.A., Inronf of VnccIno CInImnnf (Mnr l3,
20l0)(onfIIowIfhnufhorsnsCnso2?).
l50. ToIoµhonoInforvIowwIfhK.Þ.nndS.Þ.,eupronofol46.
l5l. ToIoµhonoInforvIowwIfhS.C.,eupronofol46.
47
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 52?
(C) Thoro shouId bo n µrogrnm In µInco fhnf wouId nIIow fho
courf fo ronssoss fho chIIdron Infor In IIfo fo soo If fhoIr noods
hnvo chnngod. ThIs wouId mnko fho IIfo cnro µInnnIng Ioss
confonfIous nnd wouId nIIow for chnngos In Inws, Insurnnco
covorngo, nnd mosfIy fho chIId`s IovoI of funcfIonIng. If Is
rIdIcuIous fo nssumo fhnf you cnn ndoqunfoIy µInn whon n chIId
Is vory young for ovory µossIbIo consoquonco of fho vnccIno
dnmngofhroughouffhochIId`sIIfo.
l53
Tho ovorwhoImIng mnjorIfy of µofIfIonors In fho VICI hnvo
nof rocoIvod comµonsnfIon. Of fho l3,?55 cInIms fIIod In fho
VICIfodnfo,2,62lnwnrdshnvoboonµnId,orIossfhnnlIn5of
fho fofnI numbor of cInIms fIIod. So fnr, 5,2?? cInIms hnvo boon
dIsmIssodnnd5,85?cInImsnroµondIng.AsmosfoffhoµondIng
cInIms nro In fho OmnIbus, fhoy nro IIkoIy fo bo dIsmIssod.
l54
Tho Mnrch 3, 20ll HHS SfnfIsfIcs !oµorf nofos fhnf ¨HHS hns
novor concIudod In nny cnso fhnf nufIsm wns cnusod by
vnccInnfIon.¨
l55
III. UNANSW£R£Ð QU£STIONS
InIIghfoffhosfrongIywordoddocIsIonsInfhoOmnIbusnnd
fhoHHSSfnfIsfIcnI!oµorfnofIngfhnfnocnsoofvnccIno-Inducod
nufIsm hns ovor boon comµonsnfod, If Is oxfromoIy µuzzIIng fo
fInd so mnny cnsos of nufIsm nmong VICI-comµonsnfod cnsos.
WhIIoIfIsundorsfnndnbIofhnfµofIfIonorsInfhosocnsossofouf
fo µrovo oncoµhnIoµnfhy nnd rosIdunI soIzuro dIsordor, nnd nof
nufIsm, If nIso sooms hnrd fo undorsfnnd fhnf fho SµocInI
Mnsfors,oxµorfs,fronfIngµhysIcInns,Inwyors,nndjudgoswouId
nIIhnvoboonunnwnrooffhoµrosoncoofnufIsfIcsymµfomsInso
mnny cnsos. To fInd oIghfy-fhroo cnsos of confIrmod nufIsm
nmong cnsos of confIrmod vnccIno-Inducod brnIn Injury, wIfh fho
l52. ToIoµhonoInforvIowwIfhI.Z.nndI.Z.,eupronofol4?.
l53. ToIoµhonoInforvIowwIfhK.Þ.nndS.Þ.,eupronofol46.
l54. AoIionol Voccine 1njur, ConpeneoIion Progron, SIoIieIice IeporI, MorcI
3, 2011,!.S. ÐII`T OI HIA!TH & H!MAÞ SI!VS., HIA!TH !IS. & SI!VS. AÐMIÞ.,
hffµ://www.hrsn.gov/vnccInocomµonsnfIon/ sfnfIsfIcs_roµorf.hfm (Insf vIsIfod
Mnr.l0,20ll).
l55. 1J.
48 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
528 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
IIkoIIhood fhnf fhoro mny bo mnny moro nmong fhoso
comµonsnfodforvnccInoInjury,rnIsossovornIquosfIons:
(l) Woro HHS nnd ÐOJ nwnro of fho µrovnIonco of nufIsm
dIngnosos nmong fhoso who hnvo boon comµonsnfod for
oncoµhnIoµnfhynndrosIdunIsoIzurodIsordor`
(2) Whnf µorconfngo of fho romnInIng VICI-comµonsnfod
cnsosofvnccIno-InducodInjurIosmnnIfosfnufIsm`
(3) Is ¨nufIsm¨ µorhnµs n dIfforonf form for sIIghfIy Ioss
sovoro oncoµhnIoµnfhy nnd rosIdunI soIzuro dIsordor` Is If
µossIbIofhnf¨nufIsm¨IsnformofbrnIndnmngosImIInrfoncufo
oncoµhnIoµnfhy nnd rosIdunI soIzuro dIsordor, buf vnccIno-
Inducod brnIn dnmngo nII fho snmo` ThIs nrgumonf hns boon
mndo for ovor fwo docndos; unforfunnfoIy, fho hyµofhosIs hns
boonInndoqunfoIysfudIod.
l56
1. IIkeIy CvItIcIsm
Wo nnfIcIµnfo IIvoIy crIfIquo of fhIs µroIImInnry nssossmonf.
HoronrosovornIoffhomosfIIkoIycounfornrgumonfs:
(l)¨SocondnrynufIsm¨oxIsfs,bufvnccInosonIy¨rosuIfodIn¨
nufIsmnnddIdnof¨cnuso¨If.
