In the United States Court of Federal Claims 

OFFICE OF SPECIAL MASTERS

No. 20-1246V

UNPUBLISHED

KARA COUCH,

 Petitioner,

v.

SECRETARY OF HEALTH AND 

HUMAN SERVICES,

 Respondent.

Chief Special Master Corcoran 

Filed: April 7, 2022

Special Processing Unit (SPU); 

Ruling on Entitlement; Findings of 

Fact; Prior Pain; Onset; Influenza 

(Flu); Shoulder Injury Related to 

Vaccine Administration (SIRVA).

John Robert Howie, Howie Law, PC, Dallas, TX, for Petitioner.

Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent.

RULING ON ENTITLEMENT1

On September 22, 2020, Kara Couch 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 as a result of an influenza (“flu”) vaccine received 

on September 24, 2019, she suffered a shoulder injury related to vaccine administration

(“SIRVA”) as defined on the Vaccine Injury Table (the “Table”). Petition (ECF No. 1) at 

Preamble. The case was assigned to the Special Processing Unit (“SPU”) of the Office of 

Special Masters. 

1 Because this unpublished ruling contains a reasoned explanation for the action in this case, I am required 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 Ruling 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

For the reasons discussed below, I find it most likely that Petitioner’s shoulder 

injury would not be explained by her prior medical history, that she suffered the onset of 

shoulder pain specifically within 48 hours, and that she is otherwise entitled to 

compensation. Accordingly, Petitioner’s Motion to Deem the SIRVA Table Elements are 

Satisfied (ECF No. 23) is granted.

I. Relevant Procedural History

The petition was filed with all required medical records as well as affidavits from 

Petitioner and two other witnesses. The claim was quickly determined to be sufficiently 

complete and assigned to the SPU in October 2020. 

In February 2021, Respondent provided a preliminary review of the case, asserting

that the medical records suggested that the shoulder injury at issue pre-dated vaccination. 

Status Report (ECF No. 19). Petitioner promptly filed a response. Petitioner’s 

Memorandum (ECF No. 20). I confirmed that the case would remain in SPU for that time. 

Scheduling Order (ECF No. 21). 

In April 2021, Petitioner duly transmitted a demand to Respondent (see ECF No. 

22), and additionally filed a “Motion to Deem SIRVA Table Elements Are Satisfied.” 

Petitioner’s Motion (ECF No. 20). At an April 26, 2021, status conference, the parties were 

informed that I would deny the motion without prejudice, since I deemed it somewhat 

premature. However, I also noted that from my preliminary review of the case, it appeared 

that the pre-vaccination records of shoulder pain were temporally remote, and thus 

unlikely to be fatal to that element of her Table SIRVA claim. Additionally, although 

Petitioner initially delayed treatment for her post-vaccination shoulder pain, there was 

evidence indicating onset within 48 hours. Scheduling Order (ECF No. 25). 

Respondent entered into settlement discussions on October 21, 2021, but the 

parties reached an impasse just two weeks later. Status Reports (ECF Nos. 31-32). On 

December 23, 2021, Respondent filed his formal report opposing compensation based 

on the issues mentioned above (prior pain and onset). Rule 4(c) Report (ECF No. 33). I 

allowed Respondent to file a supplemental Response addressing Petitioner’s earlier 

briefing as well as the affidavits, which were not acknowledged in his report. See 

Scheduling Order (ECF No. 34); Response (ECF No. 35). On February 10, 2022, 

Petitioner filed a Reply (ECF No. 36). The matter is now ripe for adjudication.
3

II. Authority

Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a 

preponderance of the evidence, the matters required in the petition by Vaccine Act 

Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis, 

conclusion, judgment, test result, report, or summary concerning the nature, causation, 

and aggravation of petitioner’s injury or illness that is contained in a medical record. 

Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy 

evidence. The records contain information supplied to or by health professionals to 

facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in 

the balance, accuracy has an extra premium. These records are also generally 

contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993 

F.2d 1525, 1528 (Fed. Cir. 1993). 

