ORIGIN l 

3ln tbe Wniteb ~tate~ ~ourt of jf eberal ~laim~ OFFICE OF SPECIAL MASTERS 

No. 16-407V 

Originally Filed: January 5, 2017 

Refiled in Redacted Form: January 10, 2017 

Not for Publication 

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S.B., 

FILED 

JAN 10 2017 

U.S. COURT OF 

FEDERAL CLAIMS 

Petitioner, 

V. 

SECRET ARY OF HEALTH 

AND HUMAN SERVICES, 

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Damages and costs decision based 

on stipulation; Tetanus, diphtheria, · 

and acellular pertussis ("Tdap") 

vaccine; shoulder injury related to 

vaccine administration ("SIRVA") 

Respondent. 

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S.B., Chicago, IL, prose. 

Debra A. Filteau Begley, Washington, DC, for respondent. 

MILLMAN, Special Master 

DECISION A WARDING 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 that her receipt of the 

Tdap vaccine caused her to suffer a shoulder injury related to vaccine administration ("SIRVA"). 

Petitioner further alleges that she experienced the residual effects of this 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. 

1 When this decision was originally filed the undersigned advised her intent to post it on the United States 

Comt of Federal Claims' website, in ac.cordance with the E-Government Act of2002. 44 U.S.C. § 3501 

note (2012) (Federal Management and Promotion of Electronic 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 of the 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 in the 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 of a check made payable to petitioner in the amount of 

$704.37. 

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.2 

IT IS SO ORDERED. 

Dated: January 10, 2017 

. cfA UJLA__ 

Laura 

Q_, 

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. 

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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. 

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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 

for The Federal Circuit 

I. Petitioner tiled a petition 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 of the 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. Petitioner received a Tdnp immunization on July I, 2014. 

3. The vaccine was administered within the United States. 

4. Petitioner alleges that she suffered n shoulder injury rotated to vaccine 

administration ("SIRVA") that was caused-In-fact by her Tdap vncolnatlon and that she has 

suffered the 1·eslduul effeQts of this injury for l\lOl'O tl1an six months. 

5. Petitioner represents that there has been no prior award or settlement of a civil 

action for damages 011 hot• behalf as a result of her condition. 

RECEIVED - U!lCFC 

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

6. Respondent denies that petitioner'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 n decision should be entered awarding the 

compensation desot'ibed in pnragraph 8 of this Stipulation. 

8. As soon ns practicable after an entry of judgment reflecting a decision consistent 

with the terms of this Stipulation, and after petitioner has filed an election to receive 

compensation pursuant to 42 U.S.C. § 300aa-2l(a)(l), th~ Secretary of Health 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 

amount repl'esents compensation for all damages that would be avallable imder 42 

U.S.C. § 300aa·l5(a), and 

b. A lump sum of$704.37 In the form of a 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 (other than Title XIX of the Social Security Act (42 U.S.C. § 1396 et 

seq.)), or entitles that provide health services on a pre-paid basis. 

IO. Payments made pursuantto paragraph 8 of this Stipulation will be made in 

accordance with 42 U.S.C. § 300aa-15(1), subject to the availability of sufficient 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 

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

subject to 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 behalf of he1· heirs, executors, adminisfl·ators, successors or assigns, does 

forever irrevocably and unconditionally release, acquit and discharge the United States and the 

Secretary of Health and Human 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 bl'ougbt in 

the Court of Federal Claims, tmder the National Vaccine Injury Compensation Program, 42 

U.S.C. § 300aa· 10 et seq., on ae-0ount of, 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 of Federal Claims as petition No. 16-407V, 

13. lfpetltioner should die prior to entry of judgment, this agree~ent shall ba 

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

14. If the special master fails to issue a decision In complete conformity with the 

terms of this Stipulation 01· if the Court of Federal Claims fails to enter judgment in conformity 

with a docision that ls in completo conformity with the terms of this Stipulation, then tho parties' 

settlement and this Stipulation shall be voidable at the sole discretion of either 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 a full and completo negotiated settlement of liablllty 

and damages claimed under the National Childhood Vaccine Injury Act of 1986, as amendod, 

except as otherwise noted in pai·agraph 9 above. There is absolutely no agreement on 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 that the award described In 

this Stipulation may reflect a compromise of the parties' respective positions as to lfobllity and/or 

amount of damages, and further, that a change in the nature of the injury or condition or In the 

items of compensation 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 of Health and Human Services that petitione1·'s alleged SIRVA, or any othe1· condition, 

was caused-in-fact by her Tdap vaccine. 

I 7. All l'ights and obligations of petitioner hereunder shall apply equally tc 

petitioner's heh'S, executors, administrators, successors, and/01· assigns. 

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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 of Health 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 of Justice 

P.O. Box 146 

Be1\jamin Fm11klln Station 

Washington, DC 20044-0146 

ATTORNEY OF RECORD FOR 

RESPONDENT: 

})J0yz:, 

DEBRA A. FILTEAU A·~ BEOl.,EY · ~ 

Trial Attorney 

Torts Branch 

Civil Division 

U.S. Depm·tmcnt of Justice 

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 of January, 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