Pleading COVID‑19 Vaccine Allergies as Disabilities Under the ADA:
Commentary on Cecere v. Canisius University (2d Cir. 2025)
I. Introduction
The Second Circuit’s summary order in Cecere v. Canisius University, No. 25‑798‑cv (2d Cir. Nov. 20, 2025) (summary order), arises from a dispute at the intersection of COVID‑19 vaccination mandates, medical exemptions, and disability discrimination law under the Americans with Disabilities Act (ADA), 42 U.S.C. § 12182.
The case involves a physician assistant (“PA”) student, William Cecere IV, who was dismissed from Canisius University’s PA program after failing to obtain a COVID‑19 vaccine or secure a clinical placement that accepted his claimed medical exemption. He asserted that his inability to receive the vaccine—due to alleged prior adverse reactions to other vaccines and medications—constituted a disability under the ADA, and that his dismissal was unlawful discrimination.
The court’s decision is formally nonprecedential (as a “summary order” under Second Circuit Local Rule 32.1.1), yet it offers a clear and practical illustration of how rigorously federal courts will apply Twombly’s plausibility pleading standard to ADA claims premised on vaccine allergies. The order is particularly important for:
- Students and professionals seeking medical exemptions to vaccine mandates,
- Colleges, universities, and professional programs enforcing such mandates, and
- Litigators framing disability-based challenges to vaccination requirements.
The core lesson: merely alleging a history of allergic reactions to unspecified vaccines and furnishing a brief doctor’s note is not enough, by itself, to plausibly plead an actual disability in the form of a COVID‑19 vaccine allergy under the ADA.
II. Factual and Procedural Background
A. The Parties and the Program
The plaintiff, William Cecere IV, was enrolled in the Physician Assistant Program at Canisius University (formerly Canisius College), a private university. Defendant Dr. Aimee Larson served as Director of the PA Program.
Like many health-professional programs during the COVID‑19 pandemic, the PA program required COVID‑19 vaccination in order for students to participate in clinical rotations—a core, essential component of the curriculum. Absent vaccination (or acceptance of a valid medical exemption by clinical sites), Cecere could not complete the clinical phase of his training.
B. Cecere’s Medical History as Alleged
According to the amended complaint:
- In December 2020, Cecere received a meningococcal vaccine and subsequently experienced:
- Spinal pain that limited his ability to move, and
- Difficulty breathing.
- His mother, a dentist, administered Benadryl, in part because:
- He had a past anaphylactic reaction to Motrin (ibuprofen) as a child.
- He also alleged “other adverse reactions” to unspecified “other vaccinations and medications” during childhood, without describing:
- Which vaccines or medications were involved, or
- The nature and severity of those other reactions.
Fearing that similar symptoms would recur if he received a COVID‑19 vaccine, Cecere sought a medical exemption from the vaccination requirement:
- His original physician (who administered the meningococcal vaccine) declined to provide an exemption letter.
- His mother did provide a letter, but Canisius rejected it, presumably because she was not acting as a neutral treating physician.
- In December 2021, Cecere consulted a new primary-care provider, Dr. Kevin Cleary, who issued a one-sentence exemption letter:
“William Cecere has had prior severe allergic reactions to vaccines, including viral vaccines and is unable to get the covid 19 vaccine.” (Joint App’x at 149.)
C. Dismissal from the Program and Litigation
Because Cecere did not obtain the COVID‑19 vaccine and could not secure a clinical placement that would accept him unvaccinated (even with his claimed exemption), he was dismissed from the PA program.
He then filed suit in New York state court, asserting:
- State-law claims (unspecified in the order but likely involving disability discrimination and/or contractual or statutory rights), and
- An ADA claim under 42 U.S.C. § 12182, which governs discrimination by places of public accommodation (Title III of the ADA).
Cecere alleged that:
- His inability to receive the COVID‑19 vaccine was itself a disability, and
- His dismissal from the PA program constituted ADA discrimination “by reason of” that disability.
The defendants removed the action to the U.S. District Court for the Western District of New York. The district court:
- Dismissed the ADA claim with prejudice under Federal Rule of Civil Procedure 12(b)(6) for failure to state a claim, finding:
- Cecere did not plausibly allege a qualifying disability, and
- He did not plausibly allege that any major life activity was substantially limited.
- Remanded the remaining state-law claims to state court.
Cecere appealed, challenging only the dismissal of his ADA claim. The Second Circuit affirmed.
III. Summary of the Second Circuit’s Decision
The Second Circuit, in a unanimous summary order, affirmed the judgment of the district court. It held that:
- Cecere’s ADA discrimination claim fails at the threshold “disability” element of the prima facie case.
