{ "$schema_version": "5.3", "review_mode": "fresh", "claim_restatement": { "index_wording": "Avoiding routine childhood vaccination prevents autism and produces a better overall health outcome in children eligible for routine immunization.", "entry_form": "claim", "gradeable_restatement": "Avoiding routine childhood vaccination prevents autism and produces a better overall health outcome in children eligible for routine immunization.", "restatement_required": true, "split_into": [], "parent_claim": null, "scope_qualifiers": [ { "qualifier": "Species, genotype, developmental window, exposure, baseline disease and measurement fixed before outcomes", "determinable_before_outcome": true, "determined_from": "Enrollment and experimental design, before results; no responder-defined scope.", "action": "retained" } ] }, "hypothesis": { "name": "Vaccine–Autism Claims and Vaccine Avoidance", "central_claim": "Avoiding routine childhood vaccination prevents autism and produces a better overall health outcome in children eligible for routine immunization.", "proposed_mechanism": "Avoiding routine childhood vaccination prevents autism and produces a better overall health outcome in children eligible for routine immunization.", "claimed_scope": "Children eligible for routine vaccination under baseline-defined clinical indications; autism incidence, historical vaccine formulation/dose and net infection/adverse-event outcomes are separated", "claimed_level": [ "initiation", "maintenance", "progression" ], "is_conjunctive": true, "conjunctive_note": "Primary SC3 is the registered clinical policy/benefit claim. Etiologic mechanisms and separately stated harms are reported at their own scope; proof of harm does not itself assign the nominal benefit level." }, "rubric_routing": { "primary_rubric": "07-psychiatry-neuromodulation.md", "secondary_rubrics": [ "05-immunology-inflammation.md" ], "index_notes_applied": [ "Primary SC3 is the registered clinical policy/benefit claim. Etiologic mechanisms and separately stated harms are reported at their own scope; proof of harm does not itself assign the nominal benefit level." ], "rubric_fit_note": "No frozen rubric explicitly covers developmental vaccine etiology or net preventive policy.07 is used as the nearest clinical diagnostic routing for SC1–SC3, with a preregistered adaptation to incident developmental diagnosis, valid dose/formulation natural experiments and outcome-ascertainment controls rather than psychiatric symptom treatment.05 governs antigen-specific infection prevention with incidence endpoints. Autism is neurodevelopmental, not neurodegenerative. The literal rubric threshold text is retained, while applied criteria below distinguish this adaptation. Subjective-effect/placebo confounders are relevant to rating-based chelation claims but not automatically imposed on registry autism diagnoses or pathogen-confirmed prevention trials." }, "subclaim_matrix": { "subclaims": [ { "id": "SC1", "statement": "Thimerosal exposure from childhood vaccines causally increases autism incidence.", "subclaim_type": "mechanism", "scope": "Historical ethylmercury formulations and measured doses; not all environmental mercury", "claimed_scope": "Historical ethylmercury formulations and measured doses; not all environmental mercury", "governing_rubric": "07-psychiatry-neuromodulation.md", "key_evidence_anchor": "Same-vaccine formulation changes, individual exposure and dose contrasts", "hsef_level": "Α", "confidence": "High", "governing_cap_or_threshold": "Quoted boundary and upward audit below.", "rationale": "The examined set does not establish a reproducible positive human vaccine-ethylmercury/ASD association. Cell and selected rodent experiments demonstrate restricted toxicity, but neither their endpoints nor dose/kinetic transport establish vaccine-dose human autism. Positive ecological, passive-report and referred-case associations fail to reproduce in better individual-dose, matched-formulation and validated diagnostic comparisons. Thus the registered clinical etiologic claim is Α, while real restricted toxicology is retained separately; a Β ceiling is not treated as an earned associational rung.", "rubric_adaptation": "Incident ASD is the clinical outcome; the adapted causal criterion is a valid individual dose/formulation contrast or natural experiment with diagnosis/time-at-risk validation, calendar/healthcare-use control, and clinically relevant exposure. Cell toxicity or general mercury hazards are not vaccine-dose ASD causality." }, { "id": "SC2", "statement": "MMR vaccination causally increases autism incidence.", "subclaim_type": "mechanism", "scope": "Eligible children and prospectively defined familial-risk groups; MMR has never contained thimerosal", "claimed_scope": "Eligible children and prospectively defined familial-risk groups; MMR has never contained thimerosal", "governing_rubric": "07-psychiatry-neuromodulation.md", "key_evidence_anchor": "Large linked cohorts, temporal clustering and predefined susceptibility tests", "hsef_level": "Α", "confidence": "High", "governing_cap_or_threshold": "Quoted boundary and upward audit below.", "rationale": "No credible reproducible positive MMR/ASD association is established in the examined original set. Anecdotal timing, postdiagnosis antibodies and a later school-entry association do not survive stronger age, exposure, onset, familial-risk and withdrawal comparisons. The registered etiologic claim is therefore Α. This does not assert that every conceivable rare vaccine adverse event is impossible or that ASD itself is speculative.", "rubric_adaptation": "Incident ASD and regression/timing are assessed against MMR exposure with validated baseline eligibility, age/time-at-risk, predefined familial risk and credible ascertainment. A matched natural exposure contrast is eligible without requiring a psychedelics-style active subjective comparator. No vaccine-induced autism-positive crossing is found." }, { "id": "SC3", "statement": "Avoiding routine childhood vaccination provides superior overall child health by preventing autism.", "subclaim_type": "generalization", "scope": "Children eligible for routine immunization, excluding recognized clinical contraindications before outcomes", "claimed_scope": "Children eligible for routine immunization, excluding recognized clinical contraindications before outcomes", "governing_rubric": "07-psychiatry-neuromodulation.md", "key_evidence_anchor": "Autism incidence plus infection and adverse-event outcomes; do not redefine eligibility by response", "hsef_level": "Α", "confidence": "High", "governing_cap_or_threshold": "Quoted boundary and upward audit below.", "rationale": "No examined original clinical study demonstrates that avoiding routine childhood vaccination prevents autism and improves overall health among eligible children. The claim remains narrative/unsupported at Α. Negative autism exposure tests do not earn a positive causal crossing; separate infection-prevention and refusal-outbreak evidence opposes the proposed net benefit. This level was derived from the source comparison rather than assigned because the topic is historically disputed.", "rubric_adaptation": "Net child health requires prospectively defined clinical autism, infection and adverse-event outcomes in an eligible population. Target-trial emulation of existing natural exposure variation can be informative; deliberately withholding standard vaccination to test autism is not proposed. One marker, one disease absence or a postdiagnosis rating improvement cannot establish superior overall health." }, { "id": "SC4", "statement": "Vaccine avoidance increases vaccine-preventable infection risk in individuals and their communities.", "subclaim_type": "mechanism", "scope": "Exposure opportunity, age, vaccine and setting specified before outcomes", "claimed_scope": "Exposure opportunity, age, vaccine and setting specified before outcomes", "governing_rubric": "05-immunology-inflammation.md", "key_evidence_anchor": "Refusal/exemption cohorts, outbreaks, vaccination and withdrawal natural experiments", "hsef_level": "Η", "confidence": "High", "governing_cap_or_threshold": "Quoted boundary and upward audit below.", "rationale": "Vaccine avoidance removes demonstrated pathogen-specific protection and increases infection susceptibility where exposure occurs. Randomized pertussis-component versus matched DT-control and varicella-antigen versus MMR-control trials establish clinical prevention; refusal/exemption studies, missing-dose gradients and laboratory-confirmed outbreaks connect loss of protection to individual and community risk. These classes address different failure modes and converge at Η for the specified infection-risk claim. They do not mean every unvaccinated child becomes infected, vaccines prevent every case, or every formulation/recipient has zero adverse-event risk.", "rubric_adaptation": "05 explicitly names vaccine trials with incidence endpoints as field-valid equivalents. Randomized pathogen-antigen inclusion versus matched control and clinical infection outcomes test prevention; outbreak/refusal/dose contrasts connect withdrawal or absence of that protection to exposure-conditioned infection risk. This is a preventive-policy mechanism adaptation, not a cytokine-driver claim." } ], "aggregation_rule": "primary-subclaim", "aggregation_preregistered": true, "aggregation_rationale": "Primary SC3 is the registered clinical policy/benefit claim. Etiologic mechanisms and separately stated harms are reported at their own scope; proof of harm does not itself assign the nominal benefit level.", "primary_subclaim_id": "SC3", "aggregation_derivation": "Overall Α follows preregistered primary SC3: avoiding eligible routine vaccination has no verified autism-prevention/net-health benefit in the examined originals. SC1 and SC2 are also Α because the set establishes no credible reproducible positive clinical vaccine-ASD association; restricted toxicity findings are retained without importing their inference into human ASD. Separate SC4 reaches Η through randomized antigen-specific prevention plus independently structured exposure/refusal/outbreak evidence. The harm score does not itself assign the nominal benefit score.", "aggregation_alternatives": { "weakest_link_would_return": "Α", "primary_subclaim_would_return": "Α", "scope_matched_would_return": "Α", "note": "Separate narrow successes do not replace the preregistered full-scope gate." }, "index_rule_deviation": "" }, "competing_models": { "models_evaluated": [ { "rank_in_tournament": 1, "model_id": "M3", "is_nominal": false, "name": "Pathogen-specific protection with adverse-event boundaries", "core_claim": "Immunization reduces defined clinical infection risks while formulation, age and contraindications determine specific adverse-event risks.", "explains_what_nominal_does_not": "Immunization reduces defined clinical infection risks while formulation, age and contraindications determine specific adverse-event risks.", "strongest_supporting_evidence": [ "Randomized pertussis/varicella prevention, refusal cohorts, missing-dose gradients and independently observed outbreaks converge on clinical protection and its loss." ], "strongest_contradictory_evidence": [ "Protection varies by product/dose/time/exposure and can fail; febrile seizures, ITP and rare anaphylaxis are real boundaries rather than evidence of autism causation." ], "hsef_level_for_this_model": "Η", "rationale": "Randomized pertussis/varicella prevention, refusal cohorts, missing-dose gradients and independently observed outbreaks converge on clinical protection and its loss. Protection varies by product/dose/time/exposure and can fail; febrile seizures, ITP and rare anaphylaxis are real boundaries rather than evidence of autism causation." }, { "rank_in_tournament": 2, "model_id": "M2", "is_nominal": false, "name": "Developmental liability and diagnostic timing", "core_claim": "Familial developmental liability and age-dependent recognition can coincide with vaccination timing without vaccine causation.", "explains_what_nominal_does_not": "Familial developmental liability and age-dependent recognition can coincide with vaccination timing without vaccine causation.", "strongest_supporting_evidence": [ "Affected-sibling risk is high while MMR receipt does not increase ASD; age-landmark, regression-clustering and withdrawal tests narrow timing explanations." ], "strongest_contradictory_evidence": [ "This selected vaccine-focused set does not fully explain all autism genetic/environmental causes or every individual developmental trajectory." ], "hsef_level_for_this_model": "Β", "rationale": "Affected-sibling risk is high while MMR receipt does not increase ASD; age-landmark, regression-clustering and withdrawal tests narrow timing explanations. This selected vaccine-focused set does not fully explain all autism genetic/environmental causes or every individual developmental trajectory." }, { "rank_in_tournament": 3, "model_id": "M4", "is_nominal": false, "name": "Ascertainment and exposure misclassification", "core_claim": "Healthcare contact, early-intervention requirements, calendar trends and reporting alter apparent vaccine-autism associations.", "explains_what_nominal_does_not": "Healthcare contact, early-intervention requirements, calendar trends and reporting alter apparent vaccine-autism associations.", "strongest_supporting_evidence": [ "Atlanta late-vaccination associations, EHR age anchoring and passive-report versus service-prevalence divergence map specific bias mechanisms." ], "strongest_contradictory_evidence": [ "Bias is not a complete explanation for every biological autism trend, and a near-null negative control cannot eliminate all residual confounding." ], "hsef_level_for_this_model": "Γ", "rationale": "Atlanta late-vaccination associations, EHR age anchoring and passive-report versus service-prevalence divergence map specific bias mechanisms. Bias is not a complete explanation for every biological autism trend, and a near-null negative control cannot eliminate all residual confounding." }, { "rank_in_tournament": 4, "model_id": "M1", "is_nominal": true, "name": "Autism prevention by vaccine avoidance", "core_claim": "Avoiding routine vaccines prevents autism and improves eligible children's overall health.", "explains_what_nominal_does_not": "Avoiding routine vaccines prevents autism and improves eligible children's overall health.", "strongest_supporting_evidence": [ "Its strongest case is known dose-dependent mercury toxicity, susceptible-strain animal findings and positive but weak aggregate/referred-case associations." ], "strongest_contradictory_evidence": [ "Actual vaccine-exposure clinical studies fail its main predictions, and loss of infection protection contradicts the proposed net-health improvement." ], "hsef_level_for_this_model": "Α", "rationale": "Its strongest case is known dose-dependent mercury toxicity, susceptible-strain animal findings and positive but weak aggregate/referred-case associations. Actual vaccine-exposure clinical studies fail its main predictions, and loss of infection protection contradicts the proposed net-health improvement." } ], "tournament_summary": "Descriptive comparison; does not modify the nominal score. The randomized pertussis-component versus DT-only trial (PMID 8538705) establishes clinical pathogen prevention independently of refusal/healthcare-seeking confounding, while the 2026 age-landmark MMR-autism analysis (PMID 42520244) finds a near-null ASD estimate with a separate negative-control exposure. Together they distinguish actual protection from diagnosis-timing coincidence; the negative control tests specified biases rather than proving all confounding absent.", "study_separating_rank1_from_rank2": "The randomized pertussis-component versus DT-only trial (PMID 8538705) establishes clinical pathogen prevention independently of refusal/healthcare-seeking confounding, while the 2026 age-landmark MMR-autism analysis (PMID 42520244) finds a near-null ASD estimate with a separate negative-control exposure. Together they distinguish actual protection from diagnosis-timing coincidence; the negative control tests specified biases rather than proving all confounding absent.", "nominal_wins_only_by_funding_artifact": false, "level_unchanged_by_tournament": true }, "evidence_inventory": [ { "n": 1, "pmid": "30831578", "title": "Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study.", "citation": "Hviid A, Hansen JV, Frisch M et al. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of internal medicine. 2019.", "doi": "10.7326/M18-2101", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/30831578/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/30831578/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID30831578", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Danish cohort of 657461 children finds adjusted MMR-autism HR0.93 with no consistent increase in prespecified sibling-risk, risk-score or timing groups.", "what_it_does_not_show": "Registry diagnoses without individual chart review and observational allocation cannot exclude every exceptionally rare effect.", "confounders_present": [ "Registry diagnoses without individual chart review and observational allocation cannot exclude every exceptionally rare effect." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Later distinct births but related national registry/diagnostic system; not an independent assay solely due to larger sample." ] }, { "n": 2, "pmid": "12421889", "title": "A population-based study of measles, mumps, and rubella vaccination and autism.", "citation": "Madsen KM, Hviid A, Vestergaard M et al. A population-based study of measles, mumps, and rubella vaccination and autism. The New England journal of medicine. 2002.", "doi": "10.1056/NEJMoa021134", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/12421889/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12421889/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12421889", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Earlier Danish birth cohort finds no MMR association with autism, otherASD or vaccination age/time since dose.", "what_it_does_not_show": "Shares national registry infrastructure with later Danish work; different birth cohorts are not automatically independent assay/error classes.", "confounders_present": [ "Shares national registry infrastructure with later Danish work; different birth cohorts are not automatically independent assay/error classes." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Danish national registry infrastructure and birth years partly overlap formulation cohortPMID14519711." ] }, { "n": 3, "pmid": "10376617", "title": "Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association.", "citation": "Taylor B, Miller E, Farrington CP et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet (London, England). 1999.", "doi": "10.1016/s0140-6736(99)01239-8", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/10376617/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/10376617/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "UK_TAYLOR_AUTISM_SERIES", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "UK regional time/case-series analyses show no introduction-related step or regression/onset clustering after MMR.", "what_it_does_not_show": "Symptom timing and diagnostic validation vary; rare effects remain bounded by precision rather than logically impossible.", "confounders_present": [ "Symptom timing and diagnostic validation vary; rare effects remain bounded by precision rather than logically impossible." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 4, "pmid": "25898051", "title": "Autism occurrence by MMR vaccine status among US children with older siblings with and without autism.", "citation": "Jain A, Marshall J, Buikema A et al. Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA. 2015.", "doi": "10.1001/jama.2015.3077", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/25898051/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/25898051/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "ErratumIn: PMID26757477" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID25898051", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "US insured-sibling cohort finds no increased ASD risk after MMR among children with or without an affected older sibling.", "what_it_does_not_show": "Familial-risk strata have lower coverage and broad intervals; claims ascertainment and continuous insurance selection remain, and linked correction details unexamined.", "confounders_present": [ "Familial-risk strata have lower coverage and broad intervals; claims ascertainment and continuous insurance selection remain, and linked correction details unexamined." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 5, "pmid": "14754936", "title": "Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta.", "citation": "DeStefano F, Bhasin TK, Thompson WW et al. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta. Pediatrics. 2004.", "doi": "10.1542/peds.113.2.259", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/14754936/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/14754936/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID14754936", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Atlanta cases/controls have similar vaccination by 18or24months; association by 36months is stronger in the young school-entry group.", "what_it_does_not_show": "Later association can reflect early-intervention enrollment requirements; temporal association does not establish exposure before developmental concern.", "confounders_present": [ "Later association can reflect early-intervention enrollment requirements; temporal association does not establish exposure before developmental concern." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 6, "pmid": "42520244", "title": "Association Between First MMR Vaccination Before Age 2 Years and Childhood Autism in a U.S. EHR Cohort of 2.5 Million Children.", "citation": "Burstain TL, Jacques D, Burstain JM. Association Between First MMR Vaccination Before Age 2 Years and Childhood Autism in a U.S. EHR Cohort of 2.5 Million Children. The Pediatric infectious disease journal. 