In the United States Court of Federal Claims 

OFFICE OF SPECIAL MASTERS

No. 19-0109V

UNPUBLISHED

CHRISTINE HEIL,

 Petitioner,

v.

SECRETARY OF HEALTH AND 

HUMAN SERVICES,

 Respondent.

Chief Special Master Corcoran 

Filed: January 25, 2022

Special Processing Unit (SPU);

Findings of Fact; Onset; Statutory 

Six-Month Requirement; Influenza 

(Flu) Vaccine; Ruling on Entitlement; 

Table Injury; Shoulder Injury Related 

to Vaccine Administration (SIRVA)

Scott William Rooney, Nemes, Rooney, P.C., Farmington Hills, MI, for 

Petitioner.

Joseph Adam Lewis, U.S. Department of Justice, Washington, DC, for Respondent.

FINDINGS OF FACT AND RULING ON ENTITLEMENT1

On January 22, 2019, Christine Heil 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 she suffered right arm and shoulder pain causedin-fact by the influenza (“flu”) vaccine she received on February 11, 2016. Petition at 1, 

¶¶ 6, 32. Petitioner specifically asserts that she “has been in constant pain” since 

vaccination (id. at ¶ 13) and that her “injuries have continued for more than six months 

1 Because this unpublished Ruling contains a reasoned explanation for the action in this case, I am required 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

after the vaccination injury on-set” (id. at 34). The case was assigned to the Special 

Processing Unit of the Office of Special Masters.

For the reasons set forth below, I find the onset of Petitioner’s right shoulder pain 

occurred within 48 hours of vaccination, and she has satisfied the other requirements of 

a Table shoulder injury related to vaccine administration (“SIRVA”). Furthermore, I find 

Petitioner suffered the residual effects of the right arm and shoulder pain she experienced 

post-vaccination for more than six months. Petitioner is entitled to compensation under 

the Vaccine Act. 

I. Relevant Procedural History

Ms. Heil filed her Petition without medical records on the eve of the expiration of 

the time to initiate a claim under the Vaccine Act’s statute of limitation.3 Over the 

subsequent nine-month period, she filed an affidavit and some of the required medical 

records. Exhibits 1-10, ECF Nos. 7, 11, 13, 19, 28, 30; Section 11(c). 

On December 12, 2019, Respondent indicated he was interested in engaging in 

settlement discussions. ECF No. 35. Three months later, on March 16, 2020, he informed 

me that the parties had reached an impasse. ECF No. 46. During this time, Petitioner filed 

additional medical records and a second affidavit. Exhibits 11-14, ECF Nos. 40, 44. 

On April 30, 2020, Respondent filed his Rule 4(c) Report setting forth his objections 

to compensation. ECF No. 48. Specifically, Respondent argued that Petitioner failed to 

establish that the onset of her pain began within 48 hours of vaccination (as required for 

a Table SIRVA claim), or that she suffered the residual effects of her injury for more than 

six months. Id. at 6-7; see 42 C.F.R. § 100.3(a)(XIV)(B) and (c)(10)(ii) (Table entry for 

SIRVA following receipt of a flu vaccine and Qualifications and Aids for Interpretation 

(“QAI”) requirement regarding onset of pain); Section 11(c)(1)(D)(i) (regarding six-month 

severity requirement). 

On July 8, 2020, I issued an order to show cause requiring Petitioner to file 

additional evidence regarding onset and the duration of her injury. ECF No. 51. In 

response, Petitioner filed a third affidavit (Exhibit 17); affidavits from her sister, her sister’s 

husband, her husband, her two daughters, and her son-in-law (Exhibits 15-16, 18-21); 

and medical records and letter of certification from her neurologist (Exhibits 22-23). ECF 

Nos. 52, 54, 56, 58, 61, 65. 