SomomnynrguofhnfvnccInosIndIrocfIycnusodnufIsmnsn
rosuIfofofhorvnccIno-InducodbrnIndnmngo.WhofhornufIsmIs
consIdorod n socondnry Injury fo oncoµhnIoµnfhy nnd rosIdunI
soIzuro dIsordor or n µrImnry Injury nµµonrs fo bo n somnnfIc
µoInf hnvIng IIffIo IognI sIgnIfIcnnco. !ndor oIfhor fhoory,
vnccInosIodfobrnInInjury,nndfhoVICIhnscomµonsnfodfhnf
vnccIno-Inducod brnIn Injury, IncIudIng nufIsm. In ofhor words,
HHShnsbooncomµonsnfIngcorfnInoxµonsosofvnccIno-Inducod
nufIsm for moro fhnn fwonfy yonrs, whon InboIod ns
¨oncoµhnIoµnfhy¨ nnd ¨rosIdunI soIzuro dIsordor,¨ buf nof
comµonsnfIng If whon InboIod ¨nufIsm¨ wIfhouf cogonf
oxµInnnfIon.
l56. See generoll, HA!!IS !. CO!!TI!, VACCIÞATIOÞ, SOCIA! VIO!IÞCI AÞÐ
C!IMIÞA!ITY: THI MIÐICA! ASSA!!T OÞ THI AMI!ICAÞ I!AIÞ (l990); eee oleo
IA!IA!A !OI IISHI!, VACCIÞIS, A!TISM & CH!OÞIC IÞI!AMMATIOÞ: THI ÞIW
IIIÐIMIC(2008).
49
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 529
(2) Thoso IndIvIdunIs sufforod from Ðrnvof`s Syndromo, n
gonofIcdIsordor;fhoywouIdhnvohndfhosnmooufcomoswIfhouf
vnccInnfIon.
VocnI µroµononfs of fho !.S. vnccIno µrogrnm nro IIkoIy fo
nrguofhnfmnnyoffhosocnsosworowrongIycomµonsnfodInfho
fIrsfµInco.ThoywIIInrguofhnffhosobrnIndnmngodIndIvIdunIs
sufforod from n rnro gonofIc condIfIon cnIIod Ðrnvof`s Syndromo,
nnd fhus fhoIr soIzuros nnd oncoµhnIoµnfhy shorfIy nffor
vnccInnfIon woro coIncIdonfnI. Ior oxnmµIo, Ðr. InuI OffIf,
µromInonfsµokosµorsonforfho!.S.vnccInoIndusfry,µoInfsfon
sIngIo sfudy by Ðr. SnmuoI IorkovIc of fourfoon µnfIonfs In
AusfrnIIn,fundodbyIIonomIcs¨nµroducfIvodrugdIscovorynnd
dovoIoµmonf ongIno room focusod on now fronfmonfs for cnncor
nndsorIousdIsordorsoffhoconfrnInorvoussysfom.¨
l5?
Ðr.OffIf
concIudos, nµµnronfIy on fho bnsIs of fhIs ono cnso sorIos, fhnf
IndIvIdunIs who dovoIoµod soIzuros wIfhIn sovonfy fwo hours of
vnccInnfIon wouId hnvo dovoIoµod fhoIr sovoro soIzuro dIsordors
In nny ovonf bocnuso of fhoIr gonofIc mufnfIons In fho SCÞlA
gono.
l58
|A]ffor IorkovIc`s µnµor, If wns cIonr fhnf nII fho fImo sµonf by
µnronfsfogofhonIfhoffIcInIsfondmIffhnfµorfussIsvnccInohnd
µormnnonfIy hnrmod chIIdron, nII fho monoy sµonf by
µhnrmncoufIcnIcomµnnIosfocomµonsnfonIIogodvIcfIms,nIIfho
work of Inwmnkors fo cronfo n sysfom fo dofIocf InwsuIfs nwny
from fhoso comµnnIos, nnd nII fho Ink dovofod by fho modIn fo
suµµorf fhoso chIIdron nnd fhoIr µnronfs hnd boon nn onormous
dIvorsIonfromfhoronIcnusooffhoµrobIom.
Ðr.OffIfsfnfos:
l59
Ho concIudos fhnf µnronfs woro wrong fo boIIovo fhnf
vnccInos woro fho cnuso of fhoIr chIIdron`s oµIIoµsy nnd monfnI
rofnrdnfIon.
l60
l5?. AIouI Biononice, IIOÞOMICS, hffµ://www.bIonomIcs.com.nu/
µngo.µhµ`socfIon=42 (Insf vIsIfod Jnn. l9, 20ll); eee oleo A.M. McInfosh of nI.,
1ffecIe of VoccinoIion on OneeI onJ OuIcone of DroteI S,nJrone. A
IeIroepecIite SIuJ,,9!AÞCITÞI!!O!OCY592(20l0).
l58. S. I. IorkovIc of nI., De-noto MuIoIione of IIe SoJiun CIonnel Gene
SCA1A in AllegeJ Voccine 1ncepIolopoII,. A IeIroepecIite SIuJ,, 5 !AÞCIT
ÞI!!O!OCY465,465(2006).
l59. ÐIAÐ!YCHOICIS,eupronofo56,nf42-43.
l60. 1J.nf43.
