In the United States Court of Federal Claims 

OFFICE OF SPECIAL MASTERS 

No. 16-1666V 

Filed: March 16, 2018 

UNPUBLISHED 

DAWN ANDREWS,

 Petitioner,

v.

SECRETARY OF HEALTH AND 

HUMAN SERVICES,

 Respondent.

Special Processing Unit (SPU); Joint 

Stipulation on Damages; Influenza 

(Flu) Vaccine; Shoulder Injury 

Related to Vaccine Administration 

(SIRVA)

John Robert Howie, Howie Law, PC, Dallas, TX, for petitioner. 

Sarah Christina Duncan, U.S. Department of Justice, Washington, DC, for respondent. 

DECISION ON JOINT STIPULATION1

Dorsey, Chief Special Master: 

 On December 20, 2016, petitioner filed a petition for compensation under the 

National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.,

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 (the 

“Vaccine Act”). Petitioner alleges that she suffered a Shoulder Injury Related to 

Vaccine Administration (“SIRVA”) as a result of receiving the influenza (“flu”) vaccine on 

November 24, 2015. Petition at 1; Stipulation, filed March 15, 2018, at ¶¶ 1-2. 

Petitioner further alleges that she experienced the residual effects of this injury for more 

than six months. Petition at 5; Stipulation at ¶ 4. “Respondent denies that the influenza 

vaccine caused petitioner to suffer a SIRVA or any other injury.” Stipulation at ¶ 6. 

Nevertheless, on March 15, 2018, the parties filed the attached joint stipulation, 

stating that a decision should be entered awarding compensation. The undersigned 

finds the stipulation reasonable and adopts it as the decision of the Court in awarding 

damages, on the terms set forth therein. 

 

1

 Because this unpublished decision contains a reasoned explanation for the action in this case, the 

undersigned intends 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). 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, the undersigned agrees that the identified material fits 

within this definition, the undersigned 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 

300aa (2012).
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Pursuant to the terms stated in the attached Stipulation, the undersigned 

awards the following compensation: 

A lump sum of $70,000.00 in the form of a check payable to petitioner. 

Stipulation at ¶ 8. This amount represents compensation for all items of 

damages that would be available under 42 U.S.C. § 300aa-15(a). Id. 

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 in accordance with this decision.3

IT IS SO ORDERED.

 s/Nora Beth Dorsey 

 Nora Beth Dorsey 

 Chief Special Master 

 

3

 Pursuant to Vaccine Rule 11(a), entry of judgment can be 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 

DAWN ANDREWS, 

Petitioner, 

v. 

SECRETARY OF HEALTH AND HUMAN 

SERVICES, 

Respondent. 

) 

) 

) 

) 

) No. 16-1666V 

) Chief Special Master Dorsey 

) ECF 

) 

) 

) 

) 

STIPULATION 

The parties hereby stipulate to the following matters: 

1. Dawn Andrews, petitioner, filed a petition for vaccine compensation under the 

National Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-10 to -34 (the "Vaccine 

Program"). The petition seeks compensation for iajuries allegedly related to petitioner's receipt 

of an influenza vaccine, which vaccine is contained in the Vaccine Injury Table (the "Table"), 

42 C.F.R. § 100.3(a). 

2. Petitioner received the influenza immunization on November 24, 201 S. 

3. The vaccination was administered within the United States. 

4. Petitioner alleges that she suffered a Shoulder Inju1·y Related to Vaccine 

Administration ("SIRVA") as a result ofreceiving the influenza vaccine, and experienced the 

residual effects of this injury for more than six months. 

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

for damages on he1· behalf as a result of her condition. 

6. Respondent denies that the influenza vaccine caused petitioner to suffer a SIRVA or 
any other injury. 

7. Maintaining their above*stated positions, the parties nevertheless now agree that the 

issues between them shall be settled and that a decision should be entered awarding the 

compensation described in paragraph 8 of this Stipulation. 

8. As soon as 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-2 l (a)(l ), the Secretary of Health and Human Services will issue 

the following vaccine compensation payment: 

A lump sum of $70,000.00 in the form of a check payable to petitioner. This 

amount represents compensation for all damages that would be available under 42 

U.S.C. § 300aa-l5(a). 

9. As soon as practicable after the entry of judgmer:i

t on entitlement in �his case, and after 

petitioner has filed both a proper and timely election to receive compensation pul'Suant to 

42 U.S.C. § 300aa-21(a)(J), and an application, the parties will submit to further proceedings 

before the special master to award reasonable attorneys' fees and costs incurred in proceeding 

upon this petition. 

10. Petitioner and her attorney represent that compensation to be provided pursuant to 

this Stipulation is not for any it�ms or services for which the Program is not primarily liable 

under 42 U.S.C. § 300aa-15(g), to the extent that payment has been made or can reasonably be 

expected to be made under any State compensation 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 by entities that provide health services on a pre-paid basis. 

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11. Payment made pursuant to paragraph 8 of this Stipulation and any amounts awarded 

pursuant to pamgraph 9 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa15(i), subject to the availability of sufficient statutory funds. 

12. The parties and their attorneys further agree and stipulate that, except for any award 

for attorneys' fees and litigation costs, and past unreimbursed expenses, the money provided 

pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a 

strict construction of 42 U.S.C. § 300aa" IS( a) and (d), and subject to the conditions of 42 U.S.C. 

§ 300aaH15(g) and (h). 

13. In return for the payments described in paragraphs 8 and 9, petitioner, in her 

individual capacity, and on behalf of her heirs, executors, administrators, 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 al I 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 

brought in the Court of Federal Claims, under the National Vaccine [njury Compensation 

Program, 42 U.S.C. § 300aa-10 et seq., on account of, or in any way growing out of, any and all 

known or unknown, suspected or unsuspected personal injuries to or death of petitioner l'esuiting 

from, or alleged to have resulted from, the influenza vaccination administered on November 24, 

2015, as alleged by petitioner in a petition for vaccine compensation flied on or about December 

20, 2016, in the United States Court of Federal Claims as petition No. 16-1666V. 

14. If petitioner shout d die prior to entry of judgment, this agreement shall be voidable 

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

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15. If the special master fails to issue a decision in complete conformity with the terms 

of this Stipulation or if the Comt of Federal Claims fails to enter judgment in confonnity with a 

decision that is in complete conformity with the tel'ms of this Stipulation, then the parties• 

settlement and this Stipulation shall be voidable at the sole discretion of either party. 

16. This Stipulation expresses a full and complete negotiated settlement of liability and 

damages claimed under the National Childhood Vaccine Injury Act of 1986, as amended, except 

as otherwise noted in paragraph 9 above. There is absolutely no agreement on the part of the 

parties hereto to make any payment or to do any act or thing other than is herein expressly stated 

and clearly agreed to. The parties further agree and understand that the award described in this 

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

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

items of compensation sought, is not grounds to modify or revise this agreement. 

17. This Stipulation shall not be construed as an admission by the United States or the 

Secretary of Health and Human Services that the influenza vaccine caused petitioner to have a 

SIRVA or any othe1· injury. 

18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's 

heirs, executors, administrators, successors, and/or assigns. 

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END OF STIPULATION 

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