3 Alleging immediate pain upon vaccination on February 11, 2016, Petitioner was required to file her petition 

prior to February 11, 2019. See Section 16(a)(2) (requiring that a petition be filed within 36 months of the 

first symptom or manifestation of a petitioner’s injury). 
3

On July 27, 2021, Respondent filed a motion for a ruling on the record. 

Respondent’s Brief in Support of his Motion for a Decision on the Record (“Motion”), ECF 

No. 66. Arguing that Petitioner has still not provided sufficient evidence to establish onset 

within 48 hours or to show that she has satisfied the Vaccine Act’s severity requirement, 

Respondent requested that I dismiss Petitioner’s claim. Id. at 1, 8-14. 

Regarding the issue of onset, Respondent stresses the 55-day period before 

Petitioner sought treatment of her right shoulder pain, and what he characterizes as 

Petitioner’s vague language regarding the onset of her pain. Motion at 9-10. To support 

his argument regarding severity, he emphasizes the improvement noted during 

Petitioner’s last physical therapy (“PT”) session five months post-vaccination, the 

fourteen-month gap in treatment thereafter, and his assertion that Petitioner received

another flu vaccine in her right deltoid nine months post-vaccination. Id. at 11, 13-14, He 

cites multiple cases in which a similar gap in treatment caused the special master to find 

a six-month duration of symptoms did not exist. Id. at 11-13. 

In response, Petitioner requests that I find her injury occurred within 48 hours and

lasted for more than six months, and “thereby allow[] this matter to go to hearing on 

damages.” Petitioner’s Response to Motion (“Response”), filed Sept. 10, 2021, at 1, ECF 

No. 69. Although not clearly stated, she appears to be requesting a ruling on entitlement

in her favor.

Claiming that the almost two-month delay in treatment does not equate to a lack 

of symptoms, Ms. Heil stresses that she has consistently reported an immediate onset of 

her pain throughout provided medical histories and affidavits – an assertion which is 

supported by the affidavits of her family members. Response at 7-8. Regarding the 

duration of her injury, Petitioner claims that she had not fully recovered by her last PT 

session in early July 2016, that she either did not mention her continued right shoulder 

pain at subsequent appointments for other aliments because it would have been illogical 

to do so or that she mentioned her pain and it was not noted in the record. She maintains

that she refused the second flu vaccine offered in November 2016. Id. at 8-10. Petitioner 

distinguishes the primary case cited by Respondent, Lamarre, and cites Kirby for the 

proposition that the failure to report every aliment a claimant is suffering when seeing a 

medical provider does not mean the underlying ailment did not exist at the relevant time. 

Id. (citing Lamarre v. Sec’y of Health & Human Servs., No. 17-0010V, 2019 WL 7556396 

(Fed. Cl. Spec. Mstr. Nov. 6, 2019); Kirby v. Sec’y of Health & Human Servs., 997 F.3d 

1378 (Fed. Cir. 2021)). 
4

On October 1, 2021, Respondent filed a reply addressing the arguments made by 

Petitioner in her response. Respondent’s Reply to Response (“Reply”), ECF No. 70. He 

continues to stress Petitioner’s delay and gap in treatment, maintaining Petitioner has 

provided not rationale for either. Id. at 1-2. He again asserts that “compensation is not 

appropriate in this case, and the petition should be dismissed.” Id. at 3. 

Two weeks after Respondent filed his reply, Petitioner filed medical records which 

included the results of an MRI performed on July 8, 2021. Exhibit 25, filed Oct. 14, 2021, 

ECF No. 71; see Exhibit 25 at 2 (MRI results). On November 1, 2021, she filed the

complete medical records from the orthopedist who treated her right shoulder pain and 

later left knee pain in 2016 (Exhibit 26), as well as medical records from her 2014 breast 

implant surgery (Exhibit 27). ECF No. 73. She provided no reason why the complete 

medical records from her orthopedist – now filed as Exhibit 26, which include the record 

from an August 30, 2016 visit that appears sufficient to satisfy the Vaccine Act’s severity 

requirement, was not previously provided, despite multiple requests from Respondent.4 

The matter is now ripe for adjudication. 