50 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
530 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
WhIIo Ðrnvof`s Syndromo suroIy morIfs furfhor sfudy, fo
µosIffhnfnsIngIodrugcomµnny-sµonsorodsfudyµrovosfhnfnII
IndIvIdunIs who dovoIoµ monfnI rofnrdnfIon or oµIIoµsy (or
oncoµhnIoµnfhy nnd rosIdunI soIzuro dIsordor) In fho ImmodInfo
nfformnfhofvnccInnfIonwouIdhnvodovoIoµodIfundornnyofhor
cIrcumsfnncos sfrnIns croduIIfy. Inr moro rosonrch wouId bo
noodod, IncIudIng Inrgo, µoµuInfIon-bnsod oµIdomIoIogIcnI
sfudIos, fo concIudo fhnf vnccInos µInyod no roIo or ovon no
nggrnvnfIngroIoInfhoonsofofsuchcnfnsfroµhIcsymµfoms.
l6l
(3)InronfsnroµoorroµorforsoffhoIrchIIdron`scondIfIon.
CrIfIcswIIInssorffhnfµnronfnIcnrogIvorsnroµoorroµorfors
offhoIrchIIdron`scondIfIons,subjocffo¨confIrmnfIonbIns.¨Asn
rosuIf, fhoy wIII nrguo fhnf fhoso fIndIngs nro nof crodIbIo.
Iocnuso of fhoso concorns, wo ndmInIsforod fho SCQ fo 2?° of
fho fofnI numbor of comµonsnfod fnmIIIos (nnd 35° of fho cnsos
hnvIng no µubIIshod docIsIons) nnd found n hIgh corroInfIon
bofwoon µnronfnI roµorfs nnd scoros for nufIsm usIng fhIs
rocognIzodscroonIngfooI.ThonccurncyoffhonufIsmnssossmonf
In fho cnsos for whIch wo hnvo such corrobornfIon suggosfs fho
IIkoIy nccurncy of fho µnronfnI roµorfs for whIch wo Inck such
corrobornfIon.ThonufhorswouIdbodoIIghfodfohnvofhIssfudy
roµIIcnfod wIfh n moro rIgorous nnnIysIs of fhoso nnd ofhor
comµonsnfodfnmIIIos,IncIudIngfuIIAÐI-!dIngnosos.
2. RecommendutIon: CongvessIonuI InquIvy
AufIsm Is fho mosf µrovnIonf dovoIoµmonfnI dIsordor In fho
!nIfodSfnfos,consorvnfIvoIynffocfIngnboufonoInonohundrod
nnd fon chIIdron.
l62
l6l. See YuvnI ShnfrIr, VoccinoIion onJ DroteI S,nJrone, 9 !AÞCIT
ÞI!!O!OCY ll4?, ll4?-48 (20l0), otoiloIle oI hffµ://www.fhoInncof.com/
journnIs/Innour/nrfIcIo/IIISl4?4-4422°2802°2900l60-6/nbsfrncf; Anno
McInfosh of nI., VoccinoIion onJ DroteI S,nJrone- AuIIor`e repl,, IonceI
Aeurol. 9 !AÞCIT ÞI!!O!OCY ll48, ll48-49 (20l0), otoiloIle oI
hffµ://www.fhoInncof.com/journnIs/Innour/nrfIcIo/IIISl4?4-4422°28l0°
29?0289-l/fuIIfoxf.
ThIs µroIImInnry ovnIunfIon suggosfs fhnf
vnccIno-Inducod oncoµhnIoµnfhy nnd soIzuro dIsordor mny bo
nssocInfod wIfh nufIsm. Wo rocommond fhnf Congross oµon nn
InvosfIgnfIon of nII comµonsnfod cnsos of vnccIno-Inducod Injury
l62. !Ico,eupro nofo?3.
51
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 53l
fo fInd ouf how froquonfIy fhIs nssocInfIon occurs. Congross
shouId fInd ouf whnf HHS, ÐOJ, nnd fho VICI know nbouf fho
oxIsfonco of nufIsm ns n chnrncforIsfIc of fhoso comµonsnfod for
oncoµhnIoµnfhynndrosIdunIsoIzurodIsordor.
CONCIUSION
WhIIo fhoro nro IIkoIy mnny roufos fo ¨nufIsm,¨ IncIudIng
µronnfnI nouroIogIcnI InsuIfs nnd foxIc µosf-nnfnI oxµosuros,
l63
Insod on fhIs µroIImInnry nssossmonf, fhoro mny bo no
monnIngfuI dIsfIncfIon bofwoon fho cnsos of oncoµhnIoµnfhy nnd
rosIdunI soIzuro dIsordor fhnf fho VICI comµonsnfod ovor fho
Insf fwonfy yonrs nnd fho cnsos of ¨nufIsm¨ fhnf fho VICI hns
donIod.Iffruo,fhIswouIdbonµrofoundInjusfIcofofhosodonIod
rocovory nnd fo nII who hnvo Invosfod frusf In fhIs sysfom fhnf
Congross cronfod. ThIs µroIImInnry sfudy cnIIs for Congross fo
InvosfIgnfo fho VICI nnd for scIonfIsfs fo InvosfIgnfo nII
comµonsnfod cnsos of vnccIno Injury fo gnIn n fuIIor
undorsfnndIngoffhofofnIIfyofconsoquoncosofvnccInoInjury.
fhIs µroIImInnry nnnIysIs of VICI-comµonsnfod cnsos suggosfs
fhnf nufIsm Is offon nssocInfod wIfh vnccIno-Inducod brnIn
dnmngo.IfrnIsosfhoquosfIonIffhoVICI`sdocIsIonshnvoboon
fnIr fo rojocf nII cInIms of vnccIno Injury fhnf uso fho form
¨nufIsm.¨ ThIs µroIImInnry nssossmonf nIso suggosfs fho
µossIbIIIfy fhnf ofhor confomµornry chIIdhood nouroIogIcnI
dIsordors, IncIudIng nffonfIon dofIcIf dIsordor nnd IonrnIng
dIsnbIIIfIos, mIghf bo Ioss sovoro nffor-offocfs, on fho snmo
sµocfrumofvnccIno-InducodbrnInInjury.
l63. See MnrcoIKInsbourno&IrnnkWood,DieorJere of MenIol DetelopnenI
in JOHÞH.MIÞKISITA!.,CHI!ÐÞI!!O!OCYl09?,lll2-2l(?fhod.,2006).