Accordingly, where medical records are clear, consistent, and complete, they 

should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-

1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule 

does not always apply. “Written records which are, themselves, inconsistent, should be 

accorded less deference than those which are internally consistent.” Murphy v. Sec’y of 

Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25, 

1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd 

per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as 

incorrect the presumption that medical records are accurate and complete as to all the 

patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378, 

1383 (Fed. Cir. 2021). 

The United States Court of Federal Claims has outlined four possible explanations 

for inconsistencies between contemporaneously created medical records and later 

testimony: (1) a person’s failure to recount to the medical professional everything that 

happened during the relevant time period; (2) the medical professional’s failure to 

document everything reported to her or him; (3) a person’s faulty recollection of the events 

when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did 

not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013), 

aff’d, 746 F.3d 1335 (Fed. Cir. 2014).

The Court has also said that medical records may be outweighed by testimony that 

is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y 

of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health 

& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998). 

The credibility of the individual offering such fact testimony must also be determined. 
4

Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley 

v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).

A special master may find that the first symptom or manifestation of onset of an 

injury occurred “within the time period described in the Vaccine Injury Table even though 

the occurrence of such symptom or manifestation was not recorded or was incorrectly 

recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may 

be made only upon demonstration by a preponderance of the evidence that the onset [of 

the injury] . . . did in fact occur within the time period described in the Vaccine Injury 

Table.” Id. 

The special master is obligated to fully consider and compare the medical records, 

testimony, and all other “relevant and reliable evidence contained in the record.” La 

Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v. 

Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within 

the special master’s discretion to determine whether to afford greater weight to medical 

records or to other evidence, such as oral testimony surrounding the events in question 

that was given at a later date, provided that such determination is rational).

III. Factual Evidence

I have fully reviewed the evidence, including all medical records and affidavits. The 

evidence most relevant to my analysis is presented below:

• Petitioner Kara Couch was 35 years old upon receiving the subject vaccination on 

September 24, 2019. In the preceding three years, she periodically sought medical 

care, which is largely irrelevant (but for what is specifically addressed herein). See 

generally Ex. 5, 7.

• On November 12, 2017 (and hence two years prior to the relevant vaccination),

Petitioner attended a primary care appointment to address “anxiety.” Ex. 4 at 4. 

Petitioner reported pain that “seemed to shift location – sometimes it is in her 

shoulders, sometimes in her throat, sometimes under her ribs, sometimes in the 

front of her chest.” Id. The pain was “intermittent... occur[ring] daily or... several 

times a week,” and “seem[ed] to last most of the day when [it did] occur.” Id. The 

pain had been present “for the past couple of months... since her father died 

suddenly of a heart attack at the age of 55.” Id. She denied symptoms with 

exercise. Id.

• The physician’s assistant (“PA”) recorded an unremarkable physical exam, without 

specifically addressing the shoulders or the musculoskeletal system. Ex. 4 at 4. 

The initial assessment was “chest pain, unspecified type.” Id. The PA and a 

supervising physician reviewed an EKG, deeming its results inconclusive (“reads 
5

ST junction depression... we are not seeing this when we read it...”). Id. at 5.

Petitioner was referred to cardiology “due to her family hx [history],” prescribed 

Celexa “for anxiety,” and instructed to follow up in four to six weeks. Id.

• On December 1

, 2017, Petitioner saw a cardiologist. Ex. 6 at 3. There is no patient 

questionnaire or history of present illness; the appointment reason was “chest 

discomfort.” Id. The record notes that Petitioner had never smoked cigarettes, but 

her father had suffered from premature coronary artery disease. Id. at 4. On a 

treadmill exercise test, Petitioner walked for eleven minutes, escalating to 4.2 miles 

per hour at a grade of 16%, then stopped either due to fatigue or because she 

achieved the target heart rate. Id. at 8, 27. There is no physical exam, assessment, 

or plan. The cardiologist instructed Petitioner to follow up in three months, but there 

are no further records. Id. at 6.

• At the next medical encounter (a December 20th primary care follow-up 

appointment), the same PA recorded that Petitioner’s chest pain, “sensation of 

lump in throat,” and stress were improving, without starting the prescription for 

Celexa. Ex. 4 at 6. Petitioner opted to “monitor sx [symptoms] for now.” Id. The PA 

maintained the assessment of “Chest pain, unspecified type.” Id.

