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In the United States Court of Federal Claims

OFFICE OF SPECIAL MASTERS

No. 16-97V

Filed: June 20, 2016

* * * * * * * * * * * * * * * 

JACKIE EVANS, * UNPUBLISHED

*

 Petitioner, * Special Master Hamilton-Fieldman

* 

v. * 

* Decision on Proffer; Influenza 

SECRETARY OF HEALTH AND * (“Flu”) Vaccine; Shoulder Injury 

HUMAN SERVICES, * Related to Vaccine Administration

* (“SIRVA”).

Respondent. * 

* * * * * * * * * * * * * * * 

Jeffrey S. Pop, Jeffrey S. Pop, Attorney at Law, Beverly Hills, CA, for Petitioner.

Douglas Ross, United States Department of Justice, Washington, D.C., for Respondent.

DECISION AWARDING DAMAGES1

On January 19, 2016, Jackie Evans (“Petitioner”) filed a petition for compensation under 

the National Vaccine Injury Compensation Program (“the Program”).2

 Petitioner alleged that an 

influenza (“flu”) vaccination administered on September 28, 20133 caused her to suffer from a 

shoulder injury related to vaccine administration (“SIRVA”). On April 18, 2016, the 

undersigned ruled that Petitioner is entitled to compensation for her injury. 

 1 Because this unpublished decision contains a reasoned explanation for the undersigned’s action 

in this case, the undersigned intends to post this decision on the United States Court of Federal 

Claims’ website, in accordance with the E-Government Act of 2002, Pub. L. No. 107-347, § 205, 

116 Stat. 2899, 2913 (codified as amended at 44 U.S.C. § 3501 note (2012)). As provided by 

Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any 

information furnished by that party: (1) that is a trade secret or commercial or financial in 

substance and is privileged or confidential; or (2) that includes medical files or similar files, the 

disclosure of which would constitute a clearly unwarranted invasion of privacy.” Otherwise, 

“the entire” decision will be available to the public. Id.

2 The Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, 42 

U.S.C. §§ 300aa-10 et seq. (hereinafter “Vaccine Act” or “the Act”). Hereafter, individual 

section references will be to 42 U.S.C. § 300aa of the Act.

3 The attached Proffer identifies the date of vaccination as September 18, 2013. However, the 

petition, Respondent’s Rule 4(c) Report, and the entitlement ruling identify the date of 

vaccination as September 28, 2013.
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On June 17, 2016, Respondent filed a Proffer on Award of Compensation (“Proffer”), 

attached hereto as Appendix A. In the Proffer, Respondent represents that Petitioner agrees with 

the proffered award. The undersigned finds the Proffer reasonable and adopts it as the decision 

of the Court in awarding damages, on the terms set forth therein. 

Pursuant to the terms stated in the attached Proffer, the undersigned awards the 

following:

A lump sum payment of $2,647.30, in the form of a check jointly payable 

to Petitioner and to 

Illinois Department of Healthcare and Family Services

Bureau of Collections

Technical Recovery System

PO Box 19174

Springfield, Illinois 62794-9174

Case No. 03-108-0000007716

Petitioner agrees to endorse the payment to the appropriate state agency; 

and

A lump sum payment of $55,000.00, in the form of a check payable solely 

to Petitioner. 

Proffer Section II.

The undersigned approves the requested amount for Petitioner’s compensation. In the 

absence of a motion for review filed pursuant to RCFC Appendix B, the clerk of the court is 

directed to enter judgment herewith.4

IT IS SO ORDERED.

s/Lisa D. Hamilton-Fieldman

Lisa D. Hamilton-Fieldman

Special Master

 4 Pursuant to Vaccine Rule 11(a), entry of judgment is expedited by the parties’ joint filing of 

notice renouncing the right to seek review.
 IN THE UNITED STATES COURT OF FEDERAL CLAIMS

OFFICE OF SPECIAL MASTERS

* * * * * * * * * * * * * * * * * * * * * * * * * * * * 

*

JACKIE EVANS, *

*

Petitioner, *

*

v. * No. 16-97V (ECF)

* SPECIAL MASTER

* HAMILTON-FIELDMAN

SECRETARY OF HEALTH *

AND HUMAN SERVICES, *

*

Respondent. *

* * * * * * * * * * * * * * * * * * * * * * * * * * * * * 

RESPONDENT’S PROFFER ON AWARD OF COMPENSATION

In her April 18, 2016 decision, the Special Master found that a preponderance of the 

medical evidence indicates that petitioner suffered a shoulder injury related to vaccine 

administration (“SIRVA”), which was causally related to the flu vaccination he received on 

September 18, 2013. The parties have now addressed the amount of compensation to be 

awarded in this case. 

I. Compensation

Based upon the evidence of record, respondent proffers that a lump sum of $2,647.30, 

which amount represents reimbursement of a State of Illinois Medicaid lien, should be jointly 

awarded petitioner, who will endorse the payment to the appropriate state agency, and the Illinois 

Department of Healthcare and Family Services. In addition, petitioner should be awarded a lump

sum of $55,000.00, which amount represents all other elements of compensation to which 

Case 1:16-vv-00097-UNJ Document 20 Filed 06/17/16 Page 1 of 3
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petitioner would be entitled under 42 U.S.C. § 300aa-15(a).1 Petitioner agrees. 

II. Form of the Award

The parties recommend that the compensation provided should be made through lump 

sum payments as follows:

a) in the form of a check for $2,647.30, payable jointly to petitioner and to:

Illinois Department of Healthcare and Family Services

Bureau of Collections

Technical Recovery Section

PO Box 19174

Springfield, Illinois 62794-9174

Case No. 03-108-0000007716

Petitioner agrees to endorse the payment to the appropriate state agency; AND

b) in the form of a check for $55,000.00, payable to petitioner.

Respectfully submitted, 

BENJAMIN C. MIZER

Principal Deputy Assistant Attorney General

RUPA BHATTACHARYYA

Director

Torts Branch, Civil Division

CATHARINE E. REEVES 

Acting Deputy Director

Torts Branch, Civil Division

GLENN A. MACLEOD

Senior Trial Counsel

Torts Branch, Civil Division

 1 Should petitioner die prior to entry of judgment, respondent would oppose any award for future 

medical expenses, future lost earnings, and future pain and suffering, and the parties reserve the 

right to move the Court for appropriate relief.

Case 1:16-vv-00097-UNJ Document 20 Filed 06/17/16 Page 2 of 3
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/s/ DOUGLAS ROSS

DOUGLAS ROSS

Trial Attorney

Torts Branch, Civil Division

U.S. Department of Justice

P.O. Box 146, Benjamin Franklin Station

Washington, D.C. 20044-0146

Tel.: (202) 616-3667

DATE: June 17, 2016

Case 1:16-vv-00097-UNJ Document 20 Filed 06/17/16 Page 3 of 3