52 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
532 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
APP£NÐIX I
ÐIugnostIc CvItevIu Iov 299.00 AutIstIc ÐIsovdev
164
ThofoIIowIngIsfrom
(A)AfofnIofsIx(ormoro)Ifomsfrom(l),(2),nnd(3),wIfhnf
Ionsffwofrom(l),nndonoonchfrom(2)nnd(3)
DiognoeIic onJ SIoIieIicol Monuol of MenIol
DieorJere. DSM 1V
(l)qunIIfnfIvoImµnIrmonfInsocInIInforncfIon,nsmnnIfosfod
bynfIonsffwooffhofoIIowIng:
n.mnrkodImµnIrmonfsInfhousoofmuIfIµIononvorbnI
bohnvIorssuchnsoyo-fo-oyognzo,fncInIoxµrossIon,body
µosfuro,nndgosfurosforoguInfosocInIInforncfIon
b.fnIIurofodovoIoµµoorroInfIonshIµsnµµroµrInfofo
dovoIoµmonfnIIovoI
c.nInckofsµonfnnooussookIngfoshnroonjoymonf,
Inforosfs,ornchIovomonfswIfhofhorµooµIo,(o.g.,byn
InckofshowIng,brIngIng,orµoInfIngoufobjocfsof
Inforosf)
d.InckofsocInIoromofIonnIrocIµrocIfy
(2)qunIIfnfIvoImµnIrmonfsIncommunIcnfIonnsmnnIfosfod
bynfIonsfonooffhofoIIowIng:
n.doInyIn,orfofnIInckof,fhodovoIoµmonfofsµokon
Inngungo(nofnccomµnnIodbynnnffomµffocomµonsnfo
fhroughnIfornnfIvomodosofcommunIcnfIonsuchns
gosfuroormImo)
b.InIndIvIdunIswIfhndoqunfosµooch,mnrkod
ImµnIrmonfInfhonbIIIfyfoInIfInfoorsusfnInn
convorsnfIonwIfhofhors
c.sforoofyµodnndroµofIfIvousoofInngungoor
IdIosyncrnfIcInngungo
d.InckofvnrIod,sµonfnnoousmnko-boIIovoµInyorsocInI
ImIfnfIvoµInynµµroµrInfofodovoIoµmonfnIIovoI
(3)rosfrIcfodroµofIfIvonndsforoofyµodµnffornsofbohnvIor,
Inforosfs,nndncfIvIfIos,nsmnnIfosfodbynfIonsfonooffho
foIIowIng:
l64. AM.ISYCHIAT!ICASS`Þ,eupro nofo?0,nf?5.
53
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 533
n.oncomµnssIngµrooccuµnfIonwIfhonoormoro
sforoofyµodnndrosfrIcfodµnffornsofInforosffhnfIs
nbnormnIoIfhorInInfonsIfyorfocus
b.nµµnronfIyInfIoxIbIondhoroncofosµocIfIc,
nonfuncfIonnIroufInosorrIfunIs
c.sforoofyµodnndroµofIfIvomoformnnnorIsms(o.g.hnnd
orfIngorfInµµIngorfwIsfIng,orcomµIoxwhoIo-body
movomonfs)
d.µorsIsfonfµrooccuµnfIonwIfhµnrfsofobjocfs
(I)ÐoInysornbnormnIfuncfIonIngInnfIonsfonooffhofoIIowIng
nrons,wIfhonsofµrIorfongo3yonrs:
(l)socInIInforncfIon
(2)InngungonsusodInsocInIcommunIcnfIon,
(3)symboIIcorImngInnfIvoµIny.
(C)ThodIsfurbnncoIsnofboffornccounfodforby!off`sÐIsordor
orChIIdhoodÐIsInfogrnfIvoÐIsordor.
54 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
534 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
APP£NÐIX II
VICP's ÐeIInItIons oI £ncepLuIoputLy, SeIzuve und
SequeIu
165
(2) £ncepLuIoputLy. Ior µurµosos of fho VnccIno Injury
TnbIo,nvnccInorocIµIonfshnIIboconsIdorodfohnvosufforodnn
oncoµhnIoµnfhy onIy If such rocIµIonf mnnIfosfs, wIfhIn fho
nµµIIcnbIo µorIod, nn Injury moofIng fho doscrIµfIon boIow of nn
ncufo oncoµhnIoµnfhy, nnd fhon n chronIc oncoµhnIoµnfhy
µorsIsfsInsuchµorsonformorofhnn6monfhsboyondfhodnfoof
vnccInnfIon.
QuuIIIIcutIons und AIds to IntevpvetutIon
(I) An ucute encepLuIoputLy Is ono fhnf Is suffIcIonfIy
sovoro so ns fo roquIro hosµIfnIIznfIon (whofhor or nof
hosµIfnIIznfIonoccurrod).