- Even assuming, without deciding, that an allergy to COVID‑19 vaccines could qualify as a disability under the ADA, Cecere’s complaint did not plausibly allege that he actually had such an allergy.
- The complaint provided:
- Only a conclusory assertion that he was disabled due to his inability to receive the COVID‑19 vaccine, and
- Insufficient factual support—either in his narrative allegations or in Dr. Cleary’s one-sentence letter—to raise his right to relief under the ADA “above the speculative level” required by Twombly.
- Because he did not plausibly allege that he was allergic to COVID‑19 vaccines, the court did not need to reach:
- Whether such an allergy would substantially limit a major life activity, or
- Whether his dismissal was “by reason of” any disability.
Accordingly, the dismissal with prejudice of the ADA claim was upheld, and the order leaves intact the remand of state-law claims to state court.
IV. Detailed Analysis
A. Precedents and Authorities Cited
1. Standard of Review and Pleading Materials
- Kellogg v. Nichols, 149 F.4th 155 (2d Cir. 2025)
Cited for the uncontroversial proposition that appellate review of a Rule 12(b)(6) dismissal is de novo. This means the Second Circuit gives no deference to the district court’s legal conclusions and applies the same pleading standards itself. - Santos v. Kimmel, 154 F.4th 30 (2d Cir. 2025)
The panel quotes Santos for the familiar rule that, on a motion to dismiss, courts consider:- The complaint’s factual allegations,
- Documents attached to the complaint as exhibits, and
- Documents incorporated by reference in the complaint.
- Pearson v. Gesner, 125 F.4th 400 (2d Cir. 2025)
Cited for the “integral to the complaint” doctrine. Even if a document is not attached to the complaint, a court may consider it on a motion to dismiss if:- The complaint “heavily relies” on the document, and
- The document is thus considered “integral” to the complaint.
- Clark v. Hanley, 89 F.4th 78 (2d Cir. 2023)
Cited to restate the plaintiff-friendly baseline:- Complaints are construed liberally,
- All factual allegations are accepted as true, and
- All reasonable inferences are drawn in the plaintiff’s favor.
2. The Plausibility Standard: Twombly
- Bell Atlantic Corp. v. Twombly, 550 U.S. 544 (2007)
The Second Circuit quotes Twombly’s foundational pleading principles:- A complaint’s factual allegations must be enough to “raise a right to relief above the speculative level”, and
- It cannot rely on a mere “formulaic recitation of the elements of a cause of action.”
3. ADA Framework and Disability Definition
- Dean v. University at Buffalo School of Medicine & Biomedical Sciences, 804 F.3d 178 (2d Cir. 2015)
Dean is cited for the three-part test to establish a prima facie ADA discrimination case in an educational setting. A plaintiff must show:- He is a qualified individual with a disability;
- The defendant is subject to the ADA; and
- He was denied the opportunity to participate in or benefit from the defendant’s services, programs, or activities (or otherwise discriminated against) by reason of his disability.
- 42 U.S.C. § 12102(1)(A)
The statute defines “disability” to include, among other things, a:“physical or mental impairment that substantially limits one or more major life activities.”
The court applies this definition (in the context of Title III, 42 U.S.C. § 12182) but never reaches the “substantially limits major life activities” analysis because it finds no sufficiently alleged impairment in the first place.
4. Nonprecedential Status and Citation Rules
The order begins with the standard Second Circuit disclosure:
- Summary orders “do not have precedential effect.”
- They may, however, be cited under Federal Rule of Appellate Procedure 32.1 and Local Rule 32.1.1, with proper notation and service requirements.
Thus, while Cecere does not formally bind future panels, it is a persuasive application of established pleading and ADA principles to a novel (but increasingly common) COVID‑19 vaccine context.
B. The Court’s Legal Reasoning
1. Framing the Inquiry: The Prima Facie ADA Case
Applying Dean, the court reiterates that to state an ADA discrimination claim, a plaintiff must first plead facts showing he is a “qualified individual with a disability.” That is:
- He has a disability as defined by the ADA (actual, record-of, or regarded-as), and
- He meets the essential eligibility requirements of the program, with or without reasonable modifications.
The panel decides the case at the very first step: disability status. If there is no plausibly alleged disability, there is no ADA claim—no matter what else might be said about the university’s conduct.
2. “Assuming Without Deciding” That a COVID‑19 Vaccine Allergy Could Be a Disability
Before applying the statute to Cecere’s factual allegations, the panel takes care to limit the scope of its ruling:
“even assuming (without deciding) that an allergy to any or all COVID‑19 vaccines can constitute a qualifying disability under the ADA …”
This technique—assumption without decision—is significant:
- The court does not resolve the broader legal question whether a genuine COVID‑19 vaccine allergy necessarily qualifies as a disability under the ADA.