2026.", "doi": "10.1097/INF.0000000000005349", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/42520244/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/42520244/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID42520244", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": true, "endogenous": false, "direction": "contradicts", "what_it_shows": "Prespecified age-landmark analyses in 2.56 million US EHR children yield MMR aHR0.97 and pneumococcal negative-control aHR1.01.", "what_it_does_not_show": "Near-null negative control tests specific shared biases, not every residual confounder; original body not accessed.", "confounders_present": [ "Near-null negative control tests specific shared biases, not every residual confounder; original body not accessed." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 7, "pmid": "15364187", "title": "MMR vaccination and pervasive developmental disorders: a case-control study.", "citation": "Smeeth L, Cook C, Fombonne E et al. MMR vaccination and pervasive developmental disorders: a case-control study. Lancet (London, England). 2004 Sep 11-17.", "doi": "10.1016/S0140-6736(04)17020-7", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/15364187/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/15364187/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID15364187", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "UK matched general-practice case-control study finds no increased MMR/PDD association, including pre-media and autism restrictions.", "what_it_does_not_show": "Observational exposure/diagnosis recording and vaccine selection remain; no universal zero-risk conclusion.", "confounders_present": [ "Observational exposure/diagnosis recording and vaccine selection remain; no universal zero-risk conclusion." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 8, "pmid": "15877763", "title": "No effect of MMR withdrawal on the incidence of autism: a total population study.", "citation": "Honda H, Shimizu Y, Rutter M. No effect of MMR withdrawal on the incidence of autism: a total population study. Journal of child psychology and psychiatry, and allied disciplines. 2005.", "doi": "10.1111/j.1469-7610.2005.01425.x", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/15877763/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/15877763/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID15877763", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "natural experiment", "decisive_perturbation": true, "endogenous": true, "direction": "contradicts", "what_it_shows": "Yokohama birth-cohort ASD incidence continues rising after complete MMR withdrawal from1993.", "what_it_does_not_show": "Diagnostic/ascertainment trends can change over time; population withdrawal is stronger against a main cause than against every rare subtype effect.", "confounders_present": [ "Diagnostic/ascertainment trends can change over time; population withdrawal is stronger against a main cause than against every rare subtype effect." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 9, "pmid": "11395196", "title": "MMR and autism: further evidence against a causal association.", "citation": "Farrington CP, Miller E, Taylor B. MMR and autism: further evidence against a causal association. Vaccine. 2001.", "doi": "10.1016/s0264-410x(01)00097-4", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/11395196/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/11395196/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "UK_TAYLOR_AUTISM_SERIES", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Reanalysis of the earlier UK series still finds no association allowing a longer induction interval.", "what_it_does_not_show": "Same source population asPMID10376617, not an independent cohort or causal line.", "confounders_present": [ "Same source population asPMID10376617, not an independent cohort or causal line." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 10, "pmid": "16555271", "title": "Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK.", "citation": "Afzal MA, Ozoemena LC, O'Hare A et al. Absence of detectable measles virus genome sequence in blood of autistic children who have had their MMR vaccination during the routine childhood immunization schedule of UK. Journal of medical virology. 2006.", "doi": "10.1002/jmv.20585", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/16555271/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/16555271/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID16555271", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2" ], "favors_models": [], "evidence_class": "Moderate", "system": "ex vivo", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Sensitive multiple-region PCR does not detect persistent measles genomes in leukocytes of vaccinated autistic children.", "what_it_does_not_show": "Blood sampling cannot exclude every transient event or other tissue; assay null does not alone establish all clinical safety.", "confounders_present": [ "Blood sampling cannot exclude every transient event or other tissue; assay null does not alone establish all clinical safety." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 11, "pmid": "12427783", "title": "Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine.", "citation": "Thjodleifsson B, Davídsdóttir K, Agnarsson U et al. Effect of Pentavac and measles-mumps-rubella (MMR) vaccination on the intestine. Gut. 2002.", "doi": "10.1136/gut.51.6.816", "pmcid": "PMC1773472", "url": "https://pubmed.ncbi.nlm.nih.gov/12427783/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12427783/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12427783", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Infant pre/post Pentavac or MMR vaccination shows no significant fecal-calprotectin increase.", "what_it_does_not_show": "Short subclinical inflammation endpoint is not a full autism-incidence trial or all gastrointestinal tissue assessment.", "confounders_present": [ "Short subclinical inflammation endpoint is not a full autism-incidence trial or all gastrointestinal tissue assessment." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 12, "pmid": "12849883", "title": "Elevated levels of measles antibodies in children with autism.", "citation": "Singh VK, Jensen RL. Elevated levels of measles antibodies in children with autism. Pediatric neurology. 2003.", "doi": "10.1016/s0887-8994(02)00627-6", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/12849883/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12849883/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12849883", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2" ], "favors_models": [], "evidence_class": "Weak", "system": "ex vivo", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Autistic children show elevated measles antibody and vaccine-virus immunoblot reactivity in a serologic case-control study.", "what_it_does_not_show": "Postdiagnosis immune measurements lack temporal direction, exposure isolation and proof of vaccine-strain persistence or clinical mediation.", "confounders_present": [ "Postdiagnosis immune measurements lack temporal direction, exposure isolation and proof of vaccine-strain persistence or clinical mediation." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [] }, { "n": 13, "pmid": "26868082", "title": "Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset?", "citation": "Goin-Kochel RP, Mire SS, Dempsey AG et al. Parental report of vaccine receipt in children with autism spectrum disorder: Do rates differ by pattern of ASD onset? Vaccine. 2016.", "doi": "10.1016/j.vaccine.2016.02.008", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/26868082/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/26868082/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID26868082", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC2", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Parent-reported vaccine receipt is largely equivalent across ASD onset-pattern groups in 2755children.", "what_it_does_not_show": "All participants have ASD and reports are retrospective; onset comparison is not a population incidence or selective exposure experiment.", "confounders_present": [ "All participants have ASD and reports are retrospective; onset comparison is not a population incidence or selective exposure experiment." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 14, "pmid": "14519711", "title": "Association between thimerosal-containing vaccine and autism.", "citation": "Hviid A, Stellfeld M, Wohlfahrt J et al. Association between thimerosal-containing vaccine and autism. JAMA. 2003.", "doi": "10.1001/jama.290.13.1763", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/14519711/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/14519711/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID14519711", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "natural experiment", "decisive_perturbation": true, "endogenous": true, "direction": "contradicts", "what_it_shows": "Same-vaccine Danish formulations with or without thimerosal show no increased ASD and no dose trend in 467450children.", "what_it_does_not_show": "Formulation/calendar assignment remains observational and shares Danish registry failure modes; confidence bounds do not prove absolute zero risk.", "confounders_present": [ "Formulation/calendar assignment remains observational and shares Danish registry failure modes; confidence bounds do not prove absolute zero risk." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [ "Danish birth/diagnostic registry infrastructure shared with older MMR cohort and potentially overlapping birth cohorts." ] }, { "n": 15, "pmid": "20837594", "title": "Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism.", "citation": "Price CS, Thompson WW, Goodson B et al. Prenatal and infant exposure to thimerosal from vaccines and immunoglobulins and risk of autism. Pediatrics. 2010.", "doi": "10.1542/peds.2010-0309", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/20837594/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/20837594/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "VSD_ASD256_CONTROL752", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Validated in-person ASD case-control assessment shows no increased risk with prenatal or infant ethylmercury exposure.", "what_it_does_not_show": "Medical-record/interview exposure and selection can leave residual confounding; inverse estimates do not prove thimerosal prevents autism.", "confounders_present": [ "Medical-record/interview exposure and selection can leave residual confounding; inverse estimates do not prove thimerosal prevents autism." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 16, "pmid": "15342825", "title": "Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association.", "citation": "Andrews N, Miller E, Grant A et al. Thimerosal exposure in infants and developmental disorders: a retrospective cohort study in the United kingdom does not support a causal association. Pediatrics. 2004.", "doi": "10.1542/peds.2003-1177-L", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/15342825/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/15342825/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID15342825", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "UK record cohort finds no autism or general neurodevelopment association, with one positive tic analysis and several inverse associations.", "what_it_does_not_show": "Multiplicity, record-based diagnoses and vaccine-selection bias limit interpretation of isolated positive or protective estimates.", "confounders_present": [ "Multiplicity, record-based diagnoses and vaccine-selection bias limit interpretation of isolated positive or protective estimates." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 17, "pmid": "15342824", "title": "Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association.", "citation": "Heron J, Golding J, ALSPAC Study Team. Thimerosal exposure in infants and developmental disorders: a prospective cohort study in the United kingdom does not support a causal association. Pediatrics. 2004.", "doi": "10.1542/peds.2003-1176-L", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/15342824/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/15342824/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID15342824", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Prospective Avon cohort finds one adverse result among 69comparisons and no convincing overall neurologic/psychological harm pattern.", "what_it_does_not_show": "Not all endpoints are autism and many comparisons/selection covariates are tested; isolated significance is not a replicated syndrome.", "confounders_present": [ "Not all endpoints are autism and many comparisons/selection covariates are tested; isolated significance is not a replicated syndrome." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 18, "pmid": "16818529", "title": "Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations.", "citation": "Fombonne E, Zakarian R, Bennett A et al. Pervasive developmental disorders in Montreal, Quebec, Canada: prevalence and links with immunizations. Pediatrics. 2006.", "doi": "10.1542/peds.2005-2993", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/16818529/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/16818529/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID16818529", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC2", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "natural experiment", "decisive_perturbation": false, "endogenous": true, "direction": "contradicts", "what_it_shows": "Montreal PDD prevalence rises after thimerosal removal and while MMR uptake declines, without an exposure/dose association.", "what_it_does_not_show": "Ecological cohort exposure and changing diagnostic concepts/services prevent trend alone proving no individual effect.", "confounders_present": [ "Ecological cohort exposure and changing diagnostic concepts/services prevent trend alone proving no individual effect." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 19, "pmid": "18180424", "title": "Continuing increases in autism reported to California's developmental services system: mercury in retrograde.", "citation": "Schechter R, Grether JK. Continuing increases in autism reported to California's developmental services system: mercury in retrograde. Archives of general psychiatry. 2008.", "doi": "10.1001/archgenpsychiatry.2007.1", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/18180424/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/18180424/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID18180424", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "natural experiment", "decisive_perturbation": false, "endogenous": true, "direction": "contradicts", "what_it_shows": "California DDS autism prevalence does not decline after removal of more than trace thimerosal from nearly all childhood vaccines.", "what_it_does_not_show": "Active-service prevalence is not standardized incidence; diagnostic and access changes complicate withdrawal interpretation.", "confounders_present": [ "Active-service prevalence is not standardized incidence; diagnostic and access changes complicate withdrawal interpretation." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 20, "pmid": "17898097", "title": "Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years.", "citation": "Thompson WW, Price C, Goodson B et al. Early thimerosal exposure and neuropsychological outcomes at 7 to 10 years. The New England journal of medicine. 2007.", "doi": "10.1056/NEJMoa071434", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/17898097/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/17898097/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "THOMPSON_NEUROPSYCH1047", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Standardized testing of 1047children finds small mixed positive/negative associations across42neuropsychological outcomes.", "what_it_does_not_show": "Autism-spectrum disorders were explicitly NOT assessed; this source must not be cited as a direct ASD-incidence null.", "confounders_present": [ "Autism-spectrum disorders were explicitly NOT assessed; this source must not be cited as a direct ASD-incidence null." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 21, "pmid": "19171612", "title": "Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines.", "citation": "Tozzi AE, Bisiacchi P, Tarantino V et al. Neuropsychological performance 10 years after immunization in infancy with thimerosal-containing vaccines. Pediatrics. 2009.", "doi": "10.1542/peds.2008-0795", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/19171612/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/19171612/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID19171612", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Strong", "system": "human interventional", "decisive_perturbation": true, "endogenous": true, "direction": "mixed", "what_it_shows": "Children randomized in infancy to different thimerosal-dose vaccine regimens have few small neuropsychological differences at 10years.", "what_it_does_not_show": "Follow-up participation about70%, multiple comparisons and other formulation differences limit mediation; the outcome is not an autism-incidence test.", "confounders_present": [ "Follow-up participation about70%, multiple comparisons and other formulation differences limit mediation; the outcome is not an autism-incidence test." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 22, "pmid": "14595043", "title": "Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases.", "citation": "Verstraeten T, Davis RL, DeStefano F et al. Safety of thimerosal-containing vaccines: a two-phased study of computerized health maintenance organization databases. Pediatrics. 2003.", "doi": "", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/14595043/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/14595043/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID14595043", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Two-phase HMO screening detects some tic/language associations that fail independent-site replication; no significant autism increase.", "what_it_does_not_show": "Varying ascertainment and many exposure/outcome tests remain; linked erratum lacks a supplied PMID and details unexamined.", "confounders_present": [ "Varying ascertainment and many exposure/outcome tests remain; linked erratum lacks a supplied PMID and details unexamined." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 23, "pmid": "21785120", "title": "Thimerosal exposure in early life and neuropsychological outcomes 7-10 years later.", "citation": "Barile JP, Kuperminc GP, Weintraub ES et al. Thimerosal exposure in early life and neuropsychological outcomes 7-10 years later. Journal of pediatric psychology. 2012.", "doi": "10.1093/jpepsy/jsr048", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/21785120/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/21785120/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "THOMPSON_NEUROPSYCH1047", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Latent-factor reanalysis finds no association for6of7constructs but a small boys-tic association.", "what_it_does_not_show": "Same1047-child dataset asPMID17898097; not independent replication, and tics are not autism.", "confounders_present": [ "Same1047-child dataset asPMID17898097; not independent replication, and tics are not autism." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 24, "pmid": "18482737", "title": "Thimerosal exposure in infants and neurodevelopmental disorders: an assessment of computerized medical records in the Vaccine Safety Datalink.", "citation": "Young HA, Geier DA, Geier MR. Thimerosal exposure in infants and neurodevelopmental disorders: an assessment of computerized medical records in the Vaccine Safety Datalink. Journal of the neurological sciences. 2008.", "doi": "10.1016/j.jns.2008.04.002", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/18482737/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/18482737/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID18482737", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Birth-cohort VSD mercury estimates associate with several neurodevelopmental diagnostic prevalence outcomes, including autism.", "what_it_does_not_show": "Aggregated cohort exposure, calendar/diagnosis changes and reused data undermine individual causal attribution; original authors still recommend routine vaccination.", "confounders_present": [ "Aggregated cohort exposure, calendar/diagnosis changes and reused data undermine individual causal attribution; original authors still recommend routine vaccination." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [ "VSD birth-cohort estimated exposures reused in related analyses; population-aggregate inference differs from individual validated case-control." ] }, { "n": 25, "pmid": "16733480", "title": "An assessment of downward trends in neurodevelopmental disorders in the United States following removal of Thimerosal from childhood vaccines.", "citation": "Geier DA, Geier MR. An assessment of downward trends in neurodevelopmental disorders in the United States following removal of Thimerosal from childhood vaccines. Medical science monitor : international medical journal of experimental and clinical research. 2006.", "doi": "", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/16733480/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/16733480/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID16733480", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "VAERS report proportions for neurodevelopment fall during thimerosal phaseout in an ecological analysis.", "what_it_does_not_show": "Passive adverse-event reports lack population incidence denominators and are sensitive to reporting campaigns, latency and receipt/administration dates.", "confounders_present": [ "Passive adverse-event reports lack population incidence denominators and are sensitive to reporting campaigns, latency and receipt/administration dates." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [ "VAERS passive-report program shares systematic reporting errors withPMID14534046." ] }, { "n": 26, "pmid": "14534046", "title": "An assessment of the impact of thimerosal on childhood neurodevelopmental disorders.", "citation": "Geier DA, Geier MR. An assessment of the impact of thimerosal on childhood neurodevelopmental disorders. Pediatric rehabilitation. 