(A)Iov cLIIdven Iess tLun 1B montLs oI ugewhoµrosonf
wIfhouf nn nssocInfod soIzuro ovonf, nn ncufo oncoµhnIoµnfhy Is
IndIcnfodbyn¨sIgnIfIcnnfIydocronsodIovoIofconscIousnoss¨(soo
¨Ð¨boIow)InsfIngfornfIonsf24hours.ThosochIIdronIossfhnn
l8monfhsofngowhoµrosonffoIIowIngnsoIzuroshnIIbovIowod
ns hnvIng nn ncufo oncoµhnIoµnfhy If fhoIr sIgnIfIcnnfIy
docronsod IovoI of conscIousnoss µorsIsfs boyond 24 hours nnd
cnnnofbonffrIbufodfonµosfIcfnIsfnfo(soIzuro)ormodIcnfIon.
(I) Iov uduIts und cLIIdven 1B montLs oI uge ov oIdev,
nnncufooncoµhnIoµnfhyIsonofhnfµorsIsfsfornfIonsf24hours
nndchnrncforIzodbynfIonsffwooffhofoIIowIng:
(l) A sIgnIfIcnnf chnngo In monfnI sfnfus fhnf Is nof
modIcnfIonroInfod;sµocIfIcnIIynconfusIonnIsfnfo,orndoIIrIum,
ornµsychosIs;
(2) A sIgnIfIcnnfIy docronsod IovoI of conscIousnoss, whIch Is
IndoµondonfofnsoIzuronndcnnnofbonffrIbufodfofhooffocfsof
modIcnfIon;nnd
(3)AsoIzuronssocInfodwIfhIossofconscIousnoss.
l65. AoIionol Voccine 1njur, ConpeneoIion Progron, Voccine 1njur, ToIle,
!.S. ÐII`T OI HIA!TH & H!MAÞ SI!VS., HIA!TH !IS. & SI!VS. AÐMIÞ.,
hffµ://www.hrsn.gov/vnccInocomµonsnfIon/fnbIo.hfm(InsfvIsIfodJnn.20,20l0).
55
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 535
(C)IncronsodInfrncrnnInIµrossuromnyboncIInIcnIfonfuro
ofncufooncoµhnIoµnfhyInnnyngogrouµ.
(Ð) A "sIgnIIIcuntIy decveused IeveI oI conscIousness"
Is IndIcuted by tLe pvesence oI ut Ieust one oI tLe IoIIowIng
cIInIcuI sIgns Iov ut Ieust 24 Louvs ov gveutev
(see puvugvupLs (2)(I)(A) und (2)(I)(B) oI tLIs sectIon Iov
uppIIcubIe tImeIvumes):
(1) Ðecveused ov ubsent vesponse to envIvonment
(vesponds, II ut uII, onIy to Ioud voIce ov puInIuI stImuII);
(2) Ðecveused ov ubsent eye contuct (does not II× guze
upon IumIIy membevs ov otLev IndIvIduuIs); ov
(3) InconsIstent ov ubsent vesponses to e×tevnuI
stImuII (does not vecognIze IumIIIuv peopIe ov tLIngs). |od.
omµhnsIsnddod]
(I) Tho foIIowIng cIInIcnI fonfuros nIono, or In combInnfIon,
do nof domonsfrnfo nn ncufo oncoµhnIoµnfhy or n sIgnIfIcnnf
chnngo In oIfhor monfnI sfnfus or IovoI of conscIousnoss ns
doscrIbod nbovo: SIooµInoss, IrrIfnbIIIfy (fussInoss), hIgh-µIfchod
nnd unusunI scronmIng, µorsIsfonf InconsoInbIo cryIng, nnd
buIgIng fonfnnoIIo. SoIzuros In fhomsoIvos nro nof suffIcIonf fo
consfIfufondIngnosIsofoncoµhnIoµnfhy.Infhonbsoncoofofhor
ovIdoncoofnnncufooncoµhnIoµnfhy,soIzurosshnIInofbovIowod
ns fho fIrsf symµfom or mnnIfosfnfIon of fho onsof of nn ncufo
oncoµhnIoµnfhy.
(II) CLvonIc encepLuIoputLy occurs whon n chnngo In
monfnI or nouroIogIc sfnfus, fIrsf mnnIfosfod durIng fho
nµµIIcnbIo fImo µorIod, µorsIsfs for n µorIod of nf Ionsf 6 monfhs
fromfhodnfoofvnccInnfIon.IndIvIdunIswhorofurnfonnormnI
nouroIogIc sfnfo nffor fho ncufo oncoµhnIoµnfhy shnII nof bo
µrosumodfohnvosufforodrosIdunInouroIogIcdnmngofromfhnf
ovonf; nny subsoquonf chronIc oncoµhnIoµnfhy shnII nof bo
µrosumod fo bo n soquoIn of fho ncufo oncoµhnIoµnfhy. If n
µroµondornnco of fho ovIdonco IndIcnfos fhnf n chIId`s chronIc
oncoµhnIoµnfhy Is socondnry fo gonofIc, µronnfnI or µorInnfnI
fncfors,fhnfchronIconcoµhnIoµnfhyshnIInofboconsIdorodfobo
ncondIfIonsofforfhInfhoTnbIo.