- Instead, it proceeds on the narrowest possible basis: even if such an allergy could be a disability, Cecere has failed to plausibly allege that he actually has such an allergy.
Practically, this leaves the underlying doctrinal question open for future cases, but signals that a bona fide allergy might indeed fit within the ADA’s expansive post‑ADAAA understanding of disability—particularly given that episodic conditions (like allergic reactions) can qualify if they would substantially limit a major life activity when active.
3. Evaluating the Complaint’s Allegations
The heart of the opinion lies in its parsing of the complaint’s factual content and its application of the Twombly plausibility standard.
a. Conclusory Allegation of Disability
Cecere’s amended complaint contained the broad statement that:
“Plaintiff was disabled due to his inability to receive the COVID‑19 vaccine.” (Joint App’x at 19.)
The court characterizes this as a conclusory allegation—a mere label that mirrors the statutory language without providing supporting facts. Under Twombly, such allegations are insufficient. A plaintiff must allege:
- Facts showing the existence of a physical or mental impairment, and
- Facts showing how that impairment substantially limits one or more major life activities (although the court here never reaches this second step).
Merely asserting that one is “disabled” because one cannot receive a vaccine collapses the legal conclusion with the factual predicate; it does not itself make that predicate plausible.
b. Specific Allegations of Prior Reactions
The panel then examines Cecere’s more detailed factual allegations:
- His reaction to the meningococcal vaccine (spinal pain and difficulty breathing),
- His childhood anaphylaxis to Motrin, and
- Unspecified “other adverse reactions … in childhood from other vaccinations and medications,” with no further description.
From the court’s perspective, these allegations show a history of medical sensitivities but do not plausibly show:
- That he is allergic to COVID‑19 vaccines specifically, or
- That those prior reactions are medically predictive of similar reactions to any COVID‑19 vaccine.
Critically, the complaint fails to articulate a non‑speculative causal link between prior adverse events and a COVID‑19 vaccine allergy. Without that link, the court treats Cecere’s fear—however subjectively sincere—as conjectural and insufficient under Twombly.
c. Dr. Cleary’s One-Sentence Letter
Because the complaint references Dr. Cleary’s exemption letter, and because that letter is “integral” to Cecere’s claim, the court properly considered its contents. The entire text of the letter is:
“William Cecere has had prior severe allergic reactions to vaccines, including viral vaccines and is unable to get the covid 19 vaccine.” (Joint App’x at 149.)
The panel finds this letter:
- Vague – It references “prior severe allergic reactions” and “viral vaccines” in general, but does not identify:
- Which vaccines caused those reactions,
- What those reactions were (e.g., anaphylaxis, rash, respiratory distress), or
- The basis for connecting them to COVID‑19 vaccines.
- Conclusory – It states that Cecere “is unable to get the covid 19 vaccine” but offers no explanation or medical reasoning.
Notably, the court points out that the letter does not explicitly state:
- That Cecere has an allergy to any COVID‑19 vaccine, or
- That he would likely experience a similar reaction to a COVID‑19 vaccine as to his prior vaccines or medications.
On this basis, the court concludes that the letter—rather than curing the pleading defect—underscores it. A bare medical conclusion (“unable to get the covid 19 vaccine”) without supporting factual detail does not satisfy Twombly’s requirement to move the claim from possible to plausible.
d. Rejection of an Internally Inconsistent Allegation
The opinion contains a key footnote addressing a problematic allegation in the complaint:
Cecere’s amended complaint alleged that Canisius “failed to honor plaintiff’s allergic reaction to the COVID-19 vaccination.” (Joint App’x at 19.)
However:
- Cecere also expressly alleged that he never received any COVID‑19 vaccine.
The court therefore refuses to accept as true the allegation that he had an “allergic reaction” to a vaccine he never received. This illustrates an important limitation on the otherwise generous Rule 12(b)(6) standard:
- Courts must accept as true well‑pleaded factual allegations,
- But they are not required to accept:
- Allegations that are internally inconsistent,
- Allegations that are contradicted by other factual assertions in the complaint or by integral documents, or
- Allegations that are impossible on their face.
This footnote is a useful reminder: plaintiffs cannot overcome a factual gap by inserting assertions that conflict with their own narrative.
4. The Role of Speculation and Risk
Implicit in the court’s reasoning is a distinction between:
- Actual impairment (e.g., a demonstrable allergy to a specific vaccine or class of vaccines), and
- Speculative risk or fear that an impairment might occur in the future without medically grounded support.