II. Finding of Fact Regarding Onset and Duration

At issue is whether Petitioner’s first symptom or manifestation of onset after 

vaccine administration (specifically pain) occurred within 48 hours as set forth in the 

Vaccine Injury Table and QAI for a Table SIRVA and whether her injury lasted more than 

six-months as required for all Table and non-Table claims. See 42 C.F.R. § 100.3(a) 

XIV.B.; 42 C.F.R. § 100.3(c)(10)(ii); Section 11(c)(1)(D)(i). 

A. 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 

4

Initially, Petitioner filed a portion of these orthopedic records as part of the medical records from 

Petitioner’s PCP. See Exhibit 3. Although Respondent requested medical records from orthopedic 

treatment provided from April 26 through June 20, 2016, suspecting that some were outstanding, both in 

his Rule 4(c) Report and Motion, Petitioner did not provide a complete copy of the orthopedic records until 

this filing. See Rule 4(c) Report at 3 n.2; Motion at 3 n.3. When later filing these medical records, Petitioner 

provided no explanation for their earlier omission or her denial, from as late as September 2021, that they 

did not exist. Response at 5. A comparison of these medical records with the orthopedic records previously 

filed in Exhibit 3 reveal not all had been provided until this most recent filing. 
5

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 & Human 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 & Human Servs., No. 03-

1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). “The medical 

records made at the time treatment was sought or provided are far more reliable than the 

witnesses' testimony, five years later, to the contrary.” Id. at *20. 

However, this rule does not always apply. The United States Court of Federal 

Claims has recognized that “medical records may be incomplete or inaccurate.” Camery 

v. Sec’y of Health & Human Servs., 42 Fed. Cl. 381, 391 (1998). “Written records which 

are, themselves, inconsistent, should be accorded less deference than those which are 

internally consistent.” Murphy v. Sec'y of Health & Human Servs., 23 Cl. Ct. 726, 733 

(1991) (quoting with approval the standard used by the special master below), 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 & Human Servs., 997 F.3d 1378, 

1383 (Fed. Cir. 2021).

The Claims 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, 42 Fed. Cl. at 391 (citing Blutstein v. Sec’y of Health & Human Servs., No. 90-

2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). 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 & Human 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 
6

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).

B. Analysis

I make the findings regarding onset and duration after a complete review of the 

record to include all medical records, affidavits, and additional evidence. Specifically, I 

base the findings on the following evidence:

• Prior to receiving the flu vaccine at issue, Petitioner suffered from obesity, 

breast cancer, hypothyroidism, depression, melanoma, and a right knee 

fracture due to a fall. Exhibit 3 at 17. She underwent a mastectomy in 2009, 

lap band surgery in 2011, right knee arthroscopy after a fall while 

rollerblading in 2012, and removal of her left breast implant due to infection 

in 2014. Id.; Exhibit 10 at 26 (regarding right knee surgery); Exhibit 27 at 16, 

50 (regarding implant surgery). 

• On January 14, 2016, one month prior to receiving the vaccine alleged as 

causal, Petitioner was seen by the orthopedist who performed her 2012 

right knee arthroscopy for two months of right knee instability and a popping 

sensation with pain over her medial knee screw. Exhibit 10 at 26. Petitioner 

opted to undergo reconstructive knee surgery. Id. at 27-28. 

• On February 11, 2016, Petitioner was seen by her primary care provider 

(“PCP”) for a refill of her medications. Exhibit 3 at 17-19. At this time, she

received a flu vaccine intramuscularly in her right deltoid. Exhibit 7 at 2

(vaccine record); see also Exhibit 3 at 20, 22 (noting 2/11/16 flu vaccine in 

record from the next PCP visit).