2003.", "doi": "10.1080/1363849031000139315", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/14534046/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/14534046/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID14534046", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "VAERS/education aggregate analyses claim dose-related neurodevelopment associations and compare infant mercury doses to oral methylmercury limits.", "what_it_does_not_show": "Ecological/passive-report data and mismatched compound/route guidance do not establish vaccine ethylmercury autism causality.", "confounders_present": [ "Ecological/passive-report data and mismatched compound/route guidance do not establish vaccine ethylmercury autism causality." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [] }, { "n": 27, "pmid": "12933322", "title": "Reduced levels of mercury in first baby haircuts of autistic children.", "citation": "Holmes AS, Blaxill MF, Haley BE. Reduced levels of mercury in first baby haircuts of autistic children. International journal of toxicology. 2003.", "doi": "10.1080/10915810305120", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/12933322/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12933322/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12933322", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Autistic-child first haircuts have lower mercury values with maternal-survey exposure differences, interpreted as impaired excretion.", "what_it_does_not_show": "Selected postdiagnosis samples and retrospective reporting do not measure native brain burden or prove vaccine exposure caused autism.", "confounders_present": [ "Selected postdiagnosis samples and retrospective reporting do not measure native brain burden or prove vaccine exposure caused autism." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [] }, { "n": 28, "pmid": "17674242", "title": "A prospective study of thimerosal-containing Rho(D)-immune globulin administration as a risk factor for autistic disorders.", "citation": "Geier DA, Geier MR. A prospective study of thimerosal-containing Rho(D)-immune globulin administration as a risk factor for autistic disorders. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians. 2007.", "doi": "10.1080/14767050701228057", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/17674242/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/17674242/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID17674242", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Small referred ASD series has more Rh-negative mothers than an earlier historical pregnancy-control cohort.", "what_it_does_not_show": "Rh status is an imperfect exposure proxy; referral, ancestry, cohort era and immunoglobulin indication confound attribution to thimerosal.", "confounders_present": [ "Rh status is an imperfect exposure proxy; referral, ancestry, cohort era and immunoglobulin indication confound attribution to thimerosal." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [] }, { "n": 29, "pmid": "18404135", "title": "Neurodevelopmental disorders, maternal Rh-negativity, and Rho(D) immune globulins: a multi-center assessment.", "citation": "Geier DA, Mumper E, Gladfelter B et al. Neurodevelopmental disorders, maternal Rh-negativity, and Rho(D) immune globulins: a multi-center assessment. Neuro endocrinology letters. 2008.", "doi": "", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/18404135/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/18404135/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID18404135", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Weak", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Clinic comparisons associate maternal Rh-negativity with neurodevelopmental diagnoses and fewer differences in a small post2001group.", "what_it_does_not_show": "Potential overlap with earlier clinic work, historical controls, indirect exposure and small later cohort prevent a clean withdrawal experiment.", "confounders_present": [ "Potential overlap with earlier clinic work, historical controls, indirect exposure and small later cohort prevent a clean withdrawal experiment." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": false, "decisive_test_note": "", "shared_components": [ "Referredclinic/history program may overlapPMID17674242; no independent-line credit merely for adding a clinic." ] }, { "n": 30, "pmid": "12480426", "title": "Mercury concentrations and metabolism in infants receiving vaccines containing thiomersal: a descriptive study.", "citation": "Pichichero ME, Cernichiari E, Lopreiato J et al. Mercury concentrations and metabolism in infants receiving vaccines containing thiomersal: a descriptive study. Lancet (London, England). 2002.", "doi": "10.1016/S0140-6736(02)11682-5", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/12480426/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12480426/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12480426", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Infant blood/stool measurements estimate rapid ethylmercury blood clearance after thimerosal-containing vaccination.", "what_it_does_not_show": "Descriptive pharmacokinetics do not directly assess autism or prove every tissue cleared when blood falls.", "confounders_present": [ "Descriptive pharmacokinetics do not directly assess autism or prove every tissue cleared when blood falls." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 31, "pmid": "18245396", "title": "Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines.", "citation": "Pichichero ME, Gentile A, Giglio N et al. Mercury levels in newborns and infants after receipt of thimerosal-containing vaccines. Pediatrics. 2008.", "doi": "10.1542/peds.2006-3363", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/18245396/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/18245396/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID18245396", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Infant vaccination pharmacokinetics estimate a3.7 dayblood half-life and elevated fecal mercury after doses.", "what_it_does_not_show": "Population one-compartment modeling, sparse samples and total-Hg measurements are not direct neurodevelopmental outcomes.", "confounders_present": [ "Population one-compartment modeling, sparse samples and total-Hg measurements are not direct neurodevelopmental outcomes." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 32, "pmid": "19560158", "title": "Mercury levels in premature and low birth weight newborn infants after receipt of thimerosal-containing vaccines.", "citation": "Pichichero ME, Gentile A, Giglio N et al. Mercury levels in premature and low birth weight newborn infants after receipt of thimerosal-containing vaccines. The Journal of pediatrics. 2009.", "doi": "10.1016/j.jpeds.2009.04.011", "pmcid": "PMC2767297", "url": "https://pubmed.ncbi.nlm.nih.gov/19560158/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/19560158/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID19560158", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:Methods:paragraph0, 0:Methods:paragraph1, 0:Methods:paragraph7. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Late-preterm infants have measured vaccine-associated mercury with estimated6.3 dayblood half-life and return to baseline by 30days.", "what_it_does_not_show": "Each infant contributes one pre/post sample and population modeling estimates half-life; very-preterm infants, brain clearance and autism are not assessed.", "confounders_present": [ "Each infant contributes one pre/post sample and population modeling estimates half-life; very-preterm infants, brain clearance and autism are not assessed." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 33, "pmid": "16079072", "title": "Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal.", "citation": "Burbacher TM, Shen DD, Liberato N et al. Comparison of blood and brain mercury levels in infant monkeys exposed to methylmercury or vaccines containing thimerosal. Environmental health perspectives. 2005.", "doi": "10.1289/ehp.7712", "pmcid": "PMC1280342", "url": "https://pubmed.ncbi.nlm.nih.gov/16079072/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/16079072/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID16079072", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Results:paragraph5, 1:Results:paragraph6, 1:Results:paragraph7, 1:Results:paragraph8. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Infant monkeys show faster blood clearance/lower total brainHg after thimerosal than methylmercury but a higher inorganic fraction and longer brain than blood retention.", "what_it_does_not_show": "Exposure/route and developmental timing differ; pharmacokinetics are not autism outcomes and rapid blood decline is not complete brain clearance.", "confounders_present": [ "Exposure/route and developmental timing differ; pharmacokinetics are not autism outcomes and rapid blood decline is not complete brain clearance." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Infant-monkey toxicokinetics is a different endpoint from vaccine-schedule behavior/pathology; not proof of shared autism phenotype." ] }, { "n": 34, "pmid": "15184908", "title": "Neurotoxic effects of postnatal thimerosal are mouse strain dependent.", "citation": "Hornig M, Chian D, Lipkin WI. Neurotoxic effects of postnatal thimerosal are mouse strain dependent. Molecular psychiatry. 2004.", "doi": "10.1038/sj.mp.4001529", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/15184908/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/15184908/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID15184908", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Thimerosal challenge produces selected neurobehavioral/pathologic changes in autoimmune-proneSJL mice but not testedC57BL6/BALBc strains.", "what_it_does_not_show": "Mapped strain toxicity is not human autism or universal routine-dose harm; peptide/vaccine formulation and species kinetics need transport validation.", "confounders_present": [ "Mapped strain toxicity is not human autism or universal routine-dose harm; peptide/vaccine formulation and species kinetics need transport validation." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 35, "pmid": "21225508", "title": "Lasting neuropathological changes in rat brain after intermittent neonatal administration of thimerosal.", "citation": "Olczak M, Duszczyk M, Mierzejewski P et al. Lasting neuropathological changes in rat brain after intermittent neonatal administration of thimerosal. Folia neuropathologica. 2010.", "doi": "", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/21225508/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/21225508/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID21225508", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Repeated neonatal thimerosal dosing causes lasting rat neuropathologic changes in tested dose contexts.", "what_it_does_not_show": "Histopathology is not a human ASD diagnosis; authors' dose-equivalence claim does not itself validate pharmacokinetic/developmental transport.", "confounders_present": [ "Histopathology is not a human ASD diagnosis; authors' dose-equivalence claim does not itself validate pharmacokinetic/developmental transport." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 36, "pmid": "21549155", "title": "Persistent behavioral impairments and alterations of brain dopamine system after early postnatal administration of thimerosal in rats.", "citation": "Olczak M, Duszczyk M, Mierzejewski P et al. Persistent behavioral impairments and alterations of brain dopamine system after early postnatal administration of thimerosal in rats. Behavioural brain research. 2011.", "doi": "10.1016/j.bbr.2011.04.026", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/21549155/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/21549155/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID21549155", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Neonatal dose/sex-dependent rat behavior and dopamine changes occur, with social changes at the highest dose and spatial-learning null.", "what_it_does_not_show": "Behavioral proxies, a wide toxic-dose range and sex dependence do not establish routine human vaccine autism causality.", "confounders_present": [ "Behavioral proxies, a wide toxic-dose range and sex dependence do not establish routine human vaccine autism causality." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 37, "pmid": "24235069", "title": "Effect of thimerosal on the neurodevelopment of premature rats.", "citation": "Chen YN, Wang J, Zhang J et al. Effect of thimerosal on the neurodevelopment of premature rats. World journal of pediatrics : WJP. 2013.", "doi": "10.1007/s12519-013-0443-z", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/24235069/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/24235069/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID24235069", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Premature rat single-dose thimerosal exposure alters learning/memory/apoptosis in selected dose groups.", "what_it_does_not_show": "Rat developmental timing, dose units and saline comparator do not isolate actual vaccine-regimen human autism risk.", "confounders_present": [ "Rat developmental timing, dose units and saline comparator do not isolate actual vaccine-regimen human autism risk." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 38, "pmid": "22811707", "title": "Thimerosal-Derived Ethylmercury Is a Mitochondrial Toxin in Human Astrocytes: Possible Role of Fenton Chemistry in the Oxidation and Breakage of mtDNA.", "citation": "Sharpe MA, Livingston AD, Baskin DS. Thimerosal-Derived Ethylmercury Is a Mitochondrial Toxin in Human Astrocytes: Possible Role of Fenton Chemistry in the Oxidation and Breakage of mtDNA. Journal of toxicology. 2012.", "doi": "10.1155/2012/373678", "pmcid": "PMC3395253", "url": "https://pubmed.ncbi.nlm.nih.gov/22811707/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/22811707/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID22811707", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:2. Methods:paragraph0, 1:2. Methods:paragraph10, 2:3. Results:paragraph0, 2:3. Results:paragraph3, 2:3. Results:paragraph12, 2:3. Results:paragraph13. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1" ], "favors_models": [], "evidence_class": "Moderate", "system": "in vitro", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Human astrocytes exposed to0–14.4micromolar thimerosal show ROS, membrane-potential and mitochondrial-DNA damage.", "what_it_does_not_show": "Direct cell exposure demonstrates toxicity at tested concentrations, not infant vaccine tissue kinetics or autism causality; no clinical endpoint.", "confounders_present": [ "Direct cell exposure demonstrates toxicity at tested concentrations, not infant vaccine tissue kinetics or autism causality; no clinical endpoint." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 39, "pmid": "26417083", "title": "Administration of thimerosal-containing vaccines to infant rhesus macaques does not result in autism-like behavior or neuropathology.", "citation": "Gadad BS, Li W, Yazdani U et al. Administration of thimerosal-containing vaccines to infant rhesus macaques does not result in autism-like behavior or neuropathology. Proceedings of the National Academy of Sciences of the United States of America. 2015.", "doi": "10.1073/pnas.1500968112", "pmcid": "PMC4603476", "url": "https://pubmed.ncbi.nlm.nih.gov/26417083/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/26417083/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "ErratumIn: PMID26621718" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID26417083", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC2" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Infant rhesus vaccine-schedule experiment finds no autism-like social or tested brain pathology differences.", "what_it_does_not_show": "Autism-proxy model is not human ASD; linked correction details were not examined and public body retrieval failed in this review.", "confounders_present": [ "Autism-proxy model is not human ASD; linked correction details were not examined and public body retrieval failed in this review." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Expanded macaque vaccine-schedule research program compared with earlier pilot; body/correction details not accessed." ] }, { "n": 40, "pmid": "20628439", "title": "Influence of pediatric vaccines on amygdala growth and opioid ligand binding in rhesus macaque infants: A pilot study.", "citation": "Hewitson L, Lopresti BJ, Stott C et al. Influence of pediatric vaccines on amygdala growth and opioid ligand binding in rhesus macaque infants: A pilot study. Acta neurobiologiae experimentalis. 2010.", "doi": "10.55782/ane-2010-1787", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/20628439/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/20628439/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID20628439", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC2" ], "favors_models": [], "evidence_class": "Moderate", "system": "animal model", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Small longitudinal macaque pilot reports amygdala maturation/opioid-imaging differences after a complete vaccine schedule.", "what_it_does_not_show": "Pilot imaging biomarkers do not isolate a component or show autism-like functional disease; later larger schedule tests differ.", "confounders_present": [ "Pilot imaging biomarkers do not isolate a component or show autism-like functional disease; later larger schedule tests differ." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 41, "pmid": "23545349", "title": "Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism.", "citation": "DeStefano F, Price CS, Weintraub ES. Increasing exposure to antibody-stimulating proteins and polysaccharides in vaccines is not associated with risk of autism. The Journal of pediatrics. 2013.", "doi": "10.1016/j.jpeds.2013.02.001", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/23545349/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/23545349/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "VSD_ASD256_CONTROL752", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC2", "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "contradicts", "what_it_shows": "Validated ASD case-control antigen-load analysis finds no risk increase with cumulative antibody-stimulating vaccine proteins/polysaccharides.", "what_it_does_not_show": "Same256cases/752 controls as the thimerosal studyPMID20837594; antigen counting is a dose proxy, not every immune-response property.", "confounders_present": [ "Same256cases/752 controls as the thimerosal studyPMID20837594; antigen counting is a dose proxy, not every immune-response property." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 42, "pmid": "19852789", "title": "Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results.", "citation": "Adams JB, Baral M, Geis E et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: Part A--medical results. BMC clinical pharmacology. 2009.", "doi": "10.1186/1472-6904-9-16", "pmcid": "PMC2774660", "url": "https://pubmed.ncbi.nlm.nih.gov/19852789/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/19852789/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "ADAMS_DMSA_PARENT", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Methods:paragraph0, 1:Methods:paragraph25, 1:Methods:paragraph26, 1:Methods:paragraph42, 1:Methods:paragraph43, 1:Methods:paragraph47, 1:Methods:paragraph51, 1:Methods:paragraph52, 1:Methods:paragraph53, 1:Methods:paragraph54, 1:Methods:paragraph55. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human interventional", "decisive_perturbation": false, "endogenous": true, "direction": "mixed", "what_it_shows": "DMSA study reports metal excretion/biomarker changes after all participants receive an active screening round, then additional-dose randomization.", "what_it_does_not_show": "One-versus-seven rounds lacks a never-treated control; provoked urine reference threshold is arbitrary, reported adverse dropouts occur and biomarkers do not establish vaccine-caused autism.", "confounders_present": [ "One-versus-seven rounds lacks a never-treated control; provoked urine reference threshold is arbitrary, reported adverse dropouts occur and biomarkers do not establish vaccine-caused autism." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 43, "pmid": "19852790", "title": "Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results.", "citation": "Adams JB, Baral M, Geis E et al. Safety and efficacy of oral DMSA therapy for children with autism spectrum disorders: part B - behavioral results. BMC clinical pharmacology. 2009.", "doi": "10.1186/1472-6904-9-17", "pmcid": "PMC2770991", "url": "https://pubmed.ncbi.nlm.nih.gov/19852790/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/19852790/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "ADAMS_DMSA_PARENT", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Methods:paragraph1, 1:Methods:paragraph3, 1:Methods:paragraph4, 1:Methods:paragraph5, 2:Results:paragraph14, 2:Results:paragraph20, 2:Results:paragraph26, 2:Results:paragraph28, 2:Results:paragraph30. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC1", "SC3" ], "favors_models": [], "evidence_class": "Moderate", "system": "human interventional", "decisive_perturbation": false, "endogenous": true, "direction": "mixed", "what_it_shows": "SameDMSA study has within-group symptom improvements in both arms without significant between-arm benefit on reported behavior comparisons.", "what_it_does_not_show": "All participants already receivedDMSA, post-dose enrichment and ratings/regressions prevent treatment-versus-untreated or mercury-autism causal inference.", "confounders_present": [ "All participants already receivedDMSA, post-dose enrichment and ratings/regressions prevent treatment-versus-untreated or mercury-autism causal inference." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 44, "pmid": "11135778", "title": "Individual and community risks of measles and pertussis associated with personal exemptions to immunization.", "citation": "Feikin DR, Lezotte DC, Hamman RF et al. Individual and community risks of measles and pertussis associated with personal exemptions to immunization. JAMA. 2000.", "doi": "10.1001/jama.284.24.3145", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/11135778/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/11135778/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID11135778", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": true, "endogenous": false, "direction": "supports", "what_it_shows": "Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "what_it_does_not_show": "Nonrandom refusal and social/contact clustering remain; actual community associations are distinguished from modeling and pathogen exposure is required.", "confounders_present": [ "Nonrandom refusal and social/contact clustering remain; actual community associations are distinguished from modeling and pathogen exposure is required." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 45, "pmid": "10404911", "title": "Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles.", "citation": "Salmon DA, Haber M, Gangarosa EJ et al. Health consequences of religious and philosophical exemptions from immunization laws: individual and societal risk of measles. JAMA. 1999.", "doi": "10.1001/jama.282.1.47", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/10404911/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/10404911/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID10404911", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "US exemption cohort finds higher measles risk, with a separate model exploring transmission to nonexempt persons.", "what_it_does_not_show": "Community model outputs are not observed rates; age/year/contact and refusal confounding limit standalone causal attribution, linked erratum details unexamined.", "confounders_present": [ "Community model outputs are not observed rates; age/year/contact and refusal confounding limit standalone causal attribution, linked erratum details unexamined." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 46, "pmid": "19482753", "title": "Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children.", "citation": "Glanz JM, McClure DL, Magid DJ et al. Parental refusal of pertussis vaccination is associated with an increased risk of pertussis infection in children. Pediatrics. 2009.", "doi": "10.1542/peds.2008-2150", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/19482753/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/19482753/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID19482753", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "what_it_does_not_show": "Shared health-plan/contact structure and nonrandom refusal remain; disease protection does not imply vaccination prevents every infection.", "confounders_present": [ "Shared health-plan/contact structure and nonrandom refusal remain; disease protection does not imply vaccination prevents every infection." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Colorado health-plan/contact/ascertainment framework shared with varicellaPMID20048244." ] }, { "n": 47, "pmid": "20048244", "title": "Parental refusal of varicella vaccination and the associated risk of varicella infection in children.", "citation": "Glanz JM, McClure DL, Magid DJ et al. Parental refusal of varicella vaccination and the associated risk of varicella infection in children. Archives of pediatrics & adolescent medicine. 2010.", "doi": "10.1001/archpediatrics.2009.244", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/20048244/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/20048244/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID20048244", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Matched Colorado analysis links varicella refusal with more medically attended infection.", "what_it_does_not_show": "Small refusal counts and shared health-plan infrastructure limit precision/independence; not a randomized avoidance policy.", "confounders_present": [ "Small refusal counts and shared health-plan infrastructure limit precision/independence; not a randomized avoidance policy." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 48, "pmid": "24019039", "title": "Association between undervaccination with diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine and risk of pertussis infection in children 3 to 36 months of age.", "citation": "Glanz JM, Narwaney KJ, Newcomer SR et al. Association between undervaccination with diphtheria, tetanus toxoids, and acellular pertussis (DTaP) vaccine and risk of pertussis infection in children 3 to 36 months of age. JAMA pediatrics. 2013.", "doi": "10.1001/jamapediatrics.2013.2353", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/24019039/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/24019039/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID24019039", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "what_it_does_not_show": "Under-vaccination combines delay/refusal/access barriers, with age/time/contact confounding despite matching.", "confounders_present": [ "Under-vaccination combines delay/refusal/access barriers, with age/time/contact confounding despite matching." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 49, "pmid": "24913790", "title": "An outbreak of measles in an undervaccinated community.", "citation": "Gahr P, DeVries AS, Wallace G et al. An outbreak of measles in an undervaccinated community. Pediatrics. 2014.", "doi": "10.1542/peds.2013-4260", "pmcid": "PMC8167837", "url": "https://pubmed.ncbi.nlm.nih.gov/24913790/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/24913790/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID24913790", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:METHODS:paragraph0, 0:METHODS:paragraph1, 0:METHODS:paragraph2, 0:METHODS:paragraph3, 0:METHODS:paragraph5, 0:METHODS:paragraph6, 0:METHODS:paragraph7. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Minnesota outbreak has confirmed infection, hospitalizations and an age-eligible safety-concern/refusal subgroup amid falling MMR coverage.", "what_it_does_not_show": "Descriptive outbreak has no randomized contact comparator; registry inclusion requires active vaccine records and not all unvaccinated cases were eligible.", "confounders_present": [ "Descriptive outbreak has no randomized contact comparator; registry inclusion requires active vaccine records and not all unvaccinated cases were eligible." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 50, "pmid": "27705270", "title": "A Measles Outbreak in an Underimmunized Amish Community in Ohio.", "citation": "Gastañaduy PA, Budd J, Fisher N et al. A Measles Outbreak in an Underimmunized Amish Community in Ohio. The New England journal of medicine. 2016.", "doi": "10.1056/NEJMoa1602295", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/27705270/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/27705270/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID27705270", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Imported measles spreads chiefly in low-coverage Amish households, with most cases unvaccinated and limited general-community spread.", "what_it_does_not_show": "Contact networks and combined isolation/quarantine/vaccination response prevent attributing every containment effect to one measure.", "confounders_present": [ "Contact networks and combined isolation/quarantine/vaccination response prevent attributing every containment effect to one measure." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 51, "pmid": "32160662", "title": "Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019.", "citation": "Zucker JR, Rosen JB, Iwamoto M et al. Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019. The New England journal of medicine. 2020.", "doi": "10.1056/NEJMoa1912514", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/32160662/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/32160662/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID32160662", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "NYC2018–19outbreak records649cases with pneumonia, hospitalization/ICU and mostly unvaccinated cases of known status.", "what_it_does_not_show": "Importation/contact clustering and combined response measures constrain effect estimation; communities are epidemiologic settings, not intrinsic biological causes.", "confounders_present": [ "Importation/contact clustering and combined response measures constrain effect estimation; communities are epidemiologic settings, not intrinsic biological causes." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 52, "pmid": "28704350", "title": "Measles Outbreak - Minnesota April-May 2017.", "citation": "Hall V, Banerjee E, Kenyon C et al. Measles Outbreak - Minnesota April-May 2017. MMWR. Morbidity and mortality weekly report. 2017.", "doi": "10.15585/mmwr.mm6627a1", "pmcid": "PMC5687591", "url": "https://pubmed.ncbi.nlm.nih.gov/28704350/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/28704350/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID28704350", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Moderate", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "Minnesota2017laboratory-confirmed outbreak starts in unvaccinated children and expands through low-coverage networks.", "what_it_does_not_show": "Early ongoing-outbreak count is not final incidence, and contact exposure/eligibility differ.", "confounders_present": [ "Early ongoing-outbreak count is not final incidence, and contact exposure/eligibility differ." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 53, "pmid": "30073293", "title": "Public Health Consequences of a 2013 Measles Outbreak in New York City.", "citation": "Rosen JB, Arciuolo RJ, Khawja AM et al. Public Health Consequences of a 2013 Measles Outbreak in New York City. JAMA pediatrics. 2018.", "doi": "10.1001/jamapediatrics.2018.1024", "pmcid": "PMC6143061", "url": "https://pubmed.ncbi.nlm.nih.gov/30073293/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/30073293/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID30073293", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "supports", "what_it_shows": "NYC2013measles investigation records largely age-eligible refusal/delay cases and substantial healthcare/public-health exposure burden.", "what_it_does_not_show": "Resource accounting/descriptive source cannot alone isolate vaccine effectiveness or population-wide lifetime net health.", "confounders_present": [ "Resource accounting/descriptive source cannot alone isolate vaccine effectiveness or population-wide lifetime net health." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 54, "pmid": "8538705", "title": "A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine.", "citation": "Gustafsson L, Hallander HO, Olin P et al. A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine. The New England journal of medicine. 1996.", "doi": "10.1056/NEJM199602083340602", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/8538705/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/8538705/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID8538705", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human interventional", "decisive_perturbation": true, "endogenous": true, "direction": "supports", "what_it_shows": "Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "what_it_does_not_show": "Controlled antigen prevention is not zero-risk or protection from every pathogen; whole-cell and acellular results differ and linked erratum details unexamined.", "confounders_present": [ "Controlled antigen prevention is not zero-risk or protection from every pathogen; whole-cell and acellular results differ and linked erratum details unexamined." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 55, "pmid": "9682390", "title": "Persistence of protection through 33 months of age provided by immunization in infancy with two three-component acellular pertussis vaccines. Stage II Working Group.", "citation": "Salmaso S, Mastrantonio P, Wassilak SG et al. Persistence of protection through 33 months of age provided by immunization in infancy with two three-component acellular pertussis vaccines. Stage II Working Group. Vaccine. 1998.", "doi": "10.1016/s0264-410x(98)00040-1", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/9682390/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/9682390/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "ITALIAN_PERTUSSIS_EFFICACY_PARENT", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human interventional", "decisive_perturbation": false, "endogenous": true, "direction": "supports", "what_it_shows": "Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "what_it_does_not_show": "Original trial follow-up is one study; control allocation becomes partly unblinded and pertussis protection is time/product specific.", "confounders_present": [ "Original trial follow-up is one study; control allocation becomes partly unblinded and pertussis protection is time/product specific." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 56, "pmid": "34435933", "title": "A randomized trial assessing the efficacy, immunogenicity, and safety of vaccination with live attenuated varicella zoster virus-containing vaccines: ten-year follow-up in Russian children.", "citation": "Namazova-Baranova L, Habib MA, Povey M et al. A randomized trial assessing the efficacy, immunogenicity, and safety of vaccination with live attenuated varicella zoster virus-containing vaccines: ten-year follow-up in Russian children. Human vaccines & immunotherapeutics. 2022.", "doi": "10.1080/21645515.2021.1959148", "pmcid": "PMC9067519", "url": "https://pubmed.ncbi.nlm.nih.gov/34435933/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/34435933/", "tier": "A", "source_tier": "A", "kind": "rct", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "VARICELLA_NCT00226499_PARENT", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3", "SC4" ], "favors_models": [], "evidence_class": "Strong", "system": "human interventional", "decisive_perturbation": true, "endogenous": true, "direction": "supports", "what_it_shows": "Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit.", "what_it_does_not_show": "Russian subset is part of one internationalNCT00226499trial, not an independent efficacy trial; no single cohort establishes all-vaccine safety.", "confounders_present": [ "Russian subset is part of one internationalNCT00226499trial, not an independent efficacy trial; no single cohort establishes all-vaccine safety." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [] }, { "n": 57, "pmid": "26452420", "title": "Risk of anaphylaxis after vaccination in children and adults.", "citation": "McNeil MM, Weintraub ES, Duffy J et al. Risk of anaphylaxis after vaccination in children and adults. The Journal of allergy and clinical immunology. 2016.", "doi": "10.1016/j.jaci.2015.07.048", "pmcid": "PMC4783279", "url": "https://pubmed.ncbi.nlm.nih.gov/26452420/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/26452420/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID26452420", "access_depth": "full_text_partial", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:METHODS:paragraph3, 0:METHODS:paragraph4, 0:METHODS:paragraph6. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Chart-adjudicated vaccine-triggered anaphylaxis occurs at 1.31 per million doses across children/adults in VSD.", "what_it_does_not_show": "A recognized rare adverse event is not autism or proof every vaccine/recipient has the same risk; doses differ from individuals.", "confounders_present": [ "A recognized rare adverse event is not autism or proof every vaccine/recipient has the same risk; doses differ from individuals." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 58, "pmid": "12534647", "title": "MMR vaccine and idiopathic thrombocytopaenic purpura.", "citation": "Black C, Kaye JA, Jick H. MMR vaccine and idiopathic thrombocytopaenic purpura. British journal of clinical pharmacology. 2003.", "doi": "10.1046/j.1365-2125.2003.01790.x", "pmcid": "PMC1884189", "url": "https://pubmed.ncbi.nlm.nih.gov/12534647/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/12534647/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12534647", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "MMR exposure is associated with a short-window excess of childhoodITPwith a low estimated attributable risk.", "what_it_does_not_show": "Small event counts/broad interval, nonrandom exposure and clinical context remain; no inference to autism.", "confounders_present": [ "Small event counts/broad interval, nonrandom exposure and clinical context remain; no inference to autism." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 59, "pmid": "20587679", "title": "Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures.", "citation": "Klein NP, Fireman B, Yih WK et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010.", "doi": "10.1542/peds.2010-0665", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/20587679/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/20587679/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID20587679", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": true, "endogenous": false, "direction": "mixed", "what_it_shows": "First-dose MMRV has about twice the 7–10 day febrile-seizure risk compared with separate MMR plus varicella in 12–23 month-olds.", "what_it_does_not_show": "Formulation/age-window adverse effect is not autism or a reason to generalize all vaccination avoidance; partially overlappingVSDfollow-ups count as shared components.", "confounders_present": [ "Formulation/age-window adverse effect is not autism or a reason to generalize all vaccination avoidance; partially overlappingVSDfollow-ups count as shared components." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "Pivotal test, including null or negative results and restricted contexts; this flag is not a positive threshold crossing.", "shared_components": [ "VSD measles-vaccine safety population/time partly overlaps expandedPMID25560438." ] }, { "n": 60, "pmid": "22473362", "title": "Measles-containing vaccines and febrile seizures in children age 4 to 6 years.", "citation": "Klein NP, Lewis E, Baxter R et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics. 2012.", "doi": "10.1542/peds.2011-3198", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/22473362/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/22473362/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID22473362", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "null", "what_it_shows": "At4–6 years,MMRV and separate MMR plus varicella show rare seizures without a7–10 daypeak.", "what_it_does_not_show": "Age/dose-specific null does not erase the younger first-dose risk and finite precision does not prove zero.", "confounders_present": [ "Age/dose-specific null does not erase the younger first-dose risk and finite precision does not prove zero." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [] }, { "n": 61, "pmid": "25560438", "title": "Safety of measles-containing vaccines in 1-year-old children.", "citation": "Klein NP, Lewis E, Fireman B et al. Safety of measles-containing vaccines in 1-year-old children. Pediatrics. 2015.", "doi": "10.1542/peds.2014-1822", "pmcid": "", "url": "https://pubmed.ncbi.nlm.nih.gov/25560438/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/25560438/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID25560438", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "mixed", "what_it_shows": "Large VSD analysis confirms seizure/fever andITPboundaries while other specified events are uncommon or indistinguishable across formulations.", "what_it_does_not_show": "Some outcomes have few/zero events; sharedVSDpopulation and expandedperiod are not entirely independent safety replication.", "confounders_present": [ "Some outcomes have few/zero events; sharedVSDpopulation and expandedperiod are not entirely independent safety replication." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "Expanded VSD measles-vaccine safety period shares sites and likely some recipients withPMID20587679/22473362." ] }, { "n": 62, "pmid": "35315325", "title": "Safety of measles and pertussis-containing vaccines in children with autism spectrum disorders.", "citation": "Zerbo O, Modaressi S, Goddard K et al. Safety of measles and pertussis-containing vaccines in children with autism spectrum disorders. Vaccine. 