• There is no evidence that Petitioner experienced any of the above complaints, or 

left shoulder pain, inflammation, or dysfunction, over the next 21 months.3

• On Tuesday, September 24, 2019, a pharmacy employee administered the subject 

flu vaccine into Petitioner’s left deltoid muscle. Ex. 2 at 3.

4

• The next medical encounter is from 14 days later, on Tuesday, October 8th, when 

Petitioner presented for an annual gynecological examination. Ex. 8 at 8. She 

provided a history pertaining to the listed categories of “bowels/ bladder, gyn, sex, 

bc, mamm, and pap.” Id. She “denie[d] complaints today” and requested a refill of 

one prescription medication. Id. The gynecologist examined her neck, heart, lower 

extremities, breasts, abdomen, and pelvis. Id. The encounter was unremarkable 

overall and lacked any reference to the left upper extremity. Id. at 8-9.

• The next medical encounter is from 15 weeks and two days post-vaccination, on 

Thursday, February 10, 2020, when Petitioner presented to the primary care PA5

to address left shoulder pain present “since the end of September... immediately 

following a flu vaccine that was given close to the shoulder joint.” Ex. 4 at 8. The 

pain was “constant and occasionally sharp... worse with trying to raise her arm up 

3 See, e.g., Ex. 7 at 7-8 (April 27, 2018, urgent care encounter for assessment of upper respiratory 

infections); Ex. 8 at 5-7 (July 23, 2018, annual gynecological examination).

4 During the same encounter, the pharmacy employee administered a hepatitis A vaccination into 

Petitioner’s right deltoid muscle. Ex. 2 at 2.

5 The same PA saw Petitioner in November 2017 and in February 2020. Ex. 4 at 4-5, 6-7, and 8-9.
6

or trying to lift or grab things... pain does not improve much with ibuprofen. She 

feels like there is atrophy of the shoulder.” Id.

• On exam, the PA documented tenderness on palpation of the left upper trapezius 

and rotator cuff tendons, as well as deltoid atrophy. Ex. 4 at 8. External and internal 

rotation of the left shoulder elicited pain. Id. The PA suspected rotator cuff tendinitis

and subacromial bursitis. Id. at 9. She prescribed the non-steroidal antiinflammatory drug (“NSAID”) meloxicam; printed materials on exercises for 

Petitioner to perform at home; and planned imaging and potentially EMG/NCV 

studies if the pain did not improve. Id. That same day, an x-ray of the left shoulder 

was unremarkable. Id. at 10. 

• The PA ordered a February 18th MRI of the left shoulder which visualized intact 

tendons, no abnormal fluid in the subacromial/ subdeltoid bursa, and an intact 

acromioclavicular joint. Ex. 10 at 11. The MRI did visualize “a 7 mm osteochondral 

lesion involving the lateral aspect of the greater tuberosity with extensive 

surrounding marrow edema,” which required clinical correlation. Id.

• On referral from the primary care practice, on March 9th, Petitioner had an initial 

consult at Bluegrass Orthopedics. Ex. 9 at 3. Petitioner reported “lateral left 

shoulder pain since September... since being injected with a flu shot.” Id.6 On 

exam, the left shoulder was painful with movement. Id. at 4. Ryan Patrick Donegan, 

M.D., reviewed the MRI and ordered lab work including a rheumatoid panel to rule 

out “infection of [or?] any inflammatory process that may be causing this.” Id. at 5.

• One week later, Dr. Donegan recorded that Petitioner was doing about the same,

and that the lab work had been unremarkable. Ex. 9 at 4. He asked a colleague, 

Owen McGonigle, M.D., for a second opinion. Id.

• At the second orthopedics consult on March 18th, Petitioner reported that her left 

shoulder injury resulted from the September 24th flu vaccination, which was 

“administered very proximal on her shoulder.” Ex. 9 at 9, 11. Petitioner reported 

that she had pain “immediately after the administration [which...] gradually 

increase[ed] over the next several hours until she had significant symptoms.” Id.

Petitioner denied numbness or tingling down the arm. Id.