• On April 5, 2016 (almost two months post-vaccination), Petitioner returned 

to her PCP for a physical. Exhibit 3 at 20-23. At that visit, she complained 

of right arm pain which she attributed to the February 11, 2016 flu vaccine, 

reporting that her “right arm has been very painful since that injection.” Id.

at 20. She shared her concern that the flu vaccine might have been injected 

into her bursa and indicated she had to quit working with her personal 

trainer “because she can’t do anything with her right arm.” Id. An 

examination revealed “[p]oint tenderness over [the] upper lateral arm . . . 

[and] pain lifting it anteriorly and horizontally above 45 degrees.” Id. at 21. 

Medical imaging of her right shoulder was ordered, and Petitioner was 

referred to orthopedics. Id. at 22. 
7

• Performed on April 12, 2016, the ultrasound revealed an intact rotator cuff, 

evidence suggestive of fatty atrophy, and “[a] minimal amount of fluid in the 

subacromial-subdeltoid bursa.” Exhibit 3 at 113. In the report, it was noted 

that Petitioner had complained of “left[5] shoulder pain for approximately two 

months.” Id. The same day, Petitioner also underwent a bilateral digital 

mammogram which showed evidence consistent with her prior left breast 

cancer and subsequent bilateral mastectomy. Id. at 114.

• On April 26, 2016, Petitioner was seen by an orthopedist for right shoulder 

pain. Exhibit 26 at 10-11.

6 Describing constant pain at a level of six to eight 

out of ten which was exacerbated with use, Petitioner reported that “[s]he 

had a flu shot several months ago and has had pain in the right upper arm 

ever since.” Id. at 10. She identified the onset of her pain as February 11th. 

Id. An examination revealed weakness and pain with the most painful being 

resisted external rotation. Id. at 10-11. Diagnosing Petitioner with “an early

frozen shoulder,” the orthopedist administered a steroid injection and 

prescribed PT. Id. at 11.

• On June 7, 2016, Petitioner returned to the orthopedist, indicating that the 

cortisone injection “helped for about a week” and that “she ha[d] really been 

pretty diligent with her exercises at home.” Exhibit 26 at 9. After discussing 

the available options with Petitioner, the orthopedist determined that “the 

best thing to do [wa]s to go ahead and manipulate her shoulder . . . [and] 

put her in PT after that.” Id. He prescribed additional Tramadol.7 Exhibit 26 

at 9. 

• On June 20, 2016, Petitioner underwent a right shoulder manipulation under 

general anesthesia and received a second cortisone injection. Exhibit 14 at 

1. In the history found in this record, it is noted that Petitioner experienced 

pain and stiffness within a few days of receiving the flu vaccine and “has 

5 Although this one entry indicates the pain was in Petitioner’s left, rather than right, shoulder, it appears to 

be incorrect – mostly likely due to a simple mistake. Other entries in the same record indicate the right 

shoulder MRI was administered due to right shoulder pain. Exhibit 3 at 113. And it would be illogical for a 

right shoulder MRI to have been ordered in response to left shoulder pain. 

6 All citations to this orthopedist’s medical records will be the complete copy provided in Exhibit 26. See 

supra note 4. 

7 Tramadol hydrochloride is “an opioid analgesic used for the treatment of moderate to moderately severe 

pain following surgical procedures and oral surgery, administered orally.” DORLAND’S ILLUSTRATED MEDICAL 

DICTIONARY (“DORLAND’S “) at 1950 (32th ed. 2012). 
8

now gone on to develop a frozen shoulder with loss of motion in all planes.” 

Id. After the manipulation was performed, the cortisone injection was 

administered “through the anterior portal.” Id.

• Following manipulation and the administration of a second injection, 

Petitioner attended five PT sessions in late June. Exhibit 4 at 17-21. At her 

first PT session on June 22, Petitioner rated her pain at a level of five out of 

ten. Id. at 9. It was again reported that “the pain in her shoulder started after 

a flu shot.” Id. The date of the manipulation is incorrectly listed as June 28. 