2022.", "doi": "10.1016/j.vaccine.2022.03.031", "pmcid": "PMC10987202", "url": "https://pubmed.ncbi.nlm.nih.gov/35315325/", "source_pointer": "https://pubmed.ncbi.nlm.nih.gov/35315325/", "tier": "A", "source_tier": "A", "kind": "primary", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID35315325", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "relates_to_subclaims": [ "SC3" ], "favors_models": [], "evidence_class": "Strong", "system": "human observational", "decisive_perturbation": false, "endogenous": false, "direction": "null", "what_it_shows": "VSD self-controlled analyses find no increased fever/EDresponse difference after measles/pertussis vaccines in diagnosedASD children aged4–7 years.", "what_it_does_not_show": "Postdiagnosis safety is not autism etiology; rarefebrileseizures and eligible-selection limit generalization.", "confounders_present": [ "Postdiagnosis safety is not autism etiology; rarefebrileseizures and eligible-selection limit generalization." ], "verification": "verified", "verification_note": "Bounded source attribution; not proof of the nominal mechanism.", "citation_context": { "retrieved": false, "supporting_count": 0, "mentioning_count": 0, "contrasting_count": 0, "notable_contrasting_statements": [] }, "discriminating_contrast": true, "decisive_test_note": "", "shared_components": [ "VSD site/clinical ascertainment infrastructure overlaps other safety/exposure studies; different ASD-stratified question." ] } ], "verification_summary": { "load_bearing_claims_checked": 67, "verified": 67, "unverified": 0, "contradicted": 0, "note": "Verified attribution is distinct from mechanism truth or complete body access." }, "factual_issues_found": [], "cap_rules_applied": [ { "subclaim_id": "SC1", "cap": "Α", "cap_source": "rubric", "triggered": true, "trigger_text_quoted": "Use for claims sustained by phenomenological narrative, metaphor, anecdote, or self-selected user surveys.", "specific_trigger": "The examined set does not establish a reproducible positive human vaccine-ethylmercury/ASD association. Cell and selected rodent experiments demonstrate restricted toxicity, but neither their endpoints nor dose/kinetic transport establish vaccine-dose human autism. Positive ecological, passive-report and referred-case associations fail to reproduce in better individual-dose, matched-formulation and validated diagnostic comparisons. Thus the registered clinical etiologic claim is Α, while real restricted toxicology is retained separately; a Β ceiling is not treated as an earned associational rung.", "resulting_ceiling": "Α" }, { "subclaim_id": "SC2", "cap": "Α", "cap_source": "rubric", "triggered": true, "trigger_text_quoted": "Use for claims sustained by phenomenological narrative, metaphor, anecdote, or self-selected user surveys.", "specific_trigger": "No credible reproducible positive MMR/ASD association is established in the examined original set. Anecdotal timing, postdiagnosis antibodies and a later school-entry association do not survive stronger age, exposure, onset, familial-risk and withdrawal comparisons. The registered etiologic claim is therefore Α. This does not assert that every conceivable rare vaccine adverse event is impossible or that ASD itself is speculative.", "resulting_ceiling": "Α" }, { "subclaim_id": "SC3", "cap": "Α", "cap_source": "rubric", "triggered": true, "trigger_text_quoted": "Use for claims sustained by phenomenological narrative, metaphor, anecdote, or self-selected user surveys.", "specific_trigger": "No examined original clinical study demonstrates that avoiding routine childhood vaccination prevents autism and improves overall health among eligible children. The claim remains narrative/unsupported at Α. Negative autism exposure tests do not earn a positive causal crossing; separate infection-prevention and refusal-outbreak evidence opposes the proposed net benefit. This level was derived from the source comparison rather than assigned because the topic is historically disputed.", "resulting_ceiling": "Α" } ], "cap_precedence_resolutions": [ { "collision": "Perturbation in a defined setting versus broader inference", "subclaim_scope_cap_binds_on": "Avoiding routine childhood vaccination prevents autism and produces a better overall health outcome in children eligible for routine immunization.", "subclaim_scope_threshold_binds_on": "The precise experimentally tested subclaim scope", "resolution": "Cell toxicology can demonstrate real toxicity without establishing vaccine-dose human autism; those offered inferences remain scoped. Individual formulation/dose contrasts and natural withdrawals are valid etiologic tests under the declared developmental adaptation, but negative results do not grant a positive causal crossing. SC4's randomized infection-incidence prevention is a functional clinical endpoint, not a cytokine biomarker; it is assessed together with independent refusal/exposure/outbreak classes and is not re-capped from its observational leg. Rare vaccine-specific harms are retained and do not imply autism causality or a universal net benefit of avoidance.", "note": "Convergent lines are assessed as a set; one weak leg is not re-capped over the assembled case." } ], "boundary_check_BGD": [ { "subclaim_id": "SC1", "field_valid_perturbation_quote": "at least one of:\n- Active comparator matched for acute subjective effect, blinding integrity measured and reported\n- Blinded on/off, staggered-onset, or randomized-withdrawal neuromodulation, reversible and within-subject\n- Mediator manipulation with the intervention intact: antagonist blockade of the acute experience with the drug still given, or dosing under general anaesthesia\n- Depletion or challenge experiment in humans whose outcome is symptom trajectory, not a biomarker\n- Psychotherapy component dismantling, or scaffold removal from a drug arm, with blinded assessors\n\nRating-scale or biomarker change alone does NOT satisfy this threshold when the claim is functional, and statistical mediation alone never satisfies it.", "qualifying_evidence_present": "no", "qualifying_evidence_citation": "", "gamma_hard_rules_triggered": [ "Correlational human exposure and cell/rodent toxicity are insufficient to establish vaccine-dose human ASD causality." ], "disease_phenotype_relevance": "yes", "perturbation_result_positive": "no", "perturbation_result_note": "The examined set does not establish a reproducible positive human vaccine-ethylmercury/ASD association. Cell and selected rodent experiments demonstrate restricted toxicity, but neither their endpoints nor dose/kinetic transport establish vaccine-dose human autism. Positive ecological, passive-report and referred-case associations fail to reproduce in better individual-dose, matched-formulation and validated diagnostic comparisons. Thus the registered clinical etiologic claim is Α, while real restricted toxicology is retained separately; a Β ceiling is not treated as an earned associational rung.", "ceiling_from_boundary_check": "Γ" }, { "subclaim_id": "SC2", "field_valid_perturbation_quote": "at least one of:\n- Active comparator matched for acute subjective effect, blinding integrity measured and reported\n- Blinded on/off, staggered-onset, or randomized-withdrawal neuromodulation, reversible and within-subject\n- Mediator manipulation with the intervention intact: antagonist blockade of the acute experience with the drug still given, or dosing under general anaesthesia\n- Depletion or challenge experiment in humans whose outcome is symptom trajectory, not a biomarker\n- Psychotherapy component dismantling, or scaffold removal from a drug arm, with blinded assessors\n\nRating-scale or biomarker change alone does NOT satisfy this threshold when the claim is functional, and statistical mediation alone never satisfies it.", "qualifying_evidence_present": "no", "qualifying_evidence_citation": "", "gamma_hard_rules_triggered": [ "Immune-marker or temporal association is not selective clinical etiologic perturbation." ], "disease_phenotype_relevance": "yes", "perturbation_result_positive": "no", "perturbation_result_note": "No credible reproducible positive MMR/ASD association is established in the examined original set. Anecdotal timing, postdiagnosis antibodies and a later school-entry association do not survive stronger age, exposure, onset, familial-risk and withdrawal comparisons. The registered etiologic claim is therefore Α. This does not assert that every conceivable rare vaccine adverse event is impossible or that ASD itself is speculative.", "ceiling_from_boundary_check": "Γ" }, { "subclaim_id": "SC3", "field_valid_perturbation_quote": "at least one of:\n- Active comparator matched for acute subjective effect, blinding integrity measured and reported\n- Blinded on/off, staggered-onset, or randomized-withdrawal neuromodulation, reversible and within-subject\n- Mediator manipulation with the intervention intact: antagonist blockade of the acute experience with the drug still given, or dosing under general anaesthesia\n- Depletion or challenge experiment in humans whose outcome is symptom trajectory, not a biomarker\n- Psychotherapy component dismantling, or scaffold removal from a drug arm, with blinded assessors\n\nRating-scale or biomarker change alone does NOT satisfy this threshold when the claim is functional, and statistical mediation alone never satisfies it.", "qualifying_evidence_present": "no", "qualifying_evidence_citation": "", "gamma_hard_rules_triggered": [ "No positive clinical autism-prevention and net-health crossing verified; positive narrative or anecdotes do not satisfy the adapted boundary." ], "disease_phenotype_relevance": "yes", "perturbation_result_positive": "no", "perturbation_result_note": "No examined original clinical study demonstrates that avoiding routine childhood vaccination prevents autism and improves overall health among eligible children. The claim remains narrative/unsupported at Α. Negative autism exposure tests do not earn a positive causal crossing; separate infection-prevention and refusal-outbreak evidence opposes the proposed net benefit. This level was derived from the source comparison rather than assigned because the topic is historically disputed.", "ceiling_from_boundary_check": "Γ" }, { "subclaim_id": "SC4", "field_valid_perturbation_quote": "\n- Cell-type-specific conditional knockout or depletion\n- Pathway-specific blockade (not broad immunosuppression) changing disease course\n- Human targeted therapy with mechanistic alignment showing disease-modifying effect", "qualifying_evidence_present": "yes", "qualifying_evidence_citation": "PMID11135778, PMID19482753, PMID20048244, PMID24019039, PMID8538705, PMID9682390, PMID34435933", "gamma_hard_rules_triggered": [ "No Γ hard-rule trigger on the assembled clinical incidence/prevention set; toxin-cell and biomarker studies do not carry this positive subclaim." ], "disease_phenotype_relevance": "yes", "perturbation_result_positive": "yes", "perturbation_result_note": "Vaccine avoidance removes demonstrated pathogen-specific protection and increases infection susceptibility where exposure occurs. Randomized pertussis-component versus matched DT-control and varicella-antigen versus MMR-control trials establish clinical prevention; refusal/exemption studies, missing-dose gradients and laboratory-confirmed outbreaks connect loss of protection to individual and community risk. These classes address different failure modes and converge at Η for the specified infection-risk claim. They do not mean every unvaccinated child becomes infected, vaccines prevent every case, or every formulation/recipient has zero adverse-event risk.", "ceiling_from_boundary_check": "Δ or higher" } ], "thresholds_tested": [ { "subclaim_id": "SC1", "threshold": "Δ", "requirement_quoted": "Requires a controlled human interventional study with a credible active comparator, or a mediator manipulation in humans, with a pre-registered primary outcome.", "satisfied": "no", "supporting_evidence": [], "what_would_cross_it": "A clinically relevant dose/formulation effect on independently validated incident ASD must survive calendar/healthcare-use and diagnostic-latency control, dose prediction, replication and selective exposure comparisons. It cannot be rescued by defining susceptible responders after diagnosis." }, { "subclaim_id": "SC2", "threshold": "Δ", "requirement_quoted": "Requires a controlled human interventional study with a credible active comparator, or a mediator manipulation in humans, with a pre-registered primary outcome.", "satisfied": "no", "supporting_evidence": [], "what_would_cross_it": "A prespecified MMR effect on incident ASD or regression must reproduce under valid age/time-at-risk, ascertainment and baseline familial-risk controls, with exposure-before-outcome evidence and independent validation." }, { "subclaim_id": "SC3", "threshold": "Δ", "requirement_quoted": "Requires a controlled human interventional study with a credible active comparator, or a mediator manipulation in humans, with a pre-registered primary outcome.", "satisfied": "no", "supporting_evidence": [], "what_would_cross_it": "Pre-register target-trial emulation of existing natural vaccination/formulation variation, validate timing and diagnosis, measure linked infection and adverse-event outcomes, and compare absolute net health over specified horizons. No trial deliberately withholding standard childhood immunization is proposed." }, { "subclaim_id": "SC4", "threshold": "Δ", "requirement_quoted": "Requires pathway- or cell-type-resolved causal perturbation affecting disease or phenotype.", "satisfied": "yes", "supporting_evidence": [ "[44] Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "[46] Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "[47] Matched Colorado analysis links varicella refusal with more medically attended infection.", "[48] VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "[54] Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "[55] Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "[56] Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit." ], "what_would_cross_it": "" }, { "subclaim_id": "SC4", "threshold": "Ε", "requirement_quoted": "Requires context-specific causality with explicit scope restriction.", "satisfied": "yes", "supporting_evidence": [ "[44] Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "[46] Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "[47] Matched Colorado analysis links varicella refusal with more medically attended infection.", "[48] VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "[54] Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "[55] Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "[56] Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit." ], "what_would_cross_it": "" }, { "subclaim_id": "SC4", "threshold": "Ζ", "requirement_quoted": "Requires multiple convergent causal manipulations and reduced plausibility of downstream-only interpretations.", "satisfied": "yes", "supporting_evidence": [ "[44] Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "[46] Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "[47] Matched Colorado analysis links varicella refusal with more medically attended infection.", "[48] VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "[54] Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "[55] Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "[56] Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit." ], "what_would_cross_it": "" }, { "subclaim_id": "SC4", "threshold": "Η", "requirement_quoted": "Requires robust upstream causal evidence across systems and interventions.", "satisfied": "yes", "supporting_evidence": [ "[44] Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "[46] Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "[47] Matched Colorado analysis links varicella refusal with more medically attended infection.", "[48] VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "[54] Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "[55] Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "[56] Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit." ], "what_would_cross_it": "" }, { "subclaim_id": "SC4", "threshold": "Θ", "requirement_quoted": "Requires predictive consistency and minimal contradiction in the claimed disease scope.", "satisfied": "no", "supporting_evidence": [ "[44] Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations.", "[46] Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection.", "[47] Matched Colorado analysis links varicella refusal with more medically attended infection.", "[48] VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations.", "[54] Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity.", "[55] Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy.", "[56] Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit." ], "what_would_cross_it": "For Θ, predict absolute individual/community risk prospectively across independently defined vaccines, exposure networks, ages and horizons with minimal unresolved exceptions. For Ω, establish necessity and sufficiency of the claimed immune mechanism within scope; prevention is not absolute infection immunity." } ], "generalization_check": { "generalization_tested": "yes", "context_boundary_mapped": "yes", "internal_negative_controls": [ "Same-vaccine thimerosal versus preservative-free formulation and dose slope are null for ASD (PMID 14519711).", "MMR familial-risk and timing strata show no consistent increased ASD risk; precision is stated rather than zero-risk language (PMID 30831578, PMID 25898051).", "2026 MMR age-landmark and pneumococcal negative-control estimates are near-null (PMID 42520244).", "MMR withdrawal and thimerosal phaseout do not produce the predicted falling population ASD trend, with ascertainment caveats retained (PMID 15877763, PMID 16818529, PMID 18180424).", "Thimerosal challenge toxicity varies across mouse strains and rat doses/sexes; infant primate schedule tests are null for measured ASD-like endpoints (PMID 15184908, PMID 21549155, PMID 26417083).", "Randomized DT-only and MMR-only controls separate pertussis/varicella antigen prevention from general vaccine contact (PMID 8538705, PMID 34435933).", "Younger first-dose MMRV seizure risk differs from older second-dose findings; no all-age or all-formulation extrapolation (PMID 20587679, PMID 22473362)." ], "note": "Baseline eligibility, clinical contraindications, age, formulation, dose, familial risk, exposure opportunity and follow-up horizon are determined before outcomes. Autism subgroups are not defined afterward as vaccine responders. The diagnosis is distinct from tics, cognitive test scores, cell ROS and primate imaging. Breakthrough infection, waning protection and rare adverse reactions remain within analysis; known contraindications are outside the registered eligible population rather than excluded after harm." }, "falsification_patterns_met": [ { "pattern": "Predicted dose/formulation and withdrawal signatures fail in stronger clinical exposure tests", "evidence": "Same-vaccine ethylmercury dose/formulation, MMR temporal/familial-risk tests and withdrawal do not reproduce the main autism prediction. These contradict the nominal positive association; null designs do not earn a positive causal crossing.", "downgrade_applied": false }, { "pattern": "Net-health improvement claim conflicts with demonstrated loss of pathogen protection", "evidence": "Randomized pathogen-specific prevention plus refusal/outbreak clinical consequences oppose the proposed routine-avoidance benefit. SC3 is alreadyΑfrom lack of positive clinical support; no below-ladder downgrade is possible.", "downgrade_applied": false } ], "pitfalls_flagged": [ { "pitfall": "Ethylmercury, methylmercury and MMR conflated", "where": "Compound, formulation, route and dose are different and must be observed." }, { "pitfall": "Passive reports or service counts become incidence", "where": "VAERS and DDS measure reporting/active clients with calendar and latency effects." }, { "pitfall": "Negative control eliminates every bias", "where": "Its interpretation depends on shared confounding pathways and exposure measurement." }, { "pitfall": "General toxicity or biomarker becomes clinical autism", "where": "Cell ROS, monkey imaging, rodent behavior and human tics are distinct outcomes." }, { "pitfall": "Within-group chelation improvement becomes placebo efficacy", "where": "Both DMSA arms received initial active treatment, and post-dose enrichment changes the sample." }, { "pitfall": "All-vaccine zero-risk rhetoric", "where": "Specific anaphylaxis, ITP and age/formulation seizure signals are retained." } ], "causal_tally_audit": { "tally_claimed_by_document": 7, "tally_after_audit": 7, "tally_unit": "Positive qualifying study units across scoped subclaims, not independent causal lines or full-claim necessity/sufficiency.", "screened_discriminating_contrasts": 51, "items_rejected": [ "Null and negative contrasts are discriminators, not positive threshold crossings. Reports and replications are not independent causal lines.", "Reports sharing participants, models or instruments are not independent causal lines.", "Pivotal nulls do not earn positive threshold crossings." ] }, "steelman": { "case_one_rung_higher": "One rung above the overall answer, Β: positive passive-report/cohort aggregate associations, susceptible-strain neurotoxicity, rare real vaccine adverse effects and vulnerable developmental timing make safety scrutiny reasonable. Yet the registered clinical avoidance-benefit claim lacks a credible reproducible positive association: reporting proportions, referred historical controls and postdiagnosis markers do not demonstrate autism prevention or net health improvement. Restricted toxicity is real evidence for a different system/scope rather than positive credit for this clinical proposition.", "case_one_rung_lower": "Α is the lowest HSEF rung, so no lower letter exists. A stronger dismissal would claim absolute zero biological risk or no value in further safety surveillance; that is rejected because recognized specific adverse events and finite precision are documented. The low nominal benefit score must coexist with positive infection-prevention causality and honest safety boundaries.", "which_rejected": "Retain overall Α for the unsupported avoidance-benefit claim, without converting that into an all-vaccine-zero-risk assertion. Report Η for the separately stated infection-risk consequence and preserve the strongest toxicity/positive-association evidence within its actual system and limitations.", "blocking_cap_threshold_or_missing_experiment": "Missing experiment: Pre-register a target-trial emulation of existing naturally varying vaccine timing or historical matched formulations without withholding recommended vaccination. Define eligibility and familial risk before outcomes, validate exposure and incident diagnosis, use correct time-at-risk and age landmarks, measure healthcare contact and independent negative controls, and link confirmed infection, serious morbidity and specific adverse events over a stated horizon. Independently replicate absolute net outcomes and proposed dose predictions; no responder-only or postdiagnosis susceptibility scope." }, "final_score": { "hsef_level": "Α", "hsef_descriptor": "Speculative / narrative", "confidence": "High", "confidence_rationale": "62 primary reports with 7 selected partial-body examinations; evidence density, replication across independent designs and heterogeneous controls set the confidence, not correctness and not reviewer access depth.", "rests_on_non_peer_reviewed_work": false, "rationale": "Overall Α follows preregistered primary SC3: avoiding eligible routine vaccination has no verified autism-prevention/net-health benefit in the examined originals. SC1 and SC2 are also Α because the set establishes no credible reproducible positive clinical vaccine-ASD association; restricted toxicity findings are retained without importing their inference into human ASD. Separate SC4 reaches Η through randomized antigen-specific prevention plus independently structured exposure/refusal/outbreak evidence. The harm score