# ORIGIN l 3ln tbe Wniteb**~tate~ ~ourt**  

# ofjf 

# eberal**~laim~** OFFICE OF SPECIAL MASTERS No. 16-407V Originally Filed: January 5, 2017 Refiled in Redacted Form: January 10, 2017 Not for Publication 

### ************************************* S.B., 

# FILED JAN 10 

## 2017 U

.S

. COURT OF FEDERAL CLAI MS



### Petitioner,
V. 

### SECRET ARY OF HEALTH AND HUMAN SERVICES, 

# * * 

# * * 

# * * * * * * 

# * * Damages and costs decision based on stipulation; Tetanus, diphtheria, · and acellular pertussis ("Tdap") vaccine; shoulder injury related to vaccine administration ("SIRVA")
Respondent. 

### ************************************* S.B., Chicago, IL,

### prose. Debra A. 

### Filteau Begley, Washington, DC, for respondent. MILLMAN, Special Master DECISION AWARDING DAMAGES AND LITIGATION COSTS 1 

### On January 4, 2017, the parties filed the attached stipulation in which they agreed to settle this case and described the settlement terms
. Petitioner received Tetanus, diphtheria, and acellular pertussis ("Tdap") vaccine on July 1, 2014

. Petitioner alleges thatherreceipt ofthe Tdap vaccine caused her to suffer a shoulder injury related to vaccine administration ("SIRVA"). Petitioner further alleges that she experienced the residual effects ofthis injury for more than six months. Respondent denies that petitioner's SIRVA, or any other injury, was caused by her Tdap vaccination. Nonetheless, the parties agreed to resolve this matter informally.

1When this decision was originally filed the undersigned advised her intent to post it on the United States Comt ofFederal Claims' website, in ac. cordance with the E-GovernmentAct of2002. 44 U.S.C. 

### § 3501 note (2012) (Federal Management and Promotion ofElectronic Government Services). In accordance with Vaccine Rule l 8(b), petitioner filed a timely motion to redact certain information

. This decision is being reissued without petitioner's full name. The stipulation attached to this decision has also been redacted to remove petitioner's name, signature, and address. Except for those changes and this footnote, no other substantive changes have been made. This decision will be posted on the court's website with no further opportunity to move for redaction. 

## REISSUED FOR PUBLICATION JAN 10 2017 OSM U.S. COURT OF FEDERAL CLAIMS

### The court finds the terms ofthe stipulation to be reasonable, adopts the parties' stipulation, and awards compensation in the amount and on the terms set forth in the stipulation. Pursuant to the attached stipulation, the court awards $70,000.00 for reimbursement for all damages that would be available under 42 U.S.C. 

### § 300aa-15(a) (2012). The parties have also agreed on an appropriate amount for litigation costs in this case. Petitioner requests $704.37 in costs. Respondent does not object to this amount. The undersigned finds this amount to be reasonable. Accordingly, the court awards:

a. a lump sum of$70,000.00, 

### representing compensation for all damages that would be available under 42 U.S.C. § 300aa-15(a). The award shall be inthe form ofa check made payable to petitioner in the amount of$70,000.00; 

### and b. a lump sum of$704.37, representing reimbursement for petitioner's litigation costs. The award shall be in the form ofa check made payable to petitioner in the amount of $704.37. 

### In the absence ofa motion for review filed pursuant to RCFC Appendix B, the clerk of the court is directed to enterjudgment herewith. 2



### IT IS SO ORDERED.

Dated: January 10, 2017 

# . cfA UJLA__ 

# Q_,**~** Laura D. Millman

Special Master

2 

### Pursuant to Vaccine Rule 11 (a), entry of judgment can be expedited by each party, either separately or jointly, filing a notice renouncing the right to seek review. 

