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# In the United States Court of Federal Claims

OFFICE OF SPECIAL MASTERS

No. 1 6

- 9 7 V

Filed: June 20 , 2016

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

JACKIE EVANS

, * UNPUBLISHED

*

Petitioner, * Special Master Hamilton

- Fieldman

*

v. *

* Decision o n 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 DAMAGES 1

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

the National V accine Injury Compensation Program (“the Program”). 2 Petitioner alleged that an

influenza (“flu”) vaccination administered on September 28, 2013 3 caused her to suffer from a

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

undersigned ruled that Petition er i s 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1 Because this unpublished decision contains a reasoned explanation for the undersigned’s action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 (c odified as amende d 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 fi les, 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 P roffer identifies the date of vaccination as Septem ber 18, 2013. However, the

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

vaccination as September 28, 2013.2 On June 17 , 201 6 , 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 aw ard. The undersigned finds the Proffer reasonable and adopts it as the decision

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

Pursuant to the terms stated in the attached Proffer, the u ndersigned 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

Te chnical R e covery System

PO Box 19174

Springfield, Illinois 62794

- 9174

Case No. 03

- 108

- 00 00007716

Petitioner agrees to endorse the payment to the appro priate state agency;

and

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

to Petitioner.

Proffer Section II

.

The undersigne d 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 herewi th. 4

IT IS SO ORDERED.

s/Lisa D. Hamilton

- Fieldman

Lisa D. Hamilton

- Fieldman

Special Master

4 Pursuant to Vaccine Rule 11(a), entr y 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. 1 6

- 9 7 V (ECF)

* S PECIAL M ASTER

* H AMILTON

- F IELDMAN

SECRETARY OF HEALTH *

AND HUMAN SERVICES

, *

*

Respondent. *

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

R ESPONDENT’S PROFFER ON AWARD OF COMPENSATION

I n her Ap r il 18 , 201 6 decision , the S pecial M aster 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 , 201 3

. The parties have now addres s ed the amount of compensation to be

awarded in this case.

I. Compensation

Based upon the evidence of record, respondent proffer s 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 Health care 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 whi ch Case 1:16-vv-00097-UNJ Document 20 Filed 06/17/16 Page 1 of 32 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 payment s 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

Bu reau 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 33 /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 1 7 , 201 6 Case 1:16-vv-00097-UNJ Document 20 Filed 06/17/16 Page 3 of 3