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UNPUBLISHED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 STIPULATION1

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 diphtheria acellular 

pertussis (“Tdap”) vaccination on February 27, 2019. Petition at ¶¶ 1, 21; Stipulation, filed 

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 injury 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 Petition 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1 Because this unpublished Decision contains a reasoned explanation for the action in this case, I am 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 EGovernment Act of 2002. 44 U.S.C. § 3501 note (2012) (Federal Management and Promotion of Electronic 

Government Services). This means the Decision 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 pertinent subparagraph 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 Petitioner. 

Stipulation at ¶ 8. This amount represents compensation for all items of damages 

that would be available under Section 15(a). Id. 

I approve the requested amount for Petitioner’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.
_ ___ ·~ ·· - · . . _, ..,,.,...., •- · ..,_...,, " ., • -'-· vur,. , --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/"DU 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 die prior to entry of judgment, this agreement shall be voidable 

upon proper notice to the Court on behalf of either or both of the parties . 

.... 

.} 
- .,...., _ _, ,::,•• ._,,,,..,.,..,t-'t.; '"""' · VLJUr"'\V I uL-VUf"'\I -"-ti .JV•OOUC- 1 Uf .:>UI .)O0\...,t+I 

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 enter judgment 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 HEAL TH 

AND HUMAN SERVICES: 

George R. Grimes - Digitally signed by George R. 

Grimes -514 

S 14 Date: 2022.04.13 04:57:34 -04'00' 

CDR GEORGE 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 ORI ZED REPRESENTATIVE 

OF THE ATTORNEY GENERAL: 

~~~ 

Deputy 

HEATHER 

Director 

L. PEARLMAN 

~ 

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 

5