On exam, Dr. McGonigle recorded mild tenderness to palpation over the bicipital 

groove and positive impingement signs. Id. at 12. Dr. McGonigle recorded that the 

MRI “show[ed] significant inflammation along the greater tuberosity laterally,” and

that Petitioner’s left shoulder pain was “consistent with shoulder injury related to 

6 Within the orthopedics records, the active problems and chief complaint sections refer to the right upper 

arm and humerus. Ex. 9 at 3, 7. This is likely incorrect, because the rest of this record, like the rest of the 

case file, reflects only concerns and treatment pertaining to Petitioner’s left vaccinated arm.
7

vaccine administration (SIRVA).”7Id. Dr. McGonigle recorded that the limited 

available literature supported that this injury can be prolonged, but cortisone 

injections may help – and therefore, he proceeded to administer a cortisone 

injection to Petitioner. Id. Dr. McGonigle reviewed case reports of arthroscopic 

debridement sometimes being beneficial, but he did not believe Petitioner to be a 

candidate at that point. Id. Petitioner would follow up in three months. Id.

• At the June 17th follow-up with Dr. McGonigle, Petitioner reported that since 

receiving the cortisone injection and performing home exercises, her symptoms 

had been “gradually improving.” Ex. 13 at 4. She was currently “about 65 – 70 

percent better.” Id. Dr. McGonigle documented improved range of motion and 

strength, with decreased pain. Id.

• At the next and final follow-up appointment on September 18th, Dr. McGonigle 

reviewed that Petitioner had “not changed much since her last visit.” Ex. 14 at 8. 

She had full range of motion and good strength, but persistent aching pain. Id.

After a long discussion about the treatment options including further cortisone 

injections, surgical intervention, and formal physical therapy, Petitioner expressed 

that she was “managing okay” with home-based therapy. Id. Dr. McGonigle 

recorded that according to the available literature on SIRVA, “some people never 

did fully recover from this.” Id. He directed Petitioner to follow up as needed. Id. 

• Petitioner has not filed any further records, from the orthopedics practice or any 

other medical providers, that would evidence any further complaints or treatment 

for the injury alleged.

• In an affidavit dated September 22, 2020, Petitioner recalls that her “diffuse chest 

pain was radiated into my bilateral shoulders subsided after I began to be able to 

manage the profound grief and overwhelming stress I was experiencing from 

having just lost my father” in 2017. Ex. 1 at ¶ 3. She states that these symptoms 

in 2017 were “entirely different” than her post-vaccination left shoulder pain. Id.

• Petitioner recalls that her pain began immediately upon vaccination and increased 

to the point that she left work early that day. Ex. 1 at ¶ 4.8 She initially assumed 

that the pain was “routine, albeit much worse” and would “eventually resolve on its 

own.” Id. After trying to manage the pain on her own and relying on family members

for assistance with household tasks, after over four months, she finally decided to 

7 The available evidence does not demonstrate that Petitioner was aware of SIRVA or the Vaccine Program 

at this time. The attorney of record began requesting the medical records on her behalf approximately one 

month later. See, e.g., Ex. 4 at 1; Ex. 6 at 2.

8

In his supplemental Response Brief, Respondent requests that Petitioner produce her employment record 

from 2019 to verify that she took leave from her employment due to shoulder pain. Response at n. 2. 

Respondent also suggests that such evidence would “easily corroborate” her shoulder pain.” Id. at 7. I do 

not find such evidence to be material towards resolving entitlement (or for that matter, damages, given that 

Petitioner is not seeking reimbursement for lost wages).
8

seek medical attention. Id. at ¶¶ 4-7. She also states that she did not discuss her 

left shoulder with her gynecologist because such appointments “typically only 

discussed female health issues,” and because this encounter occurred only two 

weeks after vaccination, at which point she believed the pain would resolve on its 

own. Id. at ¶ 5.

• One of Petitioner’s coworkers also filed an affidavit, dated September 13, 2020. 

Ex. 10. She recalls that a local pharmacy provided vaccinations at their place of 

employment on September 24, 2019. Id. at ¶ 2. She recalls that afterwards, 

Petitioner discussed how badly her flu vaccination hurt; how much pain she was 

experiencing at the site; and that the vaccination was administered unusually high 

on her arm. Id. The coworker also recalls that Petitioner’s pain persisted for “days 

and weeks” until she eventually sought medical attention. Id. at ¶ 5.