does not itself assign the nominal benefit score." }, "role_of_mechanism": { "classification": "epiphenomenon", "derivation_step_matched": 2, "derivation": "For the nominal vaccine-to-autism-to-beneficial-avoidance mechanism, no demonstrated clinical causal dependency in either direction is established; temporal coincidence and weak associations do not supply it. Step2 therefore gives epiphenomenon for this nominal relationship, not for autism itself or vaccination generally. The separate SC4 consequence is causally supported: avoiding immunization removes a protective susceptibility barrier while pathogen exposure initiates infection. It does not imply avoidance alone is necessary or sufficient for infection or that vaccines are merely epiphenomenal.", "tournament_used_as_tiebreaker": false, "note": "Derived from causal direction, not tournament rank." }, "extended_scoring_MSD": { "momentum": { "value": "Associational only", "artifact": "The 2026 Cosmos age-landmark/negative-control study(PMID 42520244) supplies refined observational safety output. Historical dose/formulation and animal experiments are examined, but no verified new positive native clinical avoidance-for-autism benefit experiment is underway in this bounded set. Ongoing vaccine safety and infection prevention are separate active programs.", "justification": "The 2026 Cosmos age-landmark/negative-control study(PMID 42520244) supplies refined observational safety output. Historical dose/formulation and animal experiments are examined, but no verified new positive native clinical avoidance-for-autism benefit experiment is underway in this bounded set. Ongoing vaccine safety and infection prevention are separate active programs." }, "stability": { "value": "Stable", "trigger": "No verified named pending result was identified that would establish the nominal avoidance-benefit claim. A replicated baseline-defined exposure effect with validated diagnosis and absolute net clinical outcomes could change it; additional safety surveillance can refine vaccine-specific risks without establishing autism causality.", "justification": "No verified named pending result was identified that would establish the nominal avoidance-benefit claim. A replicated baseline-defined exposure effect with validated diagnosis and absolute net clinical outcomes could change it; additional safety surveillance can refine vaccine-specific risks without establishing autism causality." }, "divergence": { "implied_level": null, "implied_level_basis": "No single field-implied level is defensible from conflicting framings.", "assessed_level": "Α", "gap_in_rungs": null, "value": "Contested", "justification": "No manufactured field consensus or arithmetic gap." }, "calibration_note": "M/S/D never modify HSEF level or confidence." }, "change_record": { "applies": false, "prior_level": "none assigned", "prior_confidence": null, "prior_source": null, "derived_before_consulting_prior": true, "new_level": "Α", "direction": "newly assigned", "what_moved_it": "Fresh primary evidence appraisal; not blinded.", "divergence_from_other_reviewers": null }, "proposed_decisive_experiments": [ { "name": "Registered boundary experiment", "experiment": "Pre-register a target-trial emulation of existing naturally varying vaccine timing or historical matched formulations without withholding recommended vaccination. Define eligibility and familial risk before outcomes, validate exposure and incident diagnosis, use correct time-at-risk and age landmarks, measure healthcare contact and independent negative controls, and link confirmed infection, serious morbidity and specific adverse events over a stated horizon. Independently replicate absolute net outcomes and proposed dose predictions; no responder-only or postdiagnosis susceptibility scope.", "readout": "Validated incident ASD and absolute pathogen-specific morbidity/serious adverse-event outcomes in an eligible population over prespecified follow-up", "critical_control": "Matched formulation/age/exposure opportunity, time-varying confounding, healthcare-use and diagnostic-latency validation, familial risk, calendar/cohort changes, independent outcome ascertainment, genuine contraindications defined before outcomes", "supporting_result": "An independently replicated dose/formulation effect predicts incident ASD before concerns arise, and avoidance's absolute benefits exceed the lost infection protection and measured harms within a prespecified eligible context", "falsifying_result": "Adequate clinical exposure contrasts remain null for ASD or inferred associations track contact/reporting/calendar rather than dose; avoidance produces infection harm without replicated autism prevention" } ], "knowledge_gaps": [ { "name": "Gap 1", "statement": "Historical ethylmercury, environmental methylmercury and MMR are different exposures; actual formulation/dose/route must be recorded.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 2", "statement": "A near-null negative control limits specified bias pathways but cannot eliminate all residual confounding.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 3", "statement": "Risk of very rare baseline-defined effects is bounded by precision; no responder-defined subgroup can rescue a failed broad prediction.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 4", "statement": "General neuropsychological tests, tics, biomarkers and animal proxies are not incident clinical autism.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 5", "statement": "Absolute net-health outcomes require linked infection, adverse-event and diagnostic follow-up rather than one favorable marker or passive-report trend.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 6", "statement": "Shared registry/VSD/clinic/trial reports require study grouping and distinct error-mode assessment.", "relevance": "Limits mechanism identification or scope." }, { "name": "Gap 7", "statement": "Safety surveillance should preserve known formulation/age-specific adverse events and baseline clinical contraindications.", "relevance": "Limits mechanism identification or scope." } ], "review_metadata": { "review_date": "2026-10-12", "reviewer": "Codex", "evidence_base_note": "62 primary reports; literature cutoff 2026-10-12; source examination UTC date 2026-10-12; bounded critical review, not exhaustive systematic review.", "literature_tools_available": true, "literature_tools_note": "Life Sciences Literature PubMed/Entrez, separately logged public original-body retrieval, and Consensus Pro browser searches. Provider output retained as observed browser text with citation-link mappings, or as previously exported connector documents where present. AI synthesis is not primary full-text verification. Consensus retrieved/included counts are not examined-primary counts. Scite monthly limit was reached earlier in this session; no new Scite query or incoming citation-context audit is claimed for these cases. Tool receipts record actual use. Supplementary discovery outputs do not earn primary-count credit. No independent blinded review.", "skill_version": "5.3", "validator_run": "PASS: exact archived HSEF v5.3 validator rerun after final sealing.", "validator_warnings_addressed": "No warnings.", "limits": "Bounded source-based critical review; no complete-paper/supplement audit, independent scientific peer review or blinded calibration. Revision cases retain original prose outside the three framework output blocks and have explicit correction logs." }, "is_calibration_entry": { "value": false, "entry_role": "not_calibration", "blind_graded": null, "completed_blinded_calibration": false, "expected_band_sealed_at": "", "target_sha256": "", "target_authorship": "not applicable", "target_author_saw_review": null, "future_run_status": "not prepared", "unblinded_reason": "The cases were selected because the user asked for historically promoted claims challenged by evidence. This selection context was visible; no blind calibration is claimed and no negative score was preregistered." }, "upper_ladder_check": { "final_level_below_zeta": true, "equivalents_considered": [ { "kind": "mendelian_randomization", "available": false, "why_not_sufficient": "Same-vaccine formulation changes, naturally discontinued exposures, randomized infant dose assignments, age-landmark/negative-control studies and large validated clinical cohorts were considered for the autism/benefit subclaims. None supplies a positive clinical autism-prevention crossing. SC4's randomized antigen-specific prevention and independently structured exposure/refusal evidence can reach higher rungs under05; absence of an unethical all-vaccine-withholding RCT is not imposed as a universal ceiling." }, { "kind": "natural_experiment", "available": true, "why_not_sufficient": "Same-vaccine formulation changes, naturally discontinued exposures, randomized infant dose assignments, age-landmark/negative-control studies and large validated clinical cohorts were considered for the autism/benefit subclaims. None supplies a positive clinical autism-prevention crossing. SC4's randomized antigen-specific prevention and independently structured exposure/refusal evidence can reach higher rungs under05; absence of an unethical all-vaccine-withholding RCT is not imposed as a universal ceiling." }, { "kind": "dose_response_across_populations", "available": true, "why_not_sufficient": "Same-vaccine formulation changes, naturally discontinued exposures, randomized infant dose assignments, age-landmark/negative-control studies and large validated clinical cohorts were considered for the autism/benefit subclaims. None supplies a positive clinical autism-prevention crossing. SC4's randomized antigen-specific prevention and independently structured exposure/refusal evidence can reach higher rungs under05; absence of an unethical all-vaccine-withholding RCT is not imposed as a universal ceiling." }, { "kind": "withdrawal_rechallenge", "available": true, "why_not_sufficient": "Same-vaccine formulation changes, naturally discontinued exposures, randomized infant dose assignments, age-landmark/negative-control studies and large validated clinical cohorts were considered for the autism/benefit subclaims. None supplies a positive clinical autism-prevention crossing. SC4's randomized antigen-specific prevention and independently structured exposure/refusal evidence can reach higher rungs under05; absence of an unethical all-vaccine-withholding RCT is not imposed as a universal ceiling." }, { "kind": "therapeutic_perturbation_hard_endpoint", "available": false, "why_not_sufficient": "Same-vaccine formulation changes, naturally discontinued exposures, randomized infant dose assignments, age-landmark/negative-control studies and large validated clinical cohorts were considered for the autism/benefit subclaims. None supplies a positive clinical autism-prevention crossing. SC4's randomized antigen-specific prevention and independently structured exposure/refusal evidence can reach higher rungs under05; absence of an unethical all-vaccine-withholding RCT is not imposed as a universal ceiling." } ], "convergence_present": true, "cap_reapplied_to_convergent_set": false }, "provenance_header": { "sources_total": 62, "claims_total": 67, "claims_verified": 67, "claims_unverified": 0, "claims_contradicted": 0, "tier_a_sources": 62, "generated_by": "Codex; HSEF v5.3", "gate_passed": true }, "claims": [ { "id": "C1", "text": "Danish cohort of 657461 children finds adjusted MMR-autism HR0.93 with no consistent increase in prespecified sibling-risk, risk-score or timing groups. Registry diagnoses without individual chart review and observational allocation cannot exclude every exceptionally rare effect.", "carries_number": true, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 1 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C2", "text": "Earlier Danish birth cohort finds no MMR association with autism, otherASD or vaccination age/time since dose. Shares national registry infrastructure with later Danish work; different birth cohorts are not automatically independent assay/error classes.", "carries_number": false, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 2 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C3", "text": "UK regional time/case-series analyses show no introduction-related step or regression/onset clustering after MMR. Symptom timing and diagnostic validation vary; rare effects remain bounded by precision rather than logically impossible.", "carries_number": false, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 3 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C4", "text": "US insured-sibling cohort finds no increased ASD risk after MMR among children with or without an affected older sibling. Familial-risk strata have lower coverage and broad intervals; claims ascertainment and continuous insurance selection remain, and linked correction details unexamined.", "carries_number": false, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 4 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C5", "text": "Atlanta cases/controls have similar vaccination by 18or24months; association by 36months is stronger in the young school-entry group. Later association can reflect early-intervention enrollment requirements; temporal association does not establish exposure before developmental concern.", "carries_number": true, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 5 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C6", "text": "Prespecified age-landmark analyses in 2.56 million US EHR children yield MMR aHR0.97 and pneumococcal negative-control aHR1.01. Near-null negative control tests specific shared biases, not every residual confounder; original body not accessed.", "carries_number": true, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 6 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C7", "text": "UK matched general-practice case-control study finds no increased MMR/PDD association, including pre-media and autism restrictions. Observational exposure/diagnosis recording and vaccine selection remain; no universal zero-risk conclusion.", "carries_number": false, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 7 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C8", "text": "Yokohama birth-cohort ASD incidence continues rising after complete MMR withdrawal from1993. Diagnostic/ascertainment trends can change over time; population withdrawal is stronger against a main cause than against every rare subtype effect.", "carries_number": true, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 8 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C9", "text": "Reanalysis of the earlier UK series still finds no association allowing a longer induction interval. Same source population asPMID10376617, not an independent cohort or causal line.", "carries_number": false, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 9 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C10", "text": "Sensitive multiple-region PCR does not detect persistent measles genomes in leukocytes of vaccinated autistic children. Blood sampling cannot exclude every transient event or other tissue; assay null does not alone establish all clinical safety.", "carries_number": false, "load_bearing_for": [ "SC2" ], "source_ns": [ 10 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C11", "text": "Infant pre/post Pentavac or MMR vaccination shows no significant fecal-calprotectin increase. Short subclinical inflammation endpoint is not a full autism-incidence trial or all gastrointestinal tissue assessment.", "carries_number": false, "load_bearing_for": [ "SC2" ], "source_ns": [ 11 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C12", "text": "Autistic children show elevated measles antibody and vaccine-virus immunoblot reactivity in a serologic case-control study. Postdiagnosis immune measurements lack temporal direction, exposure isolation and proof of vaccine-strain persistence or clinical mediation.", "carries_number": false, "load_bearing_for": [ "SC2" ], "source_ns": [ 12 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C13", "text": "Parent-reported vaccine receipt is largely equivalent across ASD onset-pattern groups in 2755children. All participants have ASD and reports are retrospective; onset comparison is not a population incidence or selective exposure experiment.", "carries_number": true, "load_bearing_for": [ "SC2", "SC3" ], "source_ns": [ 13 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C14", "text": "Same-vaccine Danish formulations with or without thimerosal show no increased ASD and no dose trend in 467450children. Formulation/calendar assignment remains observational and shares Danish registry failure modes; confidence bounds do not prove absolute zero risk.", "carries_number": true, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 14 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C15", "text": "Validated in-person ASD case-control assessment shows no increased risk with prenatal or infant ethylmercury exposure. Medical-record/interview exposure and selection can leave residual confounding; inverse estimates do not prove thimerosal prevents autism.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 15 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C16", "text": "UK record cohort finds no autism or general neurodevelopment association, with one positive tic analysis and several inverse associations. Multiplicity, record-based diagnoses and vaccine-selection bias limit interpretation of isolated positive or protective estimates.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 16 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C17", "text": "Prospective Avon cohort finds one adverse result among 69comparisons and no convincing overall neurologic/psychological harm pattern. Not all endpoints are autism and many comparisons/selection covariates are tested; isolated significance is not a replicated syndrome.", "carries_number": true, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 17 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C18", "text": "Montreal PDD prevalence rises after thimerosal removal and while MMR uptake declines, without an exposure/dose association. Ecological cohort exposure and changing diagnostic concepts/services prevent trend alone proving no individual effect.", "carries_number": false, "load_bearing_for": [ "SC1", "SC2", "SC3" ], "source_ns": [ 18 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C19", "text": "California DDS autism prevalence does not decline after removal of more than trace thimerosal from nearly all childhood vaccines. Active-service prevalence is not standardized incidence; diagnostic and access changes complicate withdrawal interpretation.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 19 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C20", "text": "Standardized testing of 1047children finds small mixed positive/negative associations across42neuropsychological outcomes. Autism-spectrum disorders were explicitly NOT assessed; this source must not be cited as a direct ASD-incidence null.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 20 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C21", "text": "Children randomized in infancy to different thimerosal-dose vaccine regimens have few small neuropsychological differences at 10years. Follow-up participation about70%, multiple comparisons and other formulation differences limit mediation; the outcome is not an autism-incidence test.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 21 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C22", "text": "Two-phase HMO screening detects some tic/language associations that fail independent-site replication; no significant autism increase. Varying ascertainment and many exposure/outcome tests remain; linked erratum lacks a supplied PMID and details unexamined.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 22 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C23", "text": "Latent-factor reanalysis finds no association for6of7constructs but a small boys-tic association. Same1047-child dataset asPMID17898097; not independent replication, and tics are not autism.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 23 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C24", "text": "Birth-cohort VSD mercury estimates associate with several neurodevelopmental diagnostic prevalence outcomes, including autism. Aggregated cohort exposure, calendar/diagnosis changes and reused data undermine individual causal attribution; original authors still recommend routine vaccination.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 24 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C25", "text": "VAERS report proportions for neurodevelopment fall during thimerosal phaseout in an ecological analysis. Passive adverse-event reports lack population incidence denominators and are sensitive to reporting campaigns, latency and receipt/administration dates.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 25 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C26", "text": "VAERS/education aggregate analyses claim dose-related neurodevelopment associations and compare infant mercury doses to oral methylmercury limits. Ecological/passive-report data and mismatched compound/route guidance do not establish vaccine ethylmercury autism causality.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 26 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C27", "text": "Autistic-child first haircuts have lower mercury values with maternal-survey exposure differences, interpreted as impaired excretion. Selected postdiagnosis samples and retrospective reporting do not measure native brain burden or prove vaccine exposure caused autism.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 27 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C28", "text": "Small referred ASD series has more Rh-negative mothers than an earlier historical pregnancy-control cohort. Rh status is an imperfect exposure proxy; referral, ancestry, cohort era and immunoglobulin indication confound attribution to thimerosal.