(III) An oncoµhnIoµnfhy shnII nof bo consIdorod fo bo n
condIfIonsofforfhInfhoTnbIoIfInnµrocoodIngonnµofIfIon,If
Is shown by n µroµondornnco of fho ovIdonco fhnf fho
56 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
536 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
oncoµhnIoµnfhy wns cnusod by nn InfocfIon, n foxIn, n mofnboIIc
dIsfurbnnco, n sfrucfurnI IosIon, n gonofIc dIsordor or frnumn
(wIfhouf rognrd fo whofhor fho cnuso of fho InfocfIon, foxIn,
frnumn, mofnboIIc dIsfurbnnco, sfrucfurnI IosIon or gonofIc
dIsordorIsknown).IfnffhofImondocIsIonIsmndoonnµofIfIon
fIIodundorsocfIon2lll(b)offho AcffornvnccIno-roInfodInjury
or donfh, If Is nof µossIbIo fo doformIno fho cnuso by n
µroµondornnco of fho ovIdonco of nn oncoµhnIoµnfhy, fho
oncoµhnIoµnfhy shnII bo consIdorod fo bo ncondIfIonsofforfh In
fhoTnbIo.
(Iv) In doformInIng whofhor or nof nn oncoµhnIoµnfhy Is n
condIfIon sof forfh In fho TnbIo, fho Courf shnII consIdor fho
onfIromodIcnIrocord.
(3) SeIzuve und convuIsIon. Ior µurµosos of µnrngrnµhs
(b)(2)offhIssocfIon,fhoforms,¨soIzuro¨nnd¨convuIsIon¨IncIudo
myocIonIc, gonornIIzod fonIc-cIonIc (grnnd mnI), nnd sImµIo nnd
comµIoxµnrfInIsoIzuros.Absonco(µofIfmnI)soIzurosshnIInofbo
consIdorod fo bo n condIfIon sof forfh In fho TnbIo. JorkIng
movomonfs or sfnrIng oµIsodos nIono nro nof nocossnrIIy nn
IndIcnfIonofsoIzuroncfIvIfy.
(4) SequeIu. Tho form¨soquoIn¨ monns n condIfIon or ovonf
whIchwnsncfunIIycnusodbyncondIfIon|eJ., i.e. o toccine]IIsfod
InfhoVnccInoInjuryTnbIo.
57
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 53?
APP£NÐIX III
£×cevpt oI HHS Response to IOIA Request
166
HonIfh!osourcosnndSorvIcos
AdmInIsfrnfIon
!ockvIIIo,MÐ2085?
JuIy9,2009
IroodomofInformnfIonAcf(IOIA)CnsoÞo.H!SA09-l?6
Ðr.Mr.Krnkow:
InmrosµondIngfoyourIOIAroquosfforrocordsrognrdIngfho
VnccInoInjuryComµonsnfIonIrogrnm(VICI).Youroquosfodfho
foIIowIngIfoms:
l.!ocordsconfnInIngnIIdocIsIons,IncIudIngSµocInIMnsfors
wrIffondocIsIonsnndordorsorofhoroxµInnnfory
mnforInI,grnnfIngonfIfIomonffocomµonsnfIonundorfho
|VICI].
2.ÐuµIIcnfoofµoInfl.
3.AIImomornndnorofhormnforInIovIdoncIngfhooufcomo
ofµofIfIonsfIIodwIfhfho|VICI].
4.AIIrocordsconfnInIngsfnfIsfIcsorofhornnnIysIsof
docIsIonsgrnnfIngordonyIngonfIfIomonffocomµonsnfIon
ofµofIfIonsfIIodwIfhfho|VICI].
5.AIIrocordsIndIcnfIngcrIforInusodbyH!SAorroInfod
ngoncIosfodoformInowhofhornvnccInoInjurycInIm
shouIdorshouIdnofbocomµonsnfod.
ÞoodIossfosny,fhIsIsnnoxcoµfIonnIIyInrgonndcomµIIcnfod
roquosffhnfwIIIbobofhcosfIynndfnkonmInImumoffourfo
fIvoyonrsfocomµIofo....
l66. See!offorfromThomnsIInvIn,IroodomofInfo.OffIcor,Ðoµ`fofHonIfh
&HumnnSorvs.,fo!oborfKrnkow(JuIy9,2009)(onfIIowIfhnufhors).
58 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
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538 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
TLe costs uve detuIIed In tLe uttucLed veceIpt und totuI
54,625.IfyouwIIIsondusndoµosIfforhnIfoffhoosfImnfod
cosfs$3??,3l2.50wowIIIµrocoodwIfhnssombIIngnnd
rovIowIngfhosorocords. I must cuutIon you tLut It wIII
vequIve ut Ieust 4 to 5 yeuvs to compIete youv vequest. . . .
.|enpIoeie oJJeJ]
ThoÐoµnrfmonfofHonIfhnndHumnnSorvIcos`µoIIcycnIIsfor
fhofuIIosfrosµonsIbIodIscIosuroconsIsfonfwIfhfho
roquIromonfsofndmInIsfrnfIvonocossIfynndconfIdonfInIIfy
whIchnrorocognIzodbyfhoIOIA,5!.S.C.§552,nndfho
Ðoµnrfmonf`sImµIomonfIngIubIIcInformnfIon!oguInfIons,45
CI!Inrf5.
IfyouroquIronnyfurfhornssIsfnnco,µIonsocnIIfhIsoffIconf
(30l)443-28655.(eic)
SIncoroIy,
/s/
ThomnsIInvIn
IroodomofInformnfIonOffIcor
59
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 539
APP£NÐIX IV
PvevIous StudIes usIng VICP Compensuted Cuses us
Ðutu
Yeuv AutLovs InstItutIonuI
AIIIIIutIon
AvtIcIe TItIe und JouvnuI oI
PubIIcutIon
l993 Cownnof
nI.
IOM ¨AcufooncoµhnIoµnfhynnd
chronIcnouroIogIcnIdnmngo
nfforµorfussIsvnccIno,¨Voccine
l993,ll(l4):l3?l-9
l6?
l994 Irovofsof
nI.