• Petitioner’s mother, in an affidavit dated September 17, 2020, recalls speaking on 

the phone on the day of vaccination about her “excruciating” pain, and helping her 

sometime thereafter with household cleaning. Ex. 11.

• In Petitioner’s second affidavit dated January 4, 2021, she avers that she cannot 

locate any further non-medical evidence relevant to onset. Ex. 15 at ¶ 15.

IV. First Issue

The first issue to be resolved is whether Petitioner had a “history of pain, 

inflammation, or dysfunction of the affected shoulder prior to intramuscular vaccine 

administration that would explain the alleged signs, symptoms, examination findings, 

and/or diagnostic studies occurring after vaccine administration.” 42 C.F.R. § 

100.3(c)(3)(10)(i).

The medical records reflect that prior to vaccination, Petitioner had a severalmonth history of intermittent pain which was recorded as being primarily in her chest, but 

also “shifted” to her ribs, throat, and bilateral shoulders There is no evidence of 

accompanying shoulder “dysfunction,” however. Within the contemporaneous medical 

records, Petitioner attributed the pain to acute anxiety following her father’s unexpected 

death. Her medical providers accepted that explanation. The very limited medical records 

relating to this pre-vaccination health condition suggest that the symptoms resolved in or 

around December 2017 and did not resume in the 21 months leading up to her 

vaccination. Petitioner’s affidavit merely provides additional support for that conclusion.

In comparison, Petitioner’s post-vaccination pain was limited to her left shoulder 

and upper arm, persistent, and worse with movement. She was documented to have 

tenderness to palpation and positive impingement signs. The clinical findings coupled 

with an MRI of the left shoulder led to an assessment of localized inflammation. She was 
9

treated with meloxicam and a cortisone injection. Finally, I note that the same primary 

care provider treated both complaints and viewed them distinctly – contrary to

Respondent’s contentions that the two complaints are “similar,” Rule 4(c) Report at 5, and

that there is “no medical evidence” to distinguish them, Supplemental Response at 6.

Accordingly, and after reviewing the evidence, there is preponderant support for 

Petitioner’s argument that no “nexus” exists between these two isolated medical events -

and therefore the prior pain “would not explain” her post-vaccination injury. Petitioner’s 

Motion at 6.

Similarly, Respondent contends that the prior history “suggests” the presence of 

another “condition or abnormality... (e.g., NCS/ EMG or clinical evidence or 

radiculopathy, brachial neuritis, mononeuropathies, or any other neuropathy).” Rule 4(c) 

Report at 6; 42 C.F.R. § 100.3(c)(3)(10)(iv). But there is insufficient evidence of such a 

condition, let alone one “that would explain” Petitioner’s post-vaccination injury. 42 C.F.R. 

§ 100.3(c)(3)(10)(iv). Rather, this set of symptoms is distinguishable.

V. Second Issue

The second issue for resolution is whether Petitioner’s left shoulder pain began 

within 48 hours after vaccination, as required for a Table SIRVA. 42 C.F.R. §§ 

100.3(a)(XIV)(B); (c)(10)(ii). 

There is a medical record from 14 days after vaccination that does not document 

left shoulder pain – but it pertains to an encounter for an annual gynecological 

examination. It would not normally be expected that a medical specialist would check for 

complaints well outside of his or her expertise. An “intervening medical encounter with a 

specialist (whose practice is generally unrelated to the musculoskeletal system or pain 

management) is not enough to disprove onset”. Dempsey v. Sec’y of Health & Hum. 

Servs., No. 18-0970, 2021 WL 1080563, at *4 (Fed. Cl. Spec. Mstr. Feb. 17, 2021) 

(emphasis in the original), cited in Petitioner’s Reply at 11. In Ms. Couch’s case, this 

particular record reflects a focused exam that does not address the shoulder. Thus, this 

particular record is not strong proof rebutting Petitioner’s onset allegations.

The fact of a 15-week delay before seeking medical treatment is more troubling –

but it does not disprove onset per se. Petitioner’s Reply at 12 (citing, e.g., O’Leary v. 

Sec’y of Health & Hum. Servs., No. 18-584V, 2021 WL 3046617, at *11 (Fed. Cl. Spec. 