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 28 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C29", "text": "Clinic comparisons associate maternal Rh-negativity with neurodevelopmental diagnoses and fewer differences in a small post2001group. Potential overlap with earlier clinic work, historical controls, indirect exposure and small later cohort prevent a clean withdrawal experiment.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 29 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C30", "text": "Infant blood/stool measurements estimate rapid ethylmercury blood clearance after thimerosal-containing vaccination. Descriptive pharmacokinetics do not directly assess autism or prove every tissue cleared when blood falls.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 30 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C31", "text": "Infant vaccination pharmacokinetics estimate a3.7 dayblood half-life and elevated fecal mercury after doses. Population one-compartment modeling, sparse samples and total-Hg measurements are not direct neurodevelopmental outcomes.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 31 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C32", "text": "Late-preterm infants have measured vaccine-associated mercury with estimated6.3 dayblood half-life and return to baseline by 30days. Each infant contributes one pre/post sample and population modeling estimates half-life; very-preterm infants, brain clearance and autism are not assessed.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 32 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:Methods:paragraph0, 0:Methods:paragraph1, 0:Methods:paragraph7. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C33", "text": "Infant monkeys show faster blood clearance/lower total brainHg after thimerosal than methylmercury but a higher inorganic fraction and longer brain than blood retention. Exposure/route and developmental timing differ; pharmacokinetics are not autism outcomes and rapid blood decline is not complete brain clearance.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 33 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Results:paragraph5, 1:Results:paragraph6, 1:Results:paragraph7, 1:Results:paragraph8. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C34", "text": "Thimerosal challenge produces selected neurobehavioral/pathologic changes in autoimmune-proneSJL mice but not testedC57BL6/BALBc strains. Mapped strain toxicity is not human autism or universal routine-dose harm; peptide/vaccine formulation and species kinetics need transport validation.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 34 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C35", "text": "Repeated neonatal thimerosal dosing causes lasting rat neuropathologic changes in tested dose contexts. Histopathology is not a human ASD diagnosis; authors' dose-equivalence claim does not itself validate pharmacokinetic/developmental transport.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 35 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C36", "text": "Neonatal dose/sex-dependent rat behavior and dopamine changes occur, with social changes at the highest dose and spatial-learning null. Behavioral proxies, a wide toxic-dose range and sex dependence do not establish routine human vaccine autism causality.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 36 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C37", "text": "Premature rat single-dose thimerosal exposure alters learning/memory/apoptosis in selected dose groups. Rat developmental timing, dose units and saline comparator do not isolate actual vaccine-regimen human autism risk.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 37 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C38", "text": "Human astrocytes exposed to0–14.4micromolar thimerosal show ROS, membrane-potential and mitochondrial-DNA damage. Direct cell exposure demonstrates toxicity at tested concentrations, not infant vaccine tissue kinetics or autism causality; no clinical endpoint.", "carries_number": true, "load_bearing_for": [ "SC1" ], "source_ns": [ 38 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:2. Methods:paragraph0, 1:2. Methods:paragraph10, 2:3. Results:paragraph0, 2:3. Results:paragraph3, 2:3. Results:paragraph12, 2:3. Results:paragraph13. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C39", "text": "Infant rhesus vaccine-schedule experiment finds no autism-like social or tested brain pathology differences. Autism-proxy model is not human ASD; linked correction details were not examined and public body retrieval failed in this review.", "carries_number": false, "load_bearing_for": [ "SC1", "SC2" ], "source_ns": [ 39 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C40", "text": "Small longitudinal macaque pilot reports amygdala maturation/opioid-imaging differences after a complete vaccine schedule. Pilot imaging biomarkers do not isolate a component or show autism-like functional disease; later larger schedule tests differ.", "carries_number": false, "load_bearing_for": [ "SC1", "SC2" ], "source_ns": [ 40 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C41", "text": "Validated ASD case-control antigen-load analysis finds no risk increase with cumulative antibody-stimulating vaccine proteins/polysaccharides. Same256cases/752 controls as the thimerosal studyPMID20837594; antigen counting is a dose proxy, not every immune-response property.", "carries_number": false, "load_bearing_for": [ "SC1", "SC2", "SC3" ], "source_ns": [ 41 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C42", "text": "DMSA study reports metal excretion/biomarker changes after all participants receive an active screening round, then additional-dose randomization. One-versus-seven rounds lacks a never-treated control; provoked urine reference threshold is arbitrary, reported adverse dropouts occur and biomarkers do not establish vaccine-caused autism.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 42 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Methods:paragraph0, 1:Methods:paragraph25, 1:Methods:paragraph26, 1:Methods:paragraph42, 1:Methods:paragraph43, 1:Methods:paragraph47, 1:Methods:paragraph51, 1:Methods:paragraph52, 1:Methods:paragraph53, 1:Methods:paragraph54, 1:Methods:paragraph55. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C43", "text": "SameDMSA study has within-group symptom improvements in both arms without significant between-arm benefit on reported behavior comparisons. All participants already receivedDMSA, post-dose enrichment and ratings/regressions prevent treatment-versus-untreated or mercury-autism causal inference.", "carries_number": false, "load_bearing_for": [ "SC1", "SC3" ], "source_ns": [ 43 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 1:Methods:paragraph1, 1:Methods:paragraph3, 1:Methods:paragraph4, 1:Methods:paragraph5, 2:Results:paragraph14, 2:Results:paragraph20, 2:Results:paragraph26, 2:Results:paragraph28, 2:Results:paragraph30. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C44", "text": "Colorado exemptions predict substantially higher measles/pertussis risk and higher community incidence/outbreak associations. Nonrandom refusal and social/contact clustering remain; actual community associations are distinguished from modeling and pathogen exposure is required.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 44 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C45", "text": "US exemption cohort finds higher measles risk, with a separate model exploring transmission to nonexempt persons. Community model outputs are not observed rates; age/year/contact and refusal confounding limit standalone causal attribution, linked erratum details unexamined.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 45 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C46", "text": "Chart-validated Colorado case-control analysis links explicit pertussis refusal to laboratory-confirmed infection. Shared health-plan/contact structure and nonrandom refusal remain; disease protection does not imply vaccination prevents every infection.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 46 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C47", "text": "Matched Colorado analysis links varicella refusal with more medically attended infection. Small refusal counts and shared health-plan infrastructure limit precision/independence; not a randomized avoidance policy.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 47 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C48", "text": "VSD lab-confirmed pertussis cases show increasing risk with more missing/delayedDTaP doses and hospitalizations. Under-vaccination combines delay/refusal/access barriers, with age/time/contact confounding despite matching.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 48 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C49", "text": "Minnesota outbreak has confirmed infection, hospitalizations and an age-eligible safety-concern/refusal subgroup amid falling MMR coverage. Descriptive outbreak has no randomized contact comparator; registry inclusion requires active vaccine records and not all unvaccinated cases were eligible.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 49 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:METHODS:paragraph0, 0:METHODS:paragraph1, 0:METHODS:paragraph2, 0:METHODS:paragraph3, 0:METHODS:paragraph5, 0:METHODS:paragraph6, 0:METHODS:paragraph7. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C50", "text": "Imported measles spreads chiefly in low-coverage Amish households, with most cases unvaccinated and limited general-community spread. Contact networks and combined isolation/quarantine/vaccination response prevent attributing every containment effect to one measure.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 50 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C51", "text": "NYC2018–19outbreak records649cases with pneumonia, hospitalization/ICU and mostly unvaccinated cases of known status. Importation/contact clustering and combined response measures constrain effect estimation; communities are epidemiologic settings, not intrinsic biological causes.", "carries_number": true, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 51 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C52", "text": "Minnesota2017laboratory-confirmed outbreak starts in unvaccinated children and expands through low-coverage networks. Early ongoing-outbreak count is not final incidence, and contact exposure/eligibility differ.", "carries_number": true, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 52 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C53", "text": "NYC2013measles investigation records largely age-eligible refusal/delay cases and substantial healthcare/public-health exposure burden. Resource accounting/descriptive source cannot alone isolate vaccine effectiveness or population-wide lifetime net health.", "carries_number": true, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 53 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C54", "text": "Randomized Swedish infant pertussis-component vaccines versusDT-only control reduce confirmed pertussis, with product-specific efficacy and reactogenicity. Controlled antigen prevention is not zero-risk or protection from every pathogen; whole-cell and acellular results differ and linked erratum details unexamined.", "carries_number": false, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 54 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C55", "text": "Italian randomized pertussis-vaccine follow-up retains clinical protection through 33 months with different product efficacy. Original trial follow-up is one study; control allocation becomes partly unblinded and pertussis protection is time/product specific.", "carries_number": true, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 55 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C56", "text": "Randomized varicella-antigen schedules versusMMR-only control provide confirmed-varicella protection through 10 years, with stronger two-dose benefit. Russian subset is part of one internationalNCT00226499trial, not an independent efficacy trial; no single cohort establishes all-vaccine safety.", "carries_number": true, "load_bearing_for": [ "SC3", "SC4" ], "source_ns": [ 56 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C57", "text": "Chart-adjudicated vaccine-triggered anaphylaxis occurs at 1.31 per million doses across children/adults in VSD. A recognized rare adverse event is not autism or proof every vaccine/recipient has the same risk; doses differ from individuals.", "carries_number": true, "load_bearing_for": [ "SC3" ], "source_ns": [ 57 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. Selected body sections: 0:METHODS:paragraph3, 0:METHODS:paragraph4, 0:METHODS:paragraph6. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C58", "text": "MMR exposure is associated with a short-window excess of childhoodITPwith a low estimated attributable risk. Small event counts/broad interval, nonrandom exposure and clinical context remain; no inference to autism.", "carries_number": false, "load_bearing_for": [ "SC3" ], "source_ns": [ 58 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C59", "text": "First-dose MMRV has about twice the 7–10 day febrile-seizure risk compared with separate MMR plus varicella in 12–23 month-olds. Formulation/age-window adverse effect is not autism or a reason to generalize all vaccination avoidance; partially overlappingVSDfollow-ups count as shared components.", "carries_number": true, "load_bearing_for": [ "SC3" ], "source_ns": [ 59 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C60", "text": "At4–6 years,MMRV and separate MMR plus varicella show rare seizures without a7–10 daypeak. Age/dose-specific null does not erase the younger first-dose risk and finite precision does not prove zero.", "carries_number": true, "load_bearing_for": [ "SC3" ], "source_ns": [ 60 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C61", "text": "Large VSD analysis confirms seizure/fever andITPboundaries while other specified events are uncommon or indistinguishable across formulations. Some outcomes have few/zero events; sharedVSDpopulation and expandedperiod are not entirely independent safety replication.", "carries_number": false, "load_bearing_for": [ "SC3" ], "source_ns": [ 61 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "C62", "text": "VSD self-controlled analyses find no increased fever/EDresponse difference after measles/pertussis vaccines in diagnosedASD children aged4–7 years. Postdiagnosis safety is not autism etiology; rarefebrileseizures and eligible-selection limit generalization.", "carries_number": true, "load_bearing_for": [ "SC3" ], "source_ns": [ 62 ], "verification": "verified", "verified_against": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "verified_on": "2026-10-12", "note": "" }, { "id": "CSC1", "text": "The examined set does not establish a reproducible positive human vaccine-ethylmercury/ASD association. Cell and selected rodent experiments demonstrate restricted toxicity, but neither their endpoints nor dose/kinetic transport establish vaccine-dose human autism. Positive ecological, passive-report and referred-case associations fail to reproduce in better individual-dose, matched-formulation and validated diagnostic comparisons. Thus the registered clinical etiologic claim is Α, while real restricted toxicology is retained separately; a Β ceiling is not treated as an earned associational rung.", "carries_number": false, "load_bearing_for": [ "SC1" ], "source_ns": [ 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43 ], "verification": "verified", "verified_against": "Synthesis of examined primary result/limit cards; framework level is adjudication.", "verified_on": "2026-10-12", "note": "" }, { "id": "CSC2", "text": "No credible reproducible positive MMR/ASD association is established in the examined original set. Anecdotal timing, postdiagnosis antibodies and a later school-entry association do not survive stronger age, exposure, onset, familial-risk and withdrawal comparisons. The registered etiologic claim is therefore Α. This does not assert that every conceivable rare vaccine adverse event is impossible or that ASD itself is speculative.", "carries_number": false, "load_bearing_for": [ "SC2" ], "source_ns": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 18, 39, 40, 41 ], "verification": "verified", "verified_against": "Synthesis of examined primary result/limit cards; framework level is adjudication.", "verified_on": "2026-10-12", "note": "" }, { "id": "CSC3", "text": "No examined original clinical study demonstrates that avoiding routine childhood vaccination prevents autism and improves overall health among eligible children. The claim remains narrative/unsupported at Α. Negative autism exposure tests do not earn a positive causal crossing; separate infection-prevention and refusal-outbreak evidence opposes the proposed net benefit. This level was derived from the source comparison rather than assigned because the topic is historically disputed.", "carries_number": false, "load_bearing_for": [ "SC3" ], "source_ns": [ 1, 2, 3, 4, 5, 6, 7, 8, 9, 13, 14, 15, 16, 17, 18, 19, 24, 25, 26, 41, 42, 43, 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56, 57, 58, 59, 60, 61, 62 ], "verification": "verified", "verified_against": "Synthesis of examined primary result/limit cards; framework level is adjudication.", "verified_on": "2026-10-12", "note": "" }, { "id": "CSC4", "text": "Vaccine avoidance removes demonstrated pathogen-specific protection and increases infection susceptibility where exposure occurs. Randomized pertussis-component versus matched DT-control and varicella-antigen versus MMR-control trials establish clinical prevention; refusal/exemption studies, missing-dose gradients and laboratory-confirmed outbreaks connect loss of protection to individual and community risk. These classes address different failure modes and converge at Η for the specified infection-risk claim. They do not mean every unvaccinated child becomes infected, vaccines prevent every case, or every formulation/recipient has zero adverse-event risk.", "carries_number": false, "load_bearing_for": [ "SC4" ], "source_ns": [ 44, 45, 46, 47, 48, 49, 50, 51, 52, 53, 54, 55, 56 ], "verification": "verified", "verified_against": "Synthesis of examined primary result/limit cards; framework level is adjudication.", "verified_on": "2026-10-12", "note": "" }, { "id": "CH", "text": "Avoiding routine childhood vaccination has no demonstrated autism-prevention benefit; loss of pathogen-specific protection increases infection risk, while genuine vaccine adverse events require separate assessment.", "carries_number": false, "load_bearing_for": [ "SC3" ], "source_ns": [ 14, 1, 6, 54, 56, 44, 57, 59 ], "verification": "verified", "verified_against": "Bounded synthesis of examined sources; score is adjudication.", "verified_on": "2026-10-12", "note": "" } ], "citation_ledger": [ { "n": 1, "citation": "Hviid A, Hansen JV, Frisch M et al. Measles, Mumps, Rubella Vaccination and Autism: A Nationwide Cohort Study. Annals of internal medicine. 2019.", "tier": "A", "kind": "primary", "pmid": "30831578", "doi": "10.7326/M18-2101", "url": "https://pubmed.ncbi.nlm.nih.gov/30831578/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID30831578", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C1", "CSC2", "CSC3", "CH" ] }, { "n": 2, "citation": "Madsen KM, Hviid A, Vestergaard M et al. A population-based study of measles, mumps, and rubella vaccination and autism. The New England journal of medicine. 2002.", "tier": "A", "kind": "primary", "pmid": "12421889", "doi": "10.1056/NEJMoa021134", "url": "https://pubmed.ncbi.nlm.nih.gov/12421889/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12421889", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C2", "CSC2", "CSC3" ] }, { "n": 3, "citation": "Taylor B, Miller E, Farrington CP et al. Autism and measles, mumps, and rubella vaccine: no epidemiological evidence for a causal association. Lancet (London, England). 1999.", "tier": "A", "kind": "primary", "pmid": "10376617", "doi": "10.1016/s0140-6736(99)01239-8", "url": "https://pubmed.ncbi.nlm.nih.gov/10376617/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "UK_TAYLOR_AUTISM_SERIES", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C3", "CSC2", "CSC3" ] }, { "n": 4, "citation": "Jain A, Marshall J, Buikema A et al. Autism occurrence by MMR vaccine status among US children with older siblings with and without autism. JAMA. 2015.", "tier": "A", "kind": "primary", "pmid": "25898051", "doi": "10.1001/jama.2015.3077", "url": "https://pubmed.ncbi.nlm.nih.gov/25898051/", "status_flags": [ "ErratumIn: PMID26757477" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID25898051", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C4", "CSC2", "CSC3" ] }, { "n": 5, "citation": "DeStefano F, Bhasin TK, Thompson WW et al. Age at first measles-mumps-rubella vaccination in children with autism and school-matched control subjects: a population-based study in metropolitan atlanta. Pediatrics. 2004.", "tier": "A", "kind": "primary", "pmid": "14754936", "doi": "10.1542/peds.113.2.259", "url": "https://pubmed.ncbi.nlm.nih.gov/14754936/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID14754936", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C5", "CSC2", "CSC3" ] }, { "n": 6, "citation": "Burstain TL, Jacques D, Burstain JM. Association Between First MMR Vaccination Before Age 2 Years and Childhood Autism in a U.S. EHR Cohort of 2.5 Million Children. 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JAMA pediatrics. 2013.", "tier": "A", "kind": "primary", "pmid": "24019039", "doi": "10.1001/jamapediatrics.2013.2353", "url": "https://pubmed.ncbi.nlm.nih.gov/24019039/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID24019039", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C48", "CSC3", "CSC4" ] }, { "n": 49, "citation": "Gahr P, DeVries AS, Wallace G et al. An outbreak of measles in an undervaccinated community. 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The New England journal of medicine. 2016.", "tier": "A", "kind": "primary", "pmid": "27705270", "doi": "10.1056/NEJMoa1602295", "url": "https://pubmed.ncbi.nlm.nih.gov/27705270/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID27705270", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C50", "CSC3", "CSC4" ] }, { "n": 51, "citation": "Zucker JR, Rosen JB, Iwamoto M et al. Consequences of Undervaccination - Measles Outbreak, New York City, 2018-2019. 