A.M. received her third HPV vaccine on February 21, 2008. Pet. Ex. 10 at 1. Later that day, she developed a fever and "brief generalized tonic-clonic seizure." Pet. Ex. 6 at 438-39. Her fever was noted to be 103.5° F on admission to the hospital. Id. at 438. She was discharged home on February 22, 2008. Id. at 449. Thereafter, A.M. was seizure free for six weeks, from February 2008 to early April 2008. Pet. Ex. 2 at 5, 9. Due to A.M.'s poor short-term memory and cognitive impairments, she was deemed medically unable to return to school. Pet. Ex. 9 at 78-79.
A.M. presented to the emergency room on September 14, 2008 after experiencing eight seizures. Pet. Ex. 6 at 117. Her temperature was noted to be 100.5° F. While admitted, A.M. underwent a psychiatric evaluation due to "suicidal ideation as well as verbal and physical aggressiveness towards her mother and grandmother . . . ." Pet. Ex. 3 at 494. A neuropsychological evaluation performed on September 24, 2008 revealed low average range of intellectual functioning and significant behavioral issues. Pet. Ex. 14 at 204-09.
On December 10, 2008, A.M. underwent brain surgery; specifically, a left fronto-temporal craniotomy, intraoperative electrocorticography, tailored left anterior temporal lobectomy and an amygdalohippocampectomy. Pet. Ex. 23 at 130-31. A biopsy of the anterior temporal lobe taken during the procedure showed mild, multifocal, neuronal disorganization "insufficient for Palmini Classification — Chaslin gliosis,6 mild, multifocal — heterotopic neurons, subcortical white matter," no evidence of inflammatory or neoplastic process, and no definite evidence of cortical dysplasia.7 Id. at 164. Her discharge summary on December 13, 2008 noted that an MRI of the brain showed bilateral hippocampal atrophy. Id. at 2. It was also noted that a work-up showed that her seizures were predominately left-sided in origin—especially in the medial structures—and that she had persistent post-operative seizures with a different etiology than before, but that her condition improved once prescribed anticonvulsants. Id. After her surgery, A.M. continued to experience three or four seizures weekly, typically occurring over a few days in a row. Pet. Ex. 17 at 18.