# In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 20 -810V UNPUBLISHED
LYNN GUSTAFSON , Petitioner, v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Chief Special Master Corcoran Filed: May 6, 2022 Special Processing Unit (SPU); Joint Stipulation on Damages; Tetanus Diphtheria acellular Pertussis (Tdap) Vaccine; Shoulder Injury Related to Vaccine Administration (SIRVA) Jessica Olins, Maglio Christopher & Toale, PA, Seattle, WA , for Petitioner. Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON JOINT STIPULATION 1 

### On July 2, 2020 , Lynn Gustafson filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa
- 10, et seq

. 2 

### (the “Vaccine Act” )

. Petitioner alleges that she suffered a Table injury

– a Shoulder Injury Related to Vaccine Administration (“SIRVA”)

– as a result of a tetanus d iphtheria acellular p ertussis ( “Tdap ” ) vaccination on February 27 , 2019. Petition at ¶¶ 1 , 21 ; Stipulation, fil ed May 5, 2022 , at ¶¶ 1
-2, 4

. Petitioner further alleges the vaccine was administered within the United States, that she suffered the residual effects of her inju ry for more than six months, and that there has been no prior award or settlement of a civil action on her behalf as a result of her injury. Stipulation at ¶¶ 3
- 5; see Petitio n at ¶¶ 1 , 23, 26
-27

. “Respondent denies that [P] etitioner sustained a SIRVA Table injury ; denies that the vaccine caused [P] etitioner’ s alleged left shoulder injury or any other injury , and denies that her current condition is a sequela of a vaccine
- related injury. ” Stipulation at ¶ 6.

1 Because this unpublished D ecision contains a reasoned explanation for the action in this case, I am required to post it on the United States Court of Federal Claims' website in accordance with the E
Government Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic Government Services). This means the D ecision will be available to anyone with access to the internet. In accordance with Vaccine Rule 18(b), Petitioner has 14 days to identify and move to redact medical or other information, the disclosure of which would constitute an unwarranted invasion of privacy. If, upon review, I agree that the identified material fits within this definition, I will redact such material from public access.
2 National Childhood Vaccine Injury Act of 1986, Pub. L. No. 99
- 660, 100 Stat. 3755. Hereinafter, for ease of citation, all section references to the Vaccine Act will be to the p ertinent subpara graph of 42 U.S.C. § 300aa (2012 ).2 

### Nevertheless, on May 5, 2022 , the parties filed the attached joint stipulation, stating that a decision should be entered awarding compensation. I find the stipulation reasonable and adopt it as my decision awarding damages, on the terms set forth therein. Pursuant to the terms stated in the attached Stipulation, I award the following compensation: A lump sum of $ 25,500.00 in the form of a check payable to P etitioner

. Stipulation at ¶ 8. This amount represents compensation for all items of damages that wo uld be available under Section 15 (a). Id

. I approve the requested amount for P etitioner’s compensation. In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of Court is directed to enter judgment in accordance with this decision. 3 

### IT IS SO ORDERED. s/Brian H. Corcoran Brian H. Corcoran Chief Special Master

3 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by the parties’ joint filing of notice renouncing the right to seek review._ ___ · ~ ·· - · . . _, ..,,.,...., • - · ..,_...,, " ., • -'- · vu r,. , --t I vv - uuv1-- I VI .JV/ .JOO\..,'+{

IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS

LYNN GUSTAFSON, Petitioner,
V. No. 20-810V Chief Special Master Corcoran ECF SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent.
STIPULATION The parties hereby stipulate to the following matters: I. Lynn Gustafson ("petitioner") filed a petition for vaccine compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-10 to -34 (the "Vaccine Program")
. The petition seeks compensation for injuries allegedly related to petitioner's receipt

or a tetanus, diphtheria, and acellular pertussis ("Tdap") vaccine, which is a vaccine contained in the Vaccine Injury Table (the " Table"), 42 C.F.R. § 100.3 (a). 2. Petitioner received the Tdap vaccine on February 27, 2019. 3. The vaccination was administered within the United States. 4. Petitioner alleges that she sustained a left shoulder i[ljury related to vaccination administration ("SIRVA") within the time period set forth in the Table following administration of the Tdap vaccine , or in the alternative, that her alleged shoulder i11jury was caused by the Tdap vaccine. She further alleges that she experienced the residual effects of this alleged it~w-y for more than six months. 5. Petitioner represents that there has been no prior award or settlement of a civil action...................... ~• • L...1 .vc1v1..1c Iu. uu-.,,....,u I oL-uof'\1-q, oo-ooot:- I U/ ..}U / jt:Sbl,.;4 /



### for damages on her behalf as a result of her alleged it~ury or condition. 6. Respondent denies that petitioner sustained a SIRVA Table i11jury; denies that the vaccine caused petitioner's alleged left shoulder injury or any other iqjury, and denies that her current condition is a sequela of a vaccine-related injury. 7. Maintaining their above-stated positions. the parties nevertheless now agree that the issues between them shall be settled and that a decision should be entered awarding the compensation described in paragraph 8 or this Stipulation. 8. As soon as practicable after an ent1y of judgment reflecting a decision consistent with the terms of this Stipulation, and after petitioner has filed an election to rccei\·c compensation pursuant to 42 U.S.C. § 

### 300aa-21(a)(I). the Secretary of Health and lluman Services will issue the following vaccine compensation payment: A lump sum of $25.500.00 in the form of a check payable to petitioner. This ammmt represents compensation tor all damages that would be available w1der 42 U.S.C. § 

### 300aa-15(a). 9. As soon as practicable after the entry of judgment on entitlement in this case, and after petitioner has filed both a proper and timely election to receive compensation pw-suant to 42 U.S.C. § 

### 300aa-2l(a)(I), and an application, the parties will submit to further proceedings before the special master to award reasonable attorneys· fees and costs incurred in proceeding upon th.is petition. 10. Petitioner and her attorney represent that compensation to be provided pw-suant to this Stipulation is not for any items or services for which the Program is not primarily liable under 42 U.S.C. 