Under the ADA, a current physical or mental impairment that would substantially limit a major life activity when active (such as anaphylaxis) can qualify as a disability—even if episodic. But the complaint must plausibly allege that such an impairment exists or is highly likely given known medical facts; mere fear of a potential reaction is not enough.
Here, the Second Circuit finds that Cecere’s allegations did not cross that line from speculation to plausibility, in large part because:
- The prior adverse events were not linked, in the pleadings, to any recognized basis for predicting adverse reactions to COVID‑19 vaccines, and
- Dr. Cleary’s letter added no substantive connective tissue between past reactions and the claimed inability to receive the COVID‑19 vaccine.
5. Unreached Issues: Major Life Activities and Causation
Having concluded that Cecere failed to plausibly allege a COVID‑19 vaccine allergy (and thus an actual impairment), the court explicitly declines to address:
- Whether any major life activity was “substantially limited” by such an impairment, and
- Whether his dismissal from the PA program was “by reason of” any disability.
Those questions remain unaddressed, leaving several doctrinal issues for future, better‑pleaded cases:
- Whether an inability to receive a specific medical treatment (such as a vaccine) substantially limits major life activities like:
- Working in certain fields (e.g., health care),
- Attending educational programs with mandatory clinical components, or
- “Normal cell growth” or “immune function,” which the ADA recognizes as major life activities.
- How to analyze causation (“by reason of” disability) where the institution’s mandate is a broadly applicable health requirement rather than a targeted decision about a particular student.
Because those issues are not reached, Cecere should be understood as a pleading sufficiency decision, not a broad ruling on the substantive scope of disability or the legality of vaccine mandates under the ADA.
C. Impact and Practical Implications
1. Heightened Attention to the Specificity of Medical Allegations
The most immediate impact of Cecere is on how plaintiffs must plead medical exemptions and alleged disabilities arising from vaccine allergies:
- A plaintiff cannot rely on a generalized history of “allergic reactions” to unspecified vaccines and medications.
- A one‑sentence doctor’s note that declares the patient “unable to get” a particular vaccine, without more, is vulnerable to being characterized as conclusory at the pleading stage.
- Counsel should consider including:
- Specifics about prior reactions (nature, severity, timing),
- Identification of the vaccines or medications that caused them, and
- An explanation—preferably grounded in recognized medical reasoning—of why those prior reactions make a similar reaction to the relevant vaccine plausible.
In other words, Cecere signals that courts will not treat a bare medical conclusion as sufficient proof—at the pleading stage—of a specific disability. Facts, not labels (even when spoken by a physician), are what count.
2. ADA Claims and COVID‑19 Vaccine Mandates in Education
For universities and professional programs:
- The decision provides comfort that not every claim of “inability to be vaccinated” will automatically clear the ADA pleading threshold.
- Institutions may continue to require detailed medical documentation supporting requested exemptions without automatically triggering viable ADA claims.
- However, once a plaintiff adequately pleads a genuine vaccine allergy, the institution must then contend with:
- Whether the student is a “qualified” individual (i.e., whether vaccination is an essential requirement), and
- Whether reasonable modifications could be made without fundamentally altering the program or creating an undue burden or direct threat.
For students and trainees in clinical or health-related programs, the case underscores that:
- They must be prepared to present a coherent medical narrative tying their past history to an actual risk from the mandated vaccine, and
- Failing to do so may result in early dismissal of ADA claims, even if state law provides broader or different protections that can still be litigated in state court (as with Cecere’s remanded state-law claims).
3. The Limited but Persuasive Nature of Summary Orders
Because Cecere is a summary order, it does not bind future Second Circuit panels as precedent. Nevertheless:
- It may be cited in future litigation as persuasive authority under Federal Rule of Appellate Procedure 32.1 and Local Rule 32.1.1.
- It offers a detailed, practical example of how Second Circuit panels currently apply:
- Twombly/ Iqbal-style plausibility to ADA claims, and
- The “integral to the complaint” doctrine to consider medical documentation at the motion-to-dismiss stage.
Practitioners should therefore expect district courts within the Circuit to find Cecere persuasive—especially in ADA cases involving alleged medical contraindications to vaccines or other medical requirements.
4. Interplay with State-Law Remedies
The federal ADA claim was dismissed with prejudice, but the district court remanded Cecere’s remaining state-law claims to state court, where:
- New York statutory or common-law disability provisions may differ in scope or standards from the ADA, and
- State courts may be more or less receptive to similar factual allegations, depending on applicable state law and pleading standards.
