In the United States Court of Federal Claims

OFFICE OF SPECIAL MASTERS

No. 18-990V

UNPUBLISHED

KILEY LIZAMA,

Petitioner,

v.

SECRETARY OF HEALTH AND 

HUMAN SERVICES,

 Respondent.

Chief Special Master Corcoran 

Filed: April 24, 2020

Special Processing Unit (SPU); Joint 

Stipulation on Damages; Tetanus 

Diphtheria acellular Pertussis (Tdap) 

Vaccine; Shoulder Injury Related to 

Vaccine Administration (SIRVA)

Amy A. Senerth, Muller Brazil, LLP, Dresher, PA, for Petitioner.

Camille Michelle Collett, U.S. Department of Justice, Washington, DC, for Respondent.

DECISION ON JOINT STIPULATION1

On January 15, 2019, Kiley Lizama 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 SIRVA resulting from adverse 

effects of her October 13, 2017 vaccination. Petition at 1; Stipulation, filed April 21, 

2020, at ¶ 1. Petitioner further alleges that the vaccine was administered in the United 

States, she experienced the residual effects of this alleged injury for more than six 

months, and there has been no prior award or settlement of a civil action for damages 

as a result of her condition. Petition at 1, 4; Stipulation at ¶¶ 1-5. “Respondent denies

that petitioner sustained a SIRVA Table injury, or and further denies that the vaccine 

caused her alleged shoulder injury or any other injury or condition.” Stipulation at ¶ 6. 

1 Because this unpublished decision contains a reasoned explanation for the action in this case, I am 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 decision 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. 

§ 300aa (2012).

CORRECTED
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Nevertheless, on April 21, 2020, the parties filed the attached joint stipulation, 

stating that a decision should be entered awarding compensation. I find the stipulation 

reasonable and adopt it as my decision awarding damages, on the terms set forth 

therein.

Pursuant to the terms stated in the attached Stipulation, I award the following 

compensation:

A lump sum of $30,000.00 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 § 15(a). Id. 

I approve 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/Brian H. Corcoran

Brian H. Corcoran

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 

KILEY LIZAMA, 

Petitioner, 

V. No. 18-990V 

SECRETARY OF HEALTH AND 

HUMAN SERVICES, 

Chief Special Master Brian Corcoran 

ECF 

Respondent. 

STIPULATION 

The parties hereby stipulate to the following matters: 

1. 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 injuries allegedly related to petitioner's receipt of the Tetanusdiphtheria-acellular pertussis ( .. Tdap") vaccine, which vaccine is contained in the Vaccine Injury 

Table (the "Table"), 42 C.F.R. § 100.3(a). 

2. Petitioner received the Tdap vaccination on or about April 23, 2016.

3. The vaccine was administered within the United States.

4. Petitioner alleges that the Tdap vaccine caused her to develop a right shoulder injury

related to vaccine administration ("SIRVA"), as defined in the Table, and further alleges that she 

experienced the residual effects of this alleged injury for more than six months. 

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

for damages as a result of her condition. 
6. Respondent denies that petitioner sustained a SIRVA Table injury, or and further

denies that the vaccine caused her alleged shoulder injury or any other injury or condition. 

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 tenns of this Stipulation, and after petitioner has filed an election to receive compensation 

pursuant to 42 U.S.C. § 300aa-2l(a)(l), the Secretary of Health and Human Services will issue 

the following vaccine compensation payment: 

A lump sum of$30,000.00 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-I 5(a). 

9. As soon as practicable after the entry of judgment on entitlement in this case, and after

petitioner has filed both a proper and timely election to receive compensation pursuant to 42 

U.S.C. § 300aa-21(a)(l), 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. 

l 0. Petitioner and her attorney represent that they have identified to respondent all

known sources of payment for items or services for which the Program is not primarily liable 

under 42 U.S.C. § 300aa-15(g), including 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 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 amount awarded

pursuant to paragraph 9, will be made in accordance with 42 U.S.C. § 300aa-15(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 attorney's fees and litigation costs, and past unreimbursable 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-l 5(a) and (d), and subject to the conditions of 42 U.S.C. 

§ 300aa-15(g) and (h).

13. In return for the payment described in paragraph 8, and any amount awarded

pursuant to paragraph 9, petitioner, in her individual capacity, and on behalf of her heirs, 

executors, administrators, successors and/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 brought in the Court of Federal 

Claims, under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-l 0 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 resulting from, or alleged to have resulted 

from, the Tdap vaccine administered on or about April 23, 2016, as alleged by petitioner in a 

petition for vaccine compensation filed on or about July 11, 20 l 8, in the United States Court of 

Federal Claims as petition No. 18-990V. 

14. If petitioner should 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 Court of Federal Claims fails to enter judgment in conformity with a 

decision that is in complete conformity with the terms 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 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 of the 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 Tdap vaccine caused petitioner's alleged 

shoulder injury or any other injury or condition. 

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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Respectfully submitted, 

PETITIONER: 

AMYSENERTH 

MULLER BRAZll.., LLP 

715 Twining Road, Suite 208 

Dresher, PA 19025 

(215) 885-1655 

AUTHORIZED REPRESENTATIVE 

OF THE SECRETARY OF HEALffl 

AND HUMAN SERVICES: 

TAMARA OVERBY 

Acting Director, Division of Injury Compensation 

Programs (DICP) 

Healthcare Systems Bureau 

Health Resources and Services Administration 

5600 Fishers Lane 

Parklawn Building, Mail Stop 08N 146B 

Rockville, MD 20857 

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AUTHORIZED REPRSENT ATIVE 

OF HE ATTORNEY GENERAL: 

C ~~~EE. REEVES 

Deputy Director 

Torts Branch 

Civil Division 

U.S. Department of Justice 

P.O. Box 146 

Benjamin Franklin Station 

Washington, DC 20044-0146 

ATTORNEY OF RECORD FOR 

RESPONDENT: 

(_ ~ m lclla:x:r 

~~- G-___ 

Trial Attorney 

Torts Branch 

Civil Division 

U.S. Department of Justice 

P.O. Box 146 

Benjamin Franklin Station 

Washington, DC 20044-0146 

Tel: (202) 616-4098