### § 300aa-15(g). to the extent that payment has been made or can reasonably be expected to be made under any State compensation programs , insurance policies. Federal or State health benefits programs (other than Title XIX of the Social Security Act (42 U.S.C.



### 2- - r - · -· --- • ,...,, ..... ._ .., ..,, ~ , .,. , ....,v - v v uL...-1UI.JV/"D U V't f

§ 1396 et seq.)), or by entities that provide health services on a pre-paid basis. 11. Payment made pursuant to paragraph 8 of this Stipulation and any amounts awarded pursuant to paragraph 9 of this Stipulation will be made in accordance with 42 U.S. C. § 300aa15(i), su~ject to the availability of sufficient statutory funds. 12. The parties and their attorneys further agree and stipulate that, except for any award for attorneys' fees and litigation costs, and past unreimbursed expenses , the money provided pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a strict construction of42 U.S.C. § 300aa-15(a) and (d), and subject to the conditions of42 U.S.C. § 300aa-15(g) and (h). 13. In return for the payments described in paragraphs 8 and 9, petitioner, in her individual capacity, and on behalf of her heirs, executors, administrators, successors or assigns, does forever irrevocably and unconditionally release, acquit and discharge the United States and the Secretary of Health and I Iuman Services from any and all actions or causes of action (including agreements, judgments, claims, damages, loss of services, expenses and all demands of whatever kind or nature) that have been brought, could have been brought, or could be timely brought in the Colll't of Federal Claims, under the National Vaccine h~ury Compensation Program, 42 U .S.C. § 300aa-10 et seq., on account of, or in any way growing out of, any and all known or unknown, suspected or unsuspected personal i11juries to or death of petitioner resulting from, or alleged to have resulted from, the Tdap vaccination administered on February 27, 2019,
as alleged by petitioner in a petition for vaccine compensation filed on or about July 2 , 2020 , in the United States Court of Federal Claims as petition No. 20-81 0V. 14
. If petitioner should di e prior to entry of judgment , this agreement shall be voidable upon proper notice to the Court on behalf o f either or both of the parties
.

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### 15. If 

### the special master fails to issue a decision in complete conformity with the terms of this Stipulation or if the Comt of Federal Claims fails to enterjudgment in conformity with a decision that is in complete conformity with the terms of this Stipulation. then the parties' settlement and this Stipulation shall be voidable at the sole discretion of either party. 16. This Stipulation expresses a full and complete negotiated settlement of liability and damages claimed under the National Childhood Vaccine Injury /\ct of 1986, as amended. except
as otherwise noted in paragraph 9 above. There is absolutely no agreement on the part of the parties hereto to make any payment or to do any act or thing other than is herein expressly stated and clearly agreed to. The parties further agree and understand that the :m ·ard described in this Stipulation may reflect a compromise of the parties' respective positions as to liability and/or amount or damages. and further, that a change in the nature of the i11jury or condition or in the items of compensation sought. is not grounds to modify or revise this agreement. 17. 

### This Stipulation shall not be construed as an admission by the United States or the Secretary of Health and I Tuman Services that the Tdap vaccine caused petitioner's alleged iqjury
or any other injury or her current condition, or that petitioner suffered an injury contained in the Vaccine Ii~ury Table. 18. 

### All rights and obligations of petitioner herew1der shall apply equally to petitioner's heirs, executors, administrators, successors. and/or assigns.

I I I I I I I / 

### END OF STIPULATION

4-- - · · - '

- - -- · .. I'..,...., VVVL. - I u, ,JU/ .JUUV't /

Rcspectf ully submitted, PETITIONER:

ATTORNEY OF RECORD FOR PETJTIONER: 

# /{:f_

- ( 

# / /------ · .JESS(c / OLINS, ESQ. Magi~ Christopher & Toale Law Firm 1015 15th St NW, Suite 1125 Washin1:,rton, D.C. 20005 888-952-5242 jolins e, mctlaw.com

AUTHORIZED REPRESENTATIVE OF THE SECRETARY OF HEALTH AND HUMAN SERVICES: 

### George R. Grimes - D ig itally signed by George R. Grimes - 514 S14 D ate: 2022.04.13 04:57:34 -04'00' CDR G E ORGE REED GRIMES, MD, MPH Director, Division of Injury

Compensation Programs I Iealthcare System Bureau Health Resources and Services

Administration U
. S. Department of Health

and Human Services 5600 Fishers Lane, 08N 146B Rockville , MD 20857

Dated: 

# _s_/

# <

# l -i &

,_ 1 -- , - ~ - - - - A UTH ORIZED REPRESENTATIVE OF THE ATTORNEY GENERAL:

# ~~~**~** HEATHER 

### L. PEARLMAN Deputy Director Torts Branch Civil Division U.S. Department of Justice P.O. Box 146 Bc1~amin Franklin Station Washington, DC 20044-0146
ATTORNEY OF RECORD FOR RESPONDENT:

Trial Attorney Torts Branch Civil Division U
. S. Department of Justice P.O
. Box 146 Be1~jamin Franklin Station Washington, DC 20044-0146 202-616-4179 alexa.roggenkamp @ usdoj.gov



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