CÐC ¨ComµIofonossofroµorfIngfor
µnrnIyfIcµoIIomyoIIfIs,!nIfod
Sfnfos,l980-l99l.ImµIIcnfIons
ofosfImnfIngfhorIskofvnccIno-
nssocInfoddIsonso,¨ArcI.
PeJioIr. AJoleec. MeJ.,l994
l48(5):4?9-85.
l68
l996 WoIboI&
Ionor
ÞVICI/!SIHS ¨ChronIcnrfhroµnfhynnd
muscuIoskoIofnIsymµfoms
nssocInfodwIfhruboIInvnccInos.
ArovIowofl24cInIms
submIffodfofhoÞnfIonnI
VnccInoInjuryComµonsnfIon
Irogrnm,¨ArIIriIie IIeun.,
l996,39(9):l529-34.
l69
l996 WoIboI&
Ionor
ÞVICI ¨!oµorfIngVnccIno-AssocInfod
InrnIyfIcIoIIomyoIIfIs:
ConcordnncobofwoonfhoCÐC
l6?. !Indn Ð. Cownn of nI., AcuIe 1ncepIolopoII, onJ CIronic Aeurologicol
Donoge ofIer PerIueeie Voccine,llVACCIÞIl3?l(l993).
l68. Ð. !oboccn Irovofs of nI., ConpleIeneee of IeporIing for Porol,Iic
Polion,eliIie, UniIeJ SIoIee, 19S0-1991. 1nplicoIione of 1eIinoIing IIe Iiel of
Voccine-oeeocioIeJ Dieeoee, l48 A!CHIVIS OI IIÐIAT!ICS & AÐO!ISCIÞT MIÐ.
4?9(l994).
l69. !oborf I. WoIboI & ÐnvId I. Ionor, CIronic ArIIropoII, onJ
MueculoeleleIol S,npIone AeeocioIeJ uiII IuIello Voccinee. A Ietieu of 124
Cloine SuIniIIeJ Io IIe AoIionol Voccine 1njur, ConpeneoIion Progron, 39
A!TH!ITIS&!HI!MATISMl529(l996).
60 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
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Yeuv AutLovs InstItutIonuI
AIIIIIutIon
AvtIcIe TItIe und JouvnuI oI
PubIIcutIon
nndfhoÞnfIonnIVnccInoInjury
ComµonsnfIonIrogrnm,¨An. J.
of PuIlic HeolII,l996,86(5):
?34-?3.
l?0
l998 !Idgwny !nIv.ofCnIIf.,
IorkoIoy
¨ÐIsµufodcInImsforµorfussIs
vnccInoInjurIosundorfho
ÞnfIonnIVnccInoInjury
ComµonsnfIonIrogrnm,¨J.
1nteeIig. MeJ.,l998,46(4):l68-
?4.
l?l
l998 WoIboI ÞVICI ¨AcufooncoµhnIoµnfhyfoIIowod
byµormnnonfbrnInInjuryor
donfhnssocInfodwIfhfurfhor
nffonunfodmonsIosvnccInos:n
rovIowofcInImssubmIffodfo
fhoÞnfIonnIVnccInoInjury
ComµonsnfIonIrogrnm,¨
PeJioIrice,l998,l0l(3Ifl):
383-?.
l?2
l999 !Idgwny !Inoborry
!osonrchAssoc.
¨ÞofnuIfvnccInoInsurnnco:
!ossonsfromfhoÞnfIonnI
VnccInoInjuryComµonsnfIon
Irogrnm,¨J. of HeolII PoliIice,
Polic, & Iou,l999,24(l):59-
90.
l?3
l?0. !oborf I. WoIboI & ÐnvId I. Ionor, IeporIing Voccine-AeeocioIeJ
Porol,Iic Polion,eliIie. ConcorJonce BeIueen IIe CDC onJ IIe AoIionol Voccine
1njur, ConpeneoIion Progron,86AM.J.OII!I.HIA!TH?34(l996).
l?l. Ðorry!Idgwny,DiepuIeJ Cloine for PerIueeie Voccine 1njuriee UnJer IIe
AoIionol Voccine 1njur, ConpeneoIion Progron, 46 J. OI IÞVISTICATIVI MIÐ.
l68(l998).
l?2. !oborf I. WoIboI of nI., AcuIe 1ncepIolopoII, IolloueJ I, PernonenI
Broin 1njur, or DeoII AeeocioIeJ uiII IurIIer AIIenuoIeJ Meoelee Voccinee. A
Ietieu of Cloine SuIniIIeJ Io IIe AoIionol Voccine 1njur, ConpeneoIion
Progron,l0lIIÐIAT!ICS383(l998).
l?3. Ðorry !Idgwny, Ao IoulI Voccine 1neuronce. Ieeeone fron IIe AoIionol
Voccine 1njur, ConpeneoIion Progron, 24 J. OI HIA!TH IO!., IO!`Y & !. 59
(l999).
