Presented as the test case by Attorney Chin-Caplan of an acute peripheral demyelinating disorder in the Hepatitis B/neuro-demyelinating omnibus proceeding, Peugh was granted entitlement for the onset of Guillain Barre Syndrome (“GBS”) after receipt of his fourth hepatitis B vaccine.  Prior to completion of damages, the petitioner died unexpectedly.  A second hearing was convened to determine whether petitioner’s untimely death was related to the receipt of the hepatitis B vaccine.

At the second hearing, Attorney Chin-Caplan presented evidence that petitioner suffered from autonomic instability as residua from GBS which would result in changes to petitioner’s blood pressure and heart rate.  Evidence was submitted that in a subsequent hospitalization for relapsing GBS, wide variations were noted by hospital staff in petitioner’s heart rate and blood pressure.  As further evidence of significant autonomic involvement, petitioner suffered from bowel and bladder problems that were treated with medications that could also affect his blood pressure.  Respondent disputed that petitioner suffered relapses of GBS despite the medical records and attributed his issues to hypothyroidism and gluteal compartment syndrome along with medications ordered for petitioner.  Respondent further disputed the cause of death assigned by the medical examiner.  Ultimately, respondent’s expert conceded that if medications ordered for petitioner to reduce pain and treat depression as a result of “failure to recover from GBS, [was implicated] then his death was GBS-related.”  Accordingly, the special master found it “unnecessary . . . to pick between the two theories [of both parties’ experts] of the cause of [petitioner’s] death since both point to GBS.”