Id.

• Petitioner attended one last PT session and was discharged on July 1, 

2016. Exhibit 4 at 2, 14. In the record from the July 1 PT session, it was 

noted that Petitioner’s pain was “better after every PT session.” Id. at 14. 

Under assessment, the box noting that the “Patient continues to make 

appropriate progress toward established functional treatment goals” was 

checked. Id. On the discharge sheet, it was reported that Petitioner had 

“made all functional goals” and was “100%”. Id. at 2. However, a mild 

restriction when lifting a gallon of milk was recorded, and Petitioner was 

instructed to continue a home exercise program (“HEP”). Id.

• On July 5, 2016, Petitioner returned to her orthopedist for a follow-up 

appointment regarding her right shoulder manipulation. Exhibit 26 at 8. 

Noting that she was doing wonderfully, the orthopedist assessed her as 

having “great range of motion,” observing that her internal rotation “is to 

about L2 or so which is pretty good compared to where she started.” Id.

Petitioner reported that her “pain ha[d] not completely subsided and 

requested another prescription for pain medicine.” Id. The orthopedist 

prescribed the requested medication and indicated “[w]e are going to put 

her back in physical therapy . . . and see how she does.” Id. 

• Petitioner returned to the orthopedist on August 23, 2016, complaining of 

“very significant pain in her left knee” which “came really just out of the blue.” 

Exhibit 26 at 6. The orthopedist noted that he “ha[d] taken care of . . . 

[Petitioner’s] shoulder in the past.” Id. He also characterized her left knee 

pain as “surprising” considering the earlier injury to her right knee and its 

arthritic and unstable condition. Id. Opining that Petitioner’s left knee pain 

may be due to a torn meniscus or bursitis, the orthopedist ordered an MRI

bloodwork for her left knee and a brace for her right knee. Id. at 7. 
9

• The MRI of Petitioner’s left knee, performed on August 29, 2016, showed a 

torn meniscus, effusion and a leaking Baker’s cyst, and evidence of an old 

injury. Exhibit 26 at 13. 

• On August 30, 2016, Petitioner attended a second follow-up appointment 

regarding her right shoulder manipulation. Exhibit 26 at 4. The record from 

that visits indicates “that her range of motion has improved significantly, she 

still has some pain from time to time and is still improving, but overall is 

happy with her progress.” Id. The orthopedist instructed Petitioner to 

continue her HEP and follow-up as needed. Explaining “that most frozen 

shoulder is resolved with conservative treatment,” he stated that “the fact 

that [Petitioner] is improving is a good sign for her prognosis.” Id. at 5.

• On September 6, 2016, at a preoperative consult, the orthopedist discussed 

the results of Petitioner’s left knee MRI. Exhibit 26 at 3. The arthroscopic 

surgery to repair Petitioner’s left knee torn meniscus was performed on 

September 16, 2016. Id. at 18-20. 

• On November 18, 2016, Petitioner was seen by her PCP for a six-month 

follow-up and refill of her medication. Exhibit 3 at 24. The history in this 

record includes information about Petitioner’s “bad flu experience” when the 

shot was given “high up on [her] shoulder” as well as her subsequent “frozen 

shoulder release.” Id. Although the record contains some evidence 

indicating Petitioner was administered another flu vaccine that day, there is 

also a notation that she refused this vaccination. Id. at 25-26. There is 

nothing in this record indicating Petitioner was currently experiencing right 

shoulder pain. 

• It appears Petitioner did not seek treatment again until April 10, 2017, when 

she visited her PCP for a physical exam. Exhibit 3 at 27. At this visit, the 

only complaints listed are depression, anxiety, hypothyroidism, and 

hypertension. Petitioner reported more anxiety since stopping drinking. 

However, she admitted having one drink while on vacation in Hawaii. Id.