Mstr. June 24, 2021) and Smallwood v. Sec’y of Health & Hum. Servs., No. 18-291, 2020 

WL 2954958, at *10 (Fed. Cl. Spec. Mstr. Apr. 29, 2020) (“[i]t is often common for a SIRVA 

petitioner to delay treatment, thinking his/ her injury will resolve on its own.”)). Ms. Couch 

explained that she initially hoped that her symptoms would self-resolve. This behavior is 
10

similar to her waiting “several months” before seeking medical treatment for her chest 

pain in 2017. Although this delay does weigh against total injury severity (for purposes of 

calculating damages), it does not prevent a favorable onset determination, absent 

additional evidence (for example, a medical record identifying onset outside the 48-hour 

period, or a much longer delay, punctuated by repeated treater visits where shoulder pain 

could more arguably have been addressed).

The medical records consistently reflect a history of left shoulder pain which began 

immediately upon vaccination, worsened over the subsequent hours, and persisted for 

months. It has been recognized that information contained within medical records, 

including “information supplied to... health professionals” is trustworthy, because it is 

intended to facilitate diagnosis and treatment and it is generally supplied shortly after the 

events in question. Cucuras, 993 F.2d at 1528.9 And Petitioner has provided additional 

support by way of supporting witness affidavits, particularly from the coworker who recalls 

her complaints beginning on the same day the vaccinations were administered in their 

workplace. In the absence of any evidence supporting a contrary onset, I find that onset 

was most likely within 48 hours. 42 C.F.R. § 100.3(c)(10)(iii).

VI. Other Table Requirements and Entitlement

In light of the lack of additional objections and my own review of the record, I find 

that Petitioner has established the other requirements for a Table SIRVA claim. 

Specifically, the vaccine administration record reflects the site of administration as the left 

deltoid. Sections 11(c)(1)(A) and (B)(i); Ex. 2 at 3, 4. Petitioner’s pain and reduced range 

of motion were limited to the affected shoulder. C.F.R. § 100.3(c)(3)(10)(iii). She suffered 

residual effects of the injury for more than six months. Section 11(c)(1)(D)(i); Ex. 14 at 8.

She has not pursued a civil action or other compensation. Ex. 1 at ¶ 12; Section 

11(c)(1)(E). Thus, she has satisfied all requirements for entitlement under the Vaccine 

Act.

9 Respondent also suggests that Petitioner must produce “objective findings from a physician documenting 

the presence of shoulder pain in the days immediately following vaccination.” Response at 7. I have 

previously rejected this argument. See, e.g., Niemi v Sec’y of Health & Hum. Servs., 19-1535, 2021 WL 

4146940, at *4 (Fed. Cl. Spec. Mstr. Aug. 10, 2021) (reasoning that the Vaccine Act “clearly does not

require” such evidence).
11

VII. Conclusion and Damages Order

Based on the entire record, I find that Petitioner has provided preponderant 

evidence satisfying all requirements for a Table SIRVA. Petitioner is entitled to 

compensation. Thus, this case is now in the damages phase.10

Petitioner shall file a status report updating on the parties’ progress towards 

informally resolving damages by no later than Monday, May 23, 2022.

11

IT IS SO ORDERED.

s/Brian H. Corcoran

Brian H. Corcoran

Chief Special Master

10 The parties are reminded that in Vaccine Act cases, damages issues are typically resolved 

collaboratively. Therefore, the parties should begin actively discussing the appropriate amount of 

compensation in this case. In many cases, damages can be resolved by Petitioners communicating a 

demand to Respondent, who may agree to the demand or may make a counter-offer. 

The parties shall not retain a medical expert, life care planner, or other expert without consulting with 

each other and the Chief Special Master. If counsel retains an expert without so consulting in advance, 

reimbursement of those costs may be affected.

11 Petitioner previously confirmed that the case does not involve a lost wages claim, a worker’s 

compensation claim, or a Medicaid lien. ECF No. 15. On April 5, 2021, she conveyed a demand for pain 

and suffering and out of pocket expenses. ECF No. 22. The parties briefly engaged in settlement 

discussions before reaching an impasse in fall 2021. Respondent’s attorney of record has since changed.