### 2

### case 1:16-vv-00401-uNJ

### ORrGJ~~1[ 01104111 Page 1of6

IN THE UNITED STATES COURT OF li'EDERAL CLAIMS OFFICE OF SPECIAL MASTERS
Petitioner,


### v. SECRETARY OF HEAL'.J:H AND lnJMAN SERVlCES, Respondent. ) ) ) ) ) ) ) ) ) )**~~.~~~~~~~~.>** No. 16-407V SPllCIAL MASTER LAURA D. MILLMAN

The parties hereby stipulate to the following matters: 

# FILED**JAN~~** 

## 2017 OSI/I U.S. COURT OF Fl!DEllAI. CLAIMS



# RECEIVED FROM NIGHTBOX 

## ,JJ'.N U .:J 

## 2017**Unite~** 6tlitGt

### court ot

### Appeals forThe FederalCircuit
I. Petitioner tiled apetition for vaccine compensation undct· the National Vaccine Injury Compensation Prog1•um, 42 U.S.C.**~** :lOOaa-10 to 34**(th~** "Vaccine Program"). The petition seeks compensation for lnjmlcs allegedly related to petltlono1·'s rocelpt ofthe Tetanus, diphtheria, and**ac~Jlula1·** pertussis ("Tdap") vaccine, which vaccine is contained In the Vaccine Injury Table (the "Table"), 42 C.P.R. § l00.3(n). 2. Petitionerreceived aTdnp immunization on July I, 2014. 3. The vaccine was administered within the United States. 4. Petitioner alleges that she suffered nshoulder injury rotated to vaccine administration ("SIRVA") that was caused-In-fact by her Tdap vncolnatlon and that she has suffered the 1·eslduul effeQts ofthis injury for l\lOl'O tl1an six months. 

### 5. Petitioner represents that there has been no prior award or settlement ofacivil action for damages 011 hot• behalfas a result ofhercondition.

RECEIVED

- U!lCFC 

## .JAN**~** 

## 4 2017Case 1:16-w-00407-UNJ Document 14 Filed 01/04/17 Page 2 of 6

6. Respondent denies thatpetitioner's alleged SIRVA, or any othel' injury, was caused-in-fact by bet· Tdap vaccination. 7. Malntainlngtheit· above-stated positions, the parties neverthell)Ss now agi-ee that the Issues between them shall be settled and that ndecision should be entered awarding the compensation desot'ibed in pnragraph 8 ofthis Stipulation. 8. As soon ns practicable afteran entry of judgment reflecting a decision consistent with the terms ofthis Stipulation, and afterpetitioner has filed an election to receive compensation pursuantto 42 U.S.C. § 300aa-2l(a)(l),**th~** Secretary ofHealth and Human Services will issue the following vaccine compensation payments:
a. A lump sum of$70,00().00 in the form ofa check payable to petitioner. This amountrepl'esents compensation for all damages thatwould be avallable imder42 U.S.C. § 300aa·l5(a), and b. Alump sum of$704.37 In the form ofa chock payable to petitioner, for litigation costs available under 42 U.S.C. § 300aa-15(e). 

### 9. Petitioner represents that she has ldentlfled to respondent all known sources of payment

### fo1· items or services forwhioh the Progmm ls not primarily liable under 42 U.S.C. § 300aa-1S(g), including State c01qponsation programs, Insurance policies, Federal 

### or State health benefits programs (otherthan Title XIX ofthe Social Security Act (42 U.S.C. § 1396 et seq.)), or entitles that provide health services on apre-paid basis. IO. Payments made pursuantto paragraph 8ofthis Stipulation will be made in accordance with 42 U.S.C. § 300aa-15(1), subjectto the availability ofsufficient statutmy funds. 11. The parties further agree and stipulate that, exoept fur any award for litigation costs, the money ptovided pursuant to this Stipulation will be used solely.fot· the benefit of petltioneras contemplated by a strlctconstruction of42 U.S.C. § 300aa-15(a) and (d). and 2

### Case 1:16-w-00407-UNJ Document 14 Filed 01/04/17 Page 3 of 6

subjectto the condltlons of42 U.S.C. § 300aa-l5(g) and (h). 12. In return fot• the payments described in pm-agraph 8, petitioner, in her Individual capacity, and on behalfofhe1· heirs, executors, adminisfl·ators, successors or assigns, does forever irrevocably and unconditionally release, acquit and discharge the United States and the Secretary ofHealth and Human Services from any and all actions or causes ofaction (including agreements,judgments, claims, damages, loss ofservices, expenses and all demands ofwhatever kind or nature) that have been brought, could have been brought, orcould be timely bl'ougbt in the Court ofFederal Claims, tmder the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa· 10 et seq., on ae-0ountof, or in any way gt"Owing out of, any and all known or unknown, suspected or unsuspected personal injuries 