The record contains no complaints or evidence of right shoulder pain or 

limited range of motion (“ROM”), even under the results of Petitioner’s 

physical examination. Id. at 27-30.

• Petitioner returned to her PCP on April 24, 2017, complaining of a cough 

and chest congestion. Exhibit 3 at 31. Again, there is no evidence of right 

shoulder pain and limited ROM in this record. Id. at 31-32. 
10

• On August 15, 2017, Petitioner was seen at the clinic of the orthopedist who 

performed her 2012 right knee arthroscopy - who she saw in January 2016 

for a re-evaluation of her right knee. Exhibit 10 at 7. She reported an 

exacerbation of her pain four days ago. Id. There is no mention of right 

shoulder pain or limited ROM in this record. Id. at 6-19.

• On September 6, 2017, more than one year after the last entry containing 

an account of right shoulder pain, Petitioner was seen by a neurologist, for 

right shoulder pain following her flu vaccine a year and a half ago. Exhibit 

23 at 1. She noted that “[t]he pain is still there when she moves her right 

shoulder” and described it as sometimes radiating from her shoulder to her 

biceps and right wrist. Id. However, she reported that the pain is not 

constant or reproduced every time. And the results of the EMG performed 

that day were normal. Petitioner was told to follow-up with her PCP and 

orthopedist. Id. at 2-3. 

• Petitioner did not complain of her right shoulder pain again until almost one 

year later, on August 30, 2018, when seen by a treating physician who 

appears to be a new PCP. Exhibit 11 at 1. The chief complaint for this visit 

is listed as a follow-up appointment for hypertension. Id. However, no prior 

medical records for this provider have been filed, and Petitioner has not 

explained when and why she switched PCPs. In the record from this visit, 

it is noted that Petitioner “[a]lso continues to complain of right shoulder pain 

for the past 3 years.” Id. Her condition was described as “[p]ain radiating to 

right shoulder.” Id. The treating physician prescribed five days of 

Prednisone. 

• The medical records reveal that Petitioner has taken 300mg of Gabapentin 

since March 2015, when it was prescribed for her right knee pain. Exhibit 3 

at 14-15. It appears the dosage of this medication has remained throughout 

2015-17. Id. at 18, 21, 25, 28, 32; Exhibit 11 at 1, 3. 

• Petitioner filed three affidavits in this case: a basic affidavit, executed on 

January 21, 2019 (Exhibit 1); an affidavit regarding the effects of her injury 

on her work as a Mary Kay sales consultant, executed on January 29, 2020 

(Exhibit 13); and an affidavit regarding the November 18, 2016 appointment 

with Petitioner’s PCP, executed on August 15, 2020 (Exhibit 17). In the third 

affidavit, Petitioner maintained that she refused the flu vaccine offered at 

the November 18, 2016 PCP appointment. Exhibit 17 at ¶¶ 6, 8 (citing 
11

Exhibit 3 at 25). She argues that the reason she rejected the vaccination 

was “continued pain in the right shoulder.” Id. at ¶ 10. 

• Petitioner also provided supporting affidavits from six family members 

regarding the onset and duration of her pain. Exhibits 15-16, 18-21. The 

affidavit from her husband provides the most detail. Exhibit 18. Except for 

the initial information regarding their relationship to Ms. Heil, the other family 

member affidavits are virtually identical and provide only basic information. 

Exhibits 15-16, 19-21. 

1. Pain Onset

It is common for a SIRVA petitioner to delay treatment, thinking his/her injury will 

resolve on its own. The almost two-month delay in this case is thus not facially 

unreasonable. Additionally, Petitioner did not seek treatment for any other medical 

condition or illness during this 55-day period. Such intervening treatment evidence can in 

many cases either corroborate a petitioner’s claim or undermine it – but it is totally absent 

here.