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Morbidity and mortality weekly report. 2017.", "tier": "A", "kind": "primary", "pmid": "28704350", "doi": "10.15585/mmwr.mm6627a1", "url": "https://pubmed.ncbi.nlm.nih.gov/28704350/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID28704350", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C52", "CSC3", "CSC4" ] }, { "n": 53, "citation": "Rosen JB, Arciuolo RJ, Khawja AM et al. Public Health Consequences of a 2013 Measles Outbreak in New York City. JAMA pediatrics. 2018.", "tier": "A", "kind": "primary", "pmid": "30073293", "doi": "10.1001/jamapediatrics.2018.1024", "url": "https://pubmed.ncbi.nlm.nih.gov/30073293/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID30073293", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C53", "CSC3", "CSC4" ] }, { "n": 54, "citation": "Gustafsson L, Hallander HO, Olin P et al. A controlled trial of a two-component acellular, a five-component acellular, and a whole-cell pertussis vaccine. The New England journal of medicine. 1996.", "tier": "A", "kind": "rct", "pmid": "8538705", "doi": "10.1056/NEJM199602083340602", "url": "https://pubmed.ncbi.nlm.nih.gov/8538705/", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID8538705", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C54", "CSC3", "CSC4", "CH" ] }, { "n": 55, "citation": "Salmaso S, Mastrantonio P, Wassilak SG et al. Persistence of protection through 33 months of age provided by immunization in infancy with two three-component acellular pertussis vaccines. Stage II Working Group. Vaccine. 1998.", "tier": "A", "kind": "rct", "pmid": "9682390", "doi": "10.1016/s0264-410x(98)00040-1", "url": "https://pubmed.ncbi.nlm.nih.gov/9682390/", "status_flags": [ "ErratumIn: PMID not supplied" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "ITALIAN_PERTUSSIS_EFFICACY_PARENT", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C55", "CSC3", "CSC4" ] }, { "n": 56, "citation": "Namazova-Baranova L, Habib MA, Povey M et al. A randomized trial assessing the efficacy, immunogenicity, and safety of vaccination with live attenuated varicella zoster virus-containing vaccines: ten-year follow-up in Russian children. Human vaccines & immunotherapeutics. 2022.", "tier": "A", "kind": "rct", "pmid": "34435933", "doi": "10.1080/21645515.2021.1959148", "url": "https://pubmed.ncbi.nlm.nih.gov/34435933/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "VARICELLA_NCT00226499_PARENT", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C56", "CSC3", "CSC4", "CH" ] }, { "n": 57, "citation": "McNeil MM, Weintraub ES, Duffy J et al. Risk of anaphylaxis after vaccination in children and adults. 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British journal of clinical pharmacology. 2003.", "tier": "A", "kind": "primary", "pmid": "12534647", "doi": "10.1046/j.1365-2125.2003.01790.x", "url": "https://pubmed.ncbi.nlm.nih.gov/12534647/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID12534647", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C58", "CSC3" ] }, { "n": 59, "citation": "Klein NP, Fireman B, Yih WK et al. Measles-mumps-rubella-varicella combination vaccine and the risk of febrile seizures. Pediatrics. 2010.", "tier": "A", "kind": "primary", "pmid": "20587679", "doi": "10.1542/peds.2010-0665", "url": "https://pubmed.ncbi.nlm.nih.gov/20587679/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID20587679", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C59", "CSC3", "CH" ] }, { "n": 60, "citation": "Klein NP, Lewis E, Baxter R et al. Measles-containing vaccines and febrile seizures in children age 4 to 6 years. Pediatrics. 2012.", "tier": "A", "kind": "primary", "pmid": "22473362", "doi": "10.1542/peds.2011-3198", "url": "https://pubmed.ncbi.nlm.nih.gov/22473362/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID22473362", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C60", "CSC3" ] }, { "n": 61, "citation": "Klein NP, Lewis E, Fireman B et al. Safety of measles-containing vaccines in 1-year-old children. 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Vaccine. 2022.", "tier": "A", "kind": "primary", "pmid": "35315325", "doi": "10.1016/j.vaccine.2022.03.031", "url": "https://pubmed.ncbi.nlm.nih.gov/35315325/", "status_flags": [ "none_found" ], "opened": true, "opened_on": "2026-10-12", "status_checked_on": "2026-10-12", "study_id": "PMID35315325", "access_depth": "abstract_metadata", "access_note": "Bounded original primary abstract Results/Findings/conclusion passages and linked-status metadata examined; no complete-abstract audit asserted. No complete-paper or supplement audit claimed.", "carries_claims": [ "C62", "CSC3" ] } ], "independence_basis": { "required": true, "lines": [ { "label": "Randomized antigen-specific clinical prevention", "sources": [ 54, 55, 56 ], "excludes_error": "Random allocation and matched vaccinated controls address refusal, healthcare use and baseline contact confounding for pathogen-specific clinical endpoints; trial ascertainment/blinding and product/time limits are retained." }, { "label": "Loss of protection under naturally occurring exposure", "sources": [ 44, 46, 47, 48, 49, 50, 51 ], "excludes_error": "Chart-validated refusal, missing-dose gradients and laboratory-confirmed imported outbreaks test loss of protection in actual communities with different allocation/ascertainment structures from trials. Cohorts and outbreaks share possible contact-network confounding and count as one broad natural-exposure class, not independent lines merely because there are multiple papers." } ], "shared_failure_mode_checked": true, "note": "The 256 ASD cases/752 controls in thimerosal PMID 20837594 and antigen PMID 23545349 are one parent study. ThompsonPMID17898097 and latent-factor PMID 21785120 reuse1047 children. UKcase-seriesPMID10376617 andPMID11395196 are one series. DMSAPartA/PartB share one trial. Danish registry cohorts/formulation analyses may overlap or share diagnostic systems; VSD safety reports overlap sites/years and some recipients. Colorado pertussis/varicella share a health-plan framework. International varicellaNCT00226499 Russian 10 year subset and Italian pertussisfollow-up count as parent trials, not extra trials.62 reports are not62 independent causal lines. The positive infection-risk inference rests on two broad error-mode classes, randomized antigen prevention and naturally occurring exposure/loss of protection. Autism-negative and adverse-event studies audit distinct claims but are not counted as extra positive infection causal lines." }, "gamma_hard_rules_considered": [ { "subclaim_id": "SC1", "rule_quoted": "**Functional-unblinding rule.** Inert-placebo trial of an intervention with unmistakable acute subjective effects — psychedelics, ketamine, entactogens, suprathreshold stimulation, ECT — with no blinding-integrity check reported. Such a trial did not control what it claims to control.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC1", "rule_quoted": "**Mediation-by-correlation rule.** Candidate mediator correlated with outcome, never manipulated.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC1", "rule_quoted": "**Open-label rule.** Open-label, single-arm, retrospective, or naturalistic evidence alone. A positive open-label result never crosses Δ, however large.", "trigger_status": "Applies to the uncontrolled or cell-only positive support class, with ceiling Γ; it does not upgrade that class or describe the whole source set." }, { "subclaim_id": "SC1", "rule_quoted": "**Unblinded-rater rule.** Outcomes rated by clinicians who delivered the intervention or knew allocation.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC1", "rule_quoted": "**Acute-pharmacodynamic rule.** Acute molecular, occupancy, or imaging change with no link to symptom trajectory.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC1", "rule_quoted": "**Rodent-proxy rule.** Forced-swim, tail-suspension, sucrose-preference, or head-twitch alone; head-twitch is pharmacodynamic, not therapeutic.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC2", "rule_quoted": "**Functional-unblinding rule.** Inert-placebo trial of an intervention with unmistakable acute subjective effects — psychedelics, ketamine, entactogens, suprathreshold stimulation, ECT — with no blinding-integrity check reported. Such a trial did not control what it claims to control.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC2", "rule_quoted": "**Mediation-by-correlation rule.** Candidate mediator correlated with outcome, never manipulated.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC2", "rule_quoted": "**Open-label rule.** Open-label, single-arm, retrospective, or naturalistic evidence alone. A positive open-label result never crosses Δ, however large.", "trigger_status": "Applies to the uncontrolled or cell-only positive support class, with ceiling Γ; it does not upgrade that class or describe the whole source set." }, { "subclaim_id": "SC2", "rule_quoted": "**Unblinded-rater rule.** Outcomes rated by clinicians who delivered the intervention or knew allocation.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC2", "rule_quoted": "**Acute-pharmacodynamic rule.** Acute molecular, occupancy, or imaging change with no link to symptom trajectory.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC2", "rule_quoted": "**Rodent-proxy rule.** Forced-swim, tail-suspension, sucrose-preference, or head-twitch alone; head-twitch is pharmacodynamic, not therapeutic.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC3", "rule_quoted": "**Functional-unblinding rule.** Inert-placebo trial of an intervention with unmistakable acute subjective effects — psychedelics, ketamine, entactogens, suprathreshold stimulation, ECT — with no blinding-integrity check reported. Such a trial did not control what it claims to control.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC3", "rule_quoted": "**Mediation-by-correlation rule.** Candidate mediator correlated with outcome, never manipulated.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC3", "rule_quoted": "**Open-label rule.** Open-label, single-arm, retrospective, or naturalistic evidence alone. A positive open-label result never crosses Δ, however large.", "trigger_status": "Applies to the uncontrolled or cell-only positive support class, with ceiling Γ; it does not upgrade that class or describe the whole source set." }, { "subclaim_id": "SC3", "rule_quoted": "**Unblinded-rater rule.** Outcomes rated by clinicians who delivered the intervention or knew allocation.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC3", "rule_quoted": "**Acute-pharmacodynamic rule.** Acute molecular, occupancy, or imaging change with no link to symptom trajectory.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC3", "rule_quoted": "**Rodent-proxy rule.** Forced-swim, tail-suspension, sucrose-preference, or head-twitch alone; head-twitch is pharmacodynamic, not therapeutic.", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC4", "rule_quoted": "Ex vivo functional assays alone", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC4", "rule_quoted": "Cytokine profile plus in vitro mechanistic work, no in vivo necessity", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC4", "rule_quoted": "Broad immunosuppression effect with pleiotropy", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." }, { "subclaim_id": "SC4", "rule_quoted": "Correlational human data plus in vitro mechanism", "trigger_status": "Not triggered literally for this assembled scoped case. Any adapted clinical, proxy or system-inference restriction is stated separately in the subclaim rationale." } ], "consensus_validation": { "completed": true, "status": "completed_original_source_reconciliation", "provider_mode": "Consensus Pro signed-in browser; observed output and citation link mappings", "queries": [ "https://consensus.app/search/childhood-vaccination-autism-risk/yh5e0JaNQSW0KIGv1VdLNQ/" ], "query_record_note": "Exact visible question/response retained privately in raw browser receipt.", "primary_comparison_count": 11, "primary_comparisons": [ { "pmid": "14519711", "doi": "10.1001/jama.290.13.1763", "source_type": "primary study report", "study_group": "PMID14519711", "access_depth": "abstract_metadata", "consensus_aspect": "Matched thimerosal formulation and dose comparison", "result_comparison": "Original abstract verifies 467450 children, about 2.99 million person-years, autism RR 0.85(CI 0.60–1.20) and dose slope per 25 micrograms0.98(CI 0.90–1.06). Provider's numerical outline agrees, but absence of an observed effect is finite-precision evidence, not a proof that every rare event is impossible. Our access was original abstract/status, not complete full text.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/14519711/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-10-22-5000.json" ], "body_receipts": [] }, { "pmid": "30831578", "doi": "10.7326/M18-2101", "source_type": "primary study report", "study_group": "PMID30831578", "access_depth": "abstract_metadata", "consensus_aspect": "MMR cohort and predefined risk/timing groups", "result_comparison": "Original abstract verifies657461 children, adjustedHR 0.93(CI 0.85–1.02), no consistent increased risk in specified familial-risk/timing groups, and explicitly no individual chart review. Provider numbers agree; 'no subgroup vulnerability' must remain limited to tested definitions and their precision. Original access was abstract/status.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/30831578/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-0-10-5000.json" ], "body_receipts": [] }, { "pmid": "42520244", "doi": "10.1097/INF.0000000000005349", "source_type": "primary study report", "study_group": "PMID42520244", "access_depth": "abstract_metadata", "consensus_aspect": "New age-landmark EHR study and negative-control interpretation", "result_comparison": "Original abstract verifies2,560,035 children, MMR aHR 0.97(99% CI 0.91–1.03) and pneumococcal negative-controlaHR 1.01(0.99–1.04). Provider's claim that this excludes residual confounding is rejected: it tests specified shared bias pathways and cannot exclude all unmeasured/measurement confounding. Original access was abstract/status; no body audit was claimed.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/42520244/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-0-10-5000.json" ], "body_receipts": [] }, { "pmid": "11135778", "doi": "10.1001/jama.284.24.3145", "source_type": "primary study report", "study_group": "PMID11135778", "access_depth": "abstract_metadata", "consensus_aspect": "Actual original exemption and infection outcomes", "result_comparison": "Original abstract verifies Colorado exemption-associated measlesRR22.2 andpertussisRR5.9, plus community incidence/contact findings. Provider attached broad infection-protection claims to secondary reviews and unrelated Geier references rather than this requested original. The review uses the actual original and distinguishes nonrandom refusal/contact clustering from randomized efficacy. Original access was abstract/status.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/11135778/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-34-44-5000.json" ], "body_receipts": [] }, { "pmid": "8538705", "doi": "10.1056/NEJM199602083340602", "source_type": "primary study report", "study_group": "PMID8538705", "access_depth": "abstract_metadata", "consensus_aspect": "Controlled pathogen prevention and real reactogenicity", "result_comparison": "Original abstract verifies randomized pertussis components versus DT-only control, product-specific clinical efficacy and higher whole-cell reactogenicity. This supplies actual intervention causality for the infection-risk branch and prevents a universal zero-adverse-effect framing. Original access was abstract/status, with linked erratum details unexamined.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/8538705/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-44-54-5000.json", "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-53-62-6000.json" ], "body_receipts": [] }, { "pmid": "34435933", "doi": "10.1080/21645515.2021.1959148", "source_type": "primary study report", "study_group": "VARICELLA_NCT00226499_PARENT", "access_depth": "abstract_metadata", "consensus_aspect": "Long-term prevention with a matched active control", "result_comparison": "Original abstract verifies randomized varicella-antigen schedules versus MMR-only control, ten-year confirmed-varicella protection and stronger two-dose efficacy. The Russian sample is a subset of one internationalNCT00226499 trial, not an extra independent trial. Original access was abstract/status.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/34435933/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-53-62-6000.json", "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-54-62-5000.json" ], "body_receipts": [] }, { "pmid": "16079072", "doi": "10.1289/ehp.7712", "source_type": "primary study report", "study_group": "PMID16079072", "access_depth": "full_text_partial", "consensus_aspect": "Blood clearance is not complete brain clearance", "result_comparison": "Original Results5–8 verify faster blood clearance after thimerosal than methylmercury but slower brain than blood clearance and retained inorganic mercury. Provider's shorter-half-life summary is incomplete if taken to mean no brain retention. These kinetic findings do not establish clinical autism; our access includes selected original body passages.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/16079072/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-22-34-5000.json" ], "body_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\body-presentation-receipts\\16079072-s1-p5-6-7-8.json" ] }, { "pmid": "19560158", "doi": "10.1016/j.jpeds.2009.04.011", "source_type": "primary study report", "study_group": "PMID19560158", "access_depth": "full_text_partial", "consensus_aspect": "Population-model pharmacokinetics and developmental scope", "result_comparison": "Original Methods0/1/7 show late-preterm infants at 32–37 weeks, vaccine exposure, one pre/post sample per infant and population-based half-life modeling. The abstract's6.3 dayestimate is not repeated individual serial kinetics, evidence for very-preterm infants, or an autism-incidence endpoint. Our access includes selected original Methods.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/19560158/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-22-34-5000.json" ], "body_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\body-presentation-receipts\\19560158-s0-p0-1-7.json" ] }, { "pmid": "19852790", "doi": "10.1186/1472-6904-9-17", "source_type": "primary study report", "study_group": "ADAMS_DMSA_PARENT", "access_depth": "full_text_partial", "consensus_aspect": "Chelation comparison and outcome hierarchy", "result_comparison": "Original Methods1/3–5 and Results14/20/26/28/30 show that every participant received initial active DMSA, with one-versus-seven-round randomization and no significant reported between-group symptom advantage. Both within-group changes and post-dose metal regressions cannot prove placebo-controlled efficacy or vaccine-caused autism. Part A(PMID 19852789) is the same trial, not an independent primary study; our access includes selected original body.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/19852790/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-34-44-5000.json" ], "body_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\body-presentation-receipts\\19852790-s1-p1-3-4-5.json", "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\body-presentation-receipts\\19852790-s2-p14-20-26-28-30.json" ] }, { "pmid": "26452420", "doi": "10.1016/j.jaci.2015.07.048", "source_type": "primary study report", "study_group": "PMID26452420", "access_depth": "full_text_partial", "consensus_aspect": "Specific true vaccine adverse-event ascertainment", "result_comparison": "Original Methods3/4/6 verify chart review, medical-officer Brighton adjudication and a per-dose denominator. The abstract reports33 cases/25,173,965 doses, or1.31 per million doses, across children/adults. Provider's general rare-adverse-event statement is strengthened with actual original evidence, while autism remains a separate outcome. Our access includes selected original Methods.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/26452420/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-53-62-6000.json", "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-54-62-5000.json" ], "body_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\body-presentation-receipts\\26452420-s0-p3-4-6.json" ] }, { "pmid": "20587679", "doi": "10.1542/peds.2010-0665", "source_type": "primary study report", "study_group": "PMID20587679", "access_depth": "abstract_metadata", "consensus_aspect": "Formulation and age-specific seizure risk", "result_comparison": "Original abstract verifies first-doseMMRVversusseparate MMR plus varicella seizureRR1.98 andaboutoneexcessfebrileseizureper2300 doses in 12–23 month-olds. The older4–6 yearstudy(PMID 22473362) differs. This is an acknowledged safety boundary, not evidence for autism or a blanket avoidance policy. Original access was abstract/status.", "original_source": "https://pubmed.ncbi.nlm.nih.gov/20587679/", "source_examination_receipts": [ "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-53-62-6000.json", "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\examinations\\original-54-62-5000.json" ], "body_receipts": [] } ], "grade_changed": false, "grade_change_note": "Source-based adjudication; no independent blinded regrade claimed.", "raw_receipts": [ { "path": "deliverables\\hsef_v53_remaining_priority_20_22_2026-10-12\\vaccine-autism-avoidance\\consensus-browser-2026-10-12.json", "sha256": "a4e9a3a08482bb9070ab7a2b5f51173cba887da71300d89288ccae031d444cff" } ], "independent_blinded_audit": false, "cutoff": "2026-10-12", "completed_utc": "2026-10-12T21:01:18.571999+00:00", "conclusion": "Endpoint hierarchy, experimental scope and original-source limits determine the evidence cards; provider wording does not override them." } }