### to or death ofpetitione1· resulting from, or alleged to have resulted from, her Tdap vaccination adminbltered on July l, 2014, as alleged by petitioner in a petition for vaccine compensation filed on or about March 28, 2016, in the United States Comt ofFederal Claims as petition No. 16-407V, 13. lfpetltionershould die prior to entry of judgment, this

### agree~ent shall ba voidable upon proper notice to the Court on behalfofeither or both ofthe parties. 14. Ifthe special masterfails to issue a decision In complete conformity with the terms ofthis Stipulation 01· ifthe Court ofFederal Claims fails to enterjudgment in conformity with a docision that ls in completo conformity with the terms ofthis Stipulation, then tho parties' settlement and this Stipulation shall be voidable at the sole discretion ofeither party.

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### Case 1:16-w-00407-UNJ Document 14 Filed 01/04/17 Page 4 of 6

IS. This Stipulation expresses afull and completo negotiated settlement ofliablllty and damages claimed underthe National Childhood Vaccine Injury Act of 1986, as amendod, except as otherwise noted in pai·agraph 9 above. There is absolutely no agreementon the pa1t of the parties hereto to make any payment or to do any aot or thing othe1• than is herein expressly stated and clearly agreed to. The parties fu1ther agree and understand thatthe award described In this Stipulation may reflect acompromise ofthe parties' respective positions as to lfobllity and/or amount ofdamages, and further, 

### that achange in the nature ofthe injury 

### or condition or In the items ofcompensation sought, is not grounds to modify or revise this agreement. 16, This Stipulation shall not.beconstrned as an admission by the United States or the Secl'etary ofHealth and Human Services that petitione1·'s alleged SIRVA, orany othe1· condition,

was caused-in-factby her Tdap vaccine. I7. All l'ights and obligations ofpetitioner hereunder shall apply equally tc petitioner's heh'S, executors, administrators, successors, and/01· assigns.



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### I END OF STlPULATlON

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### Case 1:16-vv-00407-UNJ Document 14 Filed 01/04/17 Page 5 of 6

Respectl\dly submitted, PETITIONER:

Pl'o se

AUTHORIZED REl'RESENTA'l'lVE OF THE SECRET OF HEALTH AND HUMAN ' V: CE :

AR AlR, M.D. Director, Division oflajm-y Compensation Programs Henlthcm·e Systems Bureau Health Resources nnd Servlces Administration U.S. Department ofHealth and lfoman Services 5600 Fishers Lane Porkluwn Building, 

### MaH Stop 08N!46J3 Rockville, MD 20857

### Dated:~ 

# rt

___ _ AUTIIOlUZED REPl.illSENTATlVE OF

## nm ATTORNEY GENERAL: 

# [.\___.**1~** B.RBBVES gI p ty Director Torts Branch Clvll Division U.S. Department ofJustice P.O. Box 146 Be1\jamin Fm11klln Station Washington, DC 20044-0146

ATTORNEY OF RECORD FOR RESPONDENT: 

# })J0yz:,**A·~** DEBRA A. FILTEAU BEOl.,EY ·**~** Trial Attorney Torts Branch Civil Division U.S. Depm·tmcnt ofJustice P.O. Box 146 Benjamin Frnnklin Station Washington, DC 20044-0i46 (202) 616. 4138

### Case 1:16-w-00407-UNJ Document 14 Filed 01/04/17 Page 6 of 6



### CERTIFICATE OF SERVICE I hereby certily that on this 3rd day ofJanuary, 2017, the foregoing 

### STIPULATION was served electronically and buy U.S. Mail, postage prepaid, upon:



# -----, 2 

# ( '\b/bA_/ 1

# c~-----, DTIBRA A. FILTEAU BEGLEY ' Trial attorney Torts Branch, Civil Division U.S. Department ofJusticc 

### P.O. Box 146 

### Benjamin Franklin Station Washington, D.C. 20044-0146 Tel: (202)616-4181