In multiple post-vaccination medical records, Petitioner consistently reported right 

shoulder pain, which never ceased, since vaccination. Exhibit 3 at 20, 113; Exhibit 4 at 9; 

Exhibit 26 at 10. Without fail, she attributed her injury to the flu vaccine she received on 

February 11, 2016. Exhibit 3 at 20; Exhibit 4 at 9; Exhibit 26 at 10. On at least one 

occasion, she identified the date of onset as February 11, 2016. Exhibit 26 at 10. While 

these entries were based upon information provided by Petitioner, they still should be 

afforded greater weight than more current representations, as they were uttered 

contemporaneously with Petitioner’s injury for the purposes of obtaining medical care. 

The Federal Circuit has stated that “[m]edical records, in general, warrant 

consideration as trustworthy evidence . . . [as they] contain information supplied to or by 

health professionals to facilitate diagnosis and treatment of medical conditions.” Cucuras, 

993 F.2d at 1528 (emphasis added). Thus, the Circuit has instructed that greater weight 

should be accorded to this information even when the information is provided by 

Petitioner. 

Although Respondent argues that Petitioner’s description of right shoulder pain 

since vaccination is not specific enough to show an immediate onset, the record says 

otherwise. Motion at 9. The use of the term “since” suggests that Petitioner’s right 

shoulder pain occurred immediately – upon vaccination. And, on at least one occasion, 

Petitioner identifies the date of vaccination as the onset of Petitioner’s pain as the date of 
12

vaccination. Exhibit 16 at 10; see also Exhibit 3 at 113 (April 12, 2016 entry describing 

pain for two months). 

Only one history (in the medical record from Petitioner’s right shoulder 

manipulation on June 20, 2016) indicates an onset more than a few days postvaccination. But this one later entry is outweighed by the numerous entries, closer in time 

to vaccination, describing an immediate onset. 

Accordingly, I find there is preponderant evidence to establish the onset of 

Petitioner’s pain occurred within 48 hours of vaccination. Specifically, I find the onset of 

petitioner’s pain immediately upon vaccination. 

2. Duration of Pain and other Symptoms

Petitioner obtained significant pain relief and improved ROM following her 

manipulation, second cortisone injection, and PT in June 2016 - approximately four to five 

months post-vaccination. However, later provided orthopedic records reveal Petitioner 

continued to suffer a milder level of occasional pain as late as August 30, 2016 – more 

than six months post-vaccination. 

On July 5, 2016 – four days after her last PT session, Petitioner reported that her 

“pain had not completely subsided” and requested another prescription8for pain 

medication. Exhibit 26 at 8. Her ROM was characterized as great, and she was prescribed 

60 Norco9tablets. Exhibit 26 at 8. When she returned to the orthopedist on August 30, 

2016, more than six months post-vaccination, Petitioner reported significant overall 

improvement and only “some pain from time to time.” Id. at 4. Even though intermittent, 

this pain is sufficient to satisfy the Vaccine Act’s severity requirement.

Petitioner maintains that she continued to suffer residual effects of her SIRVA 

injury for three years post-vaccination, but the record as it currently stands does not 

adequately support the longer duration Petitioner claims. Following her report of 

intermittent pain in late August 2016, despite seeking treatment for other conditions on 

numerous occasions, Petitioner complained of right shoulder pain on only two occasions: 

during a September 2017 visit to the neurologist and August 2018 visit to a treating 

physician who appears to be her new PCP. In September 2017, Petitioner admitted that 

8 On June 7, 2016, Petitioner had been prescribed 60 Tramadol tablets. Exhibit 26 at 9; see supra note 7.

9 Norco is a “trademark for combination preparations of hydrocodone bitartrate and acetaminophen.” 

DORLAND’S at 1290. 
13

her pain occurred only occasionally with movement. For the first time in September 2017, 

she described right shoulder pain radiating to her wrist. 