61
03HO!!AÞÐMAC!O3 3/28/20ll?:45IM
20ll] UAAASW1I1D QU1ST1OAS 54l
Yeuv AutLovs InstItutIonuI
AIIIIIutIon
AvtIcIe TItIe und JouvnuI oI
PubIIcutIon
20l0 Afnnnsoff !.S.HHS,
H!SA,ÞVICI
¨ShouIdorInjury!oInfodfo
VnccInoAdmInIsfrnfIon
(SI!VA),¨IoworµoInf
µrosonfnfIongIvonfofho
AdvIsoryCommIssIonon
ChIIdhoodVnccInos,Soµf.3,
20l0.
l?4
l?4. Snrnh Afnnnsoff, Mod. OffIcor, HonIfh !os. & Sorvs. AdmIn., ÐIv. of
VnccIno Injury Comµ.& !osomnry Johnnn-!Inng, ChIof Mod. OffIcor, HonIfh
!os. & Sorvs. AdmIn., ÐIv. of VnccIno Injury Comµ., IrosonfnfIon fo fho
AdvIsory CommIssIon on ChIIdhood VnccInos (Soµf. 2-3, 20l0). Ior mInufos of
fhIs moofIng, go fo hffµ://www.hrsn.gov/vnccInocomµonsnfIon/ ACCVMInufos-
Soµfombor20l0.µdf.
62 http://digitalcommons.pace.edu/pelr/vol28/iss2/6
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APP£NÐIX V
Puvent Stvuctuved IntevvIew Iovm
NutIonuI VuccIne CompensutIon JustIce PvoJect
PetItIonev Puvent Stvuctuved IntevvIew Iovm
Cnso#:CÐ ChIId`sÞnmo: ÐOI:
Ðkf.#: SµocInIMnsfor/Judgo:
Mofhor`snnmo: Infhor`snnmo: Affornoynnmo:
CunrdInn:
Addross:
ToIoµhono:
I-mnII:
Mofhor`sÐOI: Infhor`sÐOI:
SIbIIngs(gondornndngos):
Mofhor`soccuµnfIonnffhofImooffIIIng:
Infhor`soccuµnfIonnffhofImooffIIIng:
Mofhor`soccuµnfIonnow:
Infhor`soccuµnfIonnow:
Stutus oI CLIId
SubjocfchIId`sµrosonfngo:
!IvIngsIfunfIon:(WIfhfnmIIy,grouµhomo,ofc.)
HowIsyourchIId`sIIfofodny`
WhnfwnsfhoImµncfoffhovnccInoInjuryonyourfnmIIy`
PevceptIons oI Pvogvum JustIce
InyouroµInIon...
WnsyourchIId`scInImrosoIvodquIckIy`
WnsyourchIId`scInImrosoIvodwIfhcomµnssIon`
WnsyourchIId`scInImrosoIvodfnIrIy`
HnsfhoIrogrnmmoffhonoodsofyourchIId`
63
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20ll] UAAASW1I1D QU1ST1OAS 543
WhnfworofhoµosIfIvonsµocfsoffhoµrogrnm`
WhnfworofhonognfIvonsµocfsoffhoµrogrnm`
WhnfwouIdyourocommondInformsofchnngosforfhoÞVICI`
WouIdyoubowIIIIngfowrIfonIoffordoscrIbIngyourµorcoµfIons
offhoÞVICI`
WouIdyoubowIIIIngfosµonkµubIIcIyIfgIvonfhooµµorfunIfy`
VuccIne InJuvy - £ncepLuIoputLy
ÐoosyourchIId`svnccInoInjuryInducodoncoµhnIoµnfhyIncIudo
soIzuros`
ÐoosyourchIId`svnccInoInjuryInducodoncoµhnIoµnfhyIncIudo
nnnufIsmdIngnosIs,nufIsfIcfonfurosornufIsfIc-IIkobohnvIors
(whIchono)`
ÐoosyourchIId`svnccInoInjuryInducodoncoµhnIoµnfhyIncIudon
dIngnosIsofAffonfIonÐofIcIfÐIsordor`
ÐoosyourchIId`svnccInoInjuryInducodoncoµhnIoµnfhyIncIudon
dIngnosIsofÐovoIoµmonfnIÐoIny`
VuccIne InJuvy ÷ SeIzuve ÐIsovdev
ÐoosyourchIId`svnccInoInjuryInducodsoIzurodIsordorIncIudo
ndIngnosIsofAffonfIonÐofIcIfÐIsordor`
ÐoosyourchIId`svnccInoInjuryInducodsoIzurodIsordorIncIudo
nnnufIsmdIngnosIs,nufIsfIcfonfurosornufIsfIc-IIkobohnvIors
(whIchono)`
WhonyourchIIdIsnofsufforIngfromsoIzuros,doosfhochIId
oxhIbIfnufIsm-IIkobohnvIors`
ÐoosyourchIId`svnccInoInjuryInducodsoIzurodIsordorIncIudo
ndIngnosIsofÐovoIoµmonfnIÐoIny`
VuccIne InJuvy GenevuIIy
ÐoosyourchIId`svnccInoInjuryIncIudomyoIIndIsordors`
ÐoosyourchIIdnIsosufforfromnsfhmn,noworInfhoµnsf`
ÐoosyourchIIdhnvoInngungodIffIcuIfIos`
ÐoosyourchIIdhnvondIngnosIsofCI`
WouIdyoubowIIIIngfoµrovIdowrIffonmnforInIfhnfvorIfIos
yourchIId`sdIngnosIs`
WouIdyoubowIIIIngforoIonsocoµIosofyourchIId`sroµorfsfrom
modIcnIoxµorfs(usodonIyforvorIfIcnfIonµurµosos)`
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544 PAC1 1AV1IOAM1ATAI IAW I1V11W |VoI.28
WouIdyoubowIIIIngfowrIfonIoffordoscrIbIngyourchIId`s
modIcnIcondIfIon`
InIfInIdnfoofInforvIow: TImo:
InforvIowor:
IoIIowuµdnfo:
AddIfIonnInofos:
IoIIowuµdnfo:
AddIfIonnInofos:
65