Thus, while Cecere forecloses his federal ADA claim, it does not necessarily preclude relief under state law. The case therefore reminds litigants to consider a multi-layered strategy (federal and state) when challenging medical mandates.
V. Complex Concepts Simplified
A. What Is a “Disability” Under the ADA?
Under 42 U.S.C. § 12102(1), a “disability” can mean:
- An actual impairment: a physical or mental condition that substantially limits one or more major life activities;
- A record of such an impairment; or
- Being regarded as having such an impairment.
In Cecere, the court focuses only on the actual impairment theory. Cecere alleged that he physically could not safely receive a COVID‑19 vaccine because of a purported allergy. If properly supported, that kind of claim could, in principle, constitute an actual impairment. But the court found that he had not plausibly alleged such an allergy existed.
B. “Substantially Limits” and “Major Life Activities”
Although the court did not reach these issues, a brief explanation helps frame what was left undecided:
- Major life activities include:
- Obvious things like walking, seeing, breathing, working, and learning; and
- Bodily functions such as immune system function and normal cell growth.
- “Substantially limits” is interpreted broadly, after the ADA Amendments Act of 2008, to mean a significant restriction compared to most people in the general population. It does not require that the impairment prevent or severely restrict the activity.
In a future case with better pleadings, a court might consider whether an inability to receive a vaccine that is broadly required for participation in certain fields or settings substantially limits major life activities like working in a chosen profession or attending a clinical program.
C. Rule 12(b)(6) and the Plausibility Standard
A motion to dismiss under Federal Rule of Civil Procedure 12(b)(6) asks whether the complaint, taken as true, states a legal claim that is plausible on its face. This involves:
- Accepting as true:
- Well-pleaded factual allegations.
- Not accepting as true:
- Bare legal conclusions (e.g., “I am disabled”),
- Formulaic recitations of elements, and
- Allegations that are internally inconsistent or contradicted by other parts of the pleadings.
“Plausibility” is more than mere possibility, but less than probability. The question is whether the factual content allows a reasonable inference that the defendant is liable for the misconduct alleged.
D. “Integral to the Complaint” Documents
Courts generally consider only the complaint itself on a Rule 12(b)(6) motion. However, they may also review:
- Documents attached to the complaint as exhibits;
- Documents incorporated by reference in the complaint; and
- Documents “integral” to the complaint—that is, those on which the complaint heavily relies and which are essential to the claim.
In Cecere, Dr. Cleary’s letter is integral because:
- The complaint hinges on the medical exemption it purports to provide, and
- The letter itself is the core documentary expression of Cecere’s claimed vaccine allergy.
This allowed the court to read—and critique—the actual language of the letter at the motion-to-dismiss stage.
E. Summary Orders and Their Effect
A summary order is a disposition by a federal appellate court that:
- Resolves the appeal without a full published opinion,
- Is usually shorter and focused on straightforward application of established principles, and
- In the Second Circuit, “does not have precedential effect”—meaning it does not bind future panels.
Nevertheless, under Federal Rule of Appellate Procedure 32.1:
- Lawyers and courts may cite summary orders as persuasive authority, and
- They must label them as “summary order” and provide copies to pro se parties, as required by local rules.
Thus, Cecere is best understood as a persuasive example of how the Second Circuit currently views ADA pleading requirements in the vaccine-allergy context, not as a definitive, binding rule.
VI. Conclusion
Cecere v. Canisius University is a tightly focused decision that turns entirely on the sufficiency of pleadings under Twombly, but it carries important lessons for ADA litigation in the era of vaccine mandates:
- The court assumes but does not decide that a genuine allergy to COVID‑19 vaccines could constitute a disability under the ADA, leaving that substantive question for future cases.
- It holds that merely alleging an “inability to get the COVID‑19 vaccine,” supported by a brief, conclusory doctor’s note and a generalized history of adverse reactions to other vaccines or medications, does not plausibly allege such an allergy.
- As a result, plaintiffs must provide:
- Concrete, specific factual allegations about prior adverse reactions, and
- A plausible medical basis connecting those reactions to the risk of similar reactions to the mandated vaccine.
- The decision reinforces that courts will:
- Reject internally inconsistent or impossible allegations, and
- Require more than bare labels and conclusions—even when they come from a physician’s pen.
In the broader legal context, Cecere exemplifies how federal courts are likely to scrutinize ADA claims challenging vaccine mandates: the threshold question of disability—and the factual plausibility of the alleged impairment—will be decisive in many cases. Institutions and individuals alike should take note of the level of detail and coherence expected at the pleading stage, particularly when the claimed disability is a medical contraindication to widely required vaccines.
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