In their affidavits, Petitioner’s family members provided extremely general and 

nearly identical statements merely indicating Petitioner complained of pain after her last 

PT session on July 1, 2016. Exhibit 15-16, 18-21. No further information regarding the 

timing of these statements was provided. Thus, they provide nothing to contradict or 

supplement the information already contained in the medical records in this case. 

As it currently stands, the record shows that Petitioner was suffering mild SIRVA 

symptoms as late as August 30, 2016. However, it appears her injury had almost resolved 

by that time. And Petitioner did not seek treatment again or complain of any symptoms 

until almost a year later. Currently the record does not contain sufficient evidence to 

connect Petitioner’s two subsequent complaints of pain (in late 2017 and 2018) to the

SIRVA injury she appears to have suffered in February 2016. This will bear on my 

damages calculation, but it does not prevent Petitioner from obtaining an entitlement 

award.

III. Requirements for Table SIRVA

Because I have determined the onset of her right shoulder pain occurred 

immediately upon vaccination, Petitioner has met the timing required for a Table SIRVA

and has fulfilled the second of the four QAI Table criteria. See 42 C.F.R. § 100.3(a)(XIV)

(Table entry for SIRVA following influenza vaccine); 42 C.F.R. § 100.3(c)(10)(ii) (second 

QAI requirement). To establish that she suffered a Table SIRVA, Petitioner must satisfy 

the additional three QAI requirements. 42 C.F.R. § 100.3(c)(10)(i) (iii-iv).

The record in this case contains no indication that Petitioner suffered prior right 

shoulder issues. See 42 C.F.R. § 100.3(c)(10)(i). Nor is there evidence of any other 

condition or abnormality that would explain the left shoulder pain she experienced in 

2016. See 42 C.F.R. § 100.3(c)(10)(iv). 

Petitioner consistently described the pain she experienced in 2016 as located in 

her right upper arm or shoulder. Exhibit 3 at 20; Exhibit 4 at 9; Exhibit 14 at 1; Exhibit 26 

at 8, 10. She did not describe pain which radiated to other locations until 2017. Exhibit 23 

at 1. Likewise, Petitioner exhibited limited ROM in only her right shoulder. Thus, Petitioner 

has satisfied all QAI criteria for a Table SIRVA. 
14

IV. Additional Requirements for Entitlement

Because Petitioner has satisfied the requirements of a Table SIRVA, she need not 

prove causation. Section 11(c)(1)(C). However, she must satisfy the other requirements 

of Section 11(c) regarding the vaccination received, the duration and severity of 

petitioner’s injury, and the lack of other award or settlement. Section 11(c)(A), (B), and 

(D). 

The vaccine record shows Petitioner received the flu vaccine in her right deltoid at

her PCP in Flint, Michigan. Exhibit 3 at 20; Exhibit 7 at 2; see Section 11(c)(1)(A) 

(requiring receipt of a covered vaccine); Section 11(c)(1)(B)(i) (requiring administration 

within the United States or its territories). Additionally, there is no evidence that Petitioner 

has collected a civil award for his injury. See Section 11(c)(1)(E) (lack of prior civil award).

Finally, as I have determined in this ruling, the medical records show that Petitioner 

continued to suffer right shoulder pain at least as late as August 30, 2016. See supra

Section II.B.2. Thus, Petitioner suffered the residual effects of her SIRVA for at least six 

months post-vaccination, in this case beyond August 11, 2016. See Section 11(c)(1)(D)(i) 

(statutory six-month requirement). Thus, Petitioner has satisfied all requirements for 

entitlement under the Vaccine Act. 

V. Conclusion

Based on the entire record in this case, I find that Petitioner has provided 

preponderant evidence satisfying all requirements for a Table SIRVA and the 

Vaccine Act’s severity requirement needed for both Table and non-Table claims. 

Petitioner is entitled to compensation in this case. 

IT IS SO ORDERED.

s/Brian H. Corcoran

Brian H. Corcoran

Chief Special Master