VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-00771
Package ID: USCOURTS-cofc-1_15-vv-00771
Petitioner: Carrie Payne
Filed: 2015-10-26
Decided: 2016-05-19
Vaccine: influenza
Vaccination date: 2014-10-14
Condition: left rotator cuff injury
Outcome: compensated
Award amount USD: 103793

AI-assisted case summary:
Carrie Payne filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered a left rotator cuff injury as a result of an influenza vaccine she received on October 14, 2014. The respondent conceded that the injury was caused in fact by the flu vaccination and that it was not due to unrelated factors. The respondent also noted that the petitioner suffered the sequelae of her injury for more than six months. Based on the respondent's concession and the evidence presented, the court found that Carrie Payne was entitled to compensation. Subsequently, the parties submitted a proffer for the award of compensation. The respondent proffered that Carrie Payne should be awarded a lump sum of $100,000.00 for pain and suffering, and $3,793.34 to satisfy the State of Pennsylvania Medicaid lien. The petitioner agreed with this proffered award. The court awarded Carrie Payne a total of $103,793.34.

Theory of causation field:
Off-Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-00771-0
Date issued/filed: 2015-11-17
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/26/2015) regarding 15 Ruling on Entitlement (Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-00771-UNJ Document 17 Filed 11/17/15 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-771V
Filed: October 26, 2015
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
CARRIE PAYNE, *
*
Petitioner, * Ruling on Entitlement; Concession;
* Influenza (Flu) Vaccine; Left Shoulder
* Injury; Shoulder Injury Related to
SECRETARY OF HEALTH * Vaccine Administration (SIRVA);
AND HUMAN SERVICES, * Special Processing Unit (SPU).
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Lawrence R. Cohan, Anapol, Schwartz, et al., Philadelphia, PA, for petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 23, 2015, Carrie Payne (“petitioner”) filed a petition for compensation
under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et
seq.,2 [the “Vaccine Act” or “Program”]. Petitioner alleges that as a result of receiving
the influenza (“flu”) vaccine on October 14, 2014, she suffered a left rotator cuff injury
that was caused in fact by her flu vaccination. Petition at 3. The case was assigned to
the Special Processing Unit of the Office of Special Masters.
On October 26, 2015, respondent filed her Rule 4(c) report in which she
concedes that petitioner is entitled to compensation in this case. Respondent’s Rule
4(c) Report at 3. Specifically, respondent states “that a preponderance of the medical
evidence establishes that the injury to petitioner’s left shoulder was caused-in-fact by
the administration of her October 14, 2014 flu vaccine, and that petitioner’s injury is not
1 Because this unpublished ruling contains a reasoned explanation for the action in this case, I intend to
post it on the United States Court of Federal Claims' website, in accordance with the E-Government Act
of 2002, Pub. L. No. 107-347, § 205, 116 Stat. 2899, 2913 (codified as amended at 44 U.S.C. § 3501
note (2006)). 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).

Case 1:15-vv-00771-UNJ Document 17 Filed 11/17/15 Page 2 of 2
due to factors unrelated to the administration of the flu vaccine.” Id. at 3. Respondent
further states that the records show that petitioner suffered the sequela of her injury for
more than six months. Id. Thus, respondent states that she “has concluded that
[petitioner’s] left shoulder injury is compensable as a ‘caused-in-fact’ injury under the
Act.” Id.
In view of respondent’s concession and the evidence presented, the
undersigned finds that petitioner is entitled to compensation.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_15-vv-00771-1
Date issued/filed: 2016-05-19
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 03/30/2016) regarding 30 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-00771-UNJ Document 35 Filed 05/19/16 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-0771V
Filed: March 30, 2016
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
CARRIE PAYNE, *
*
Petitioner, * Damages Decision Based on Proffer;
* Influenza (“Flu”) Vaccine; Left Shoulder
* Injury; Shoulder Injury Related to
SECRETARY OF HEALTH * Vaccine Administration (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Lawrence R. Cohan, Anapol Weiss, Philadelphia, PA, for petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On July 23, 2015, Carrie Payne (“petitioner”) 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 a left rotator cuff injury as
a result of an influenza (“flu”) vaccine she received on October 14, 2014. Petition at 3.
The case was assigned to the Special Processing Unit of the Office of Special Masters.
On October 26, 2015, a ruling on entitlement was issued finding petitioner
entitled to compensation. On March 30, 2016, respondent filed a proffer on award of
compensation (“Proffer”) stating that petitioner should be awarded a lump sum of
$100,000.00, for petitioner’s actual and projected pain and suffering, and $3,793.34, to
satisfy the State of Pennsylvania Medicaid lien. Proffer at 1. In the Proffer, respondent
represented that petitioner agrees with the proffered award. Based on the record as a
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).

Case 1:15-vv-00771-UNJ Document 35 Filed 05/19/16 Page 2 of 5
whole, the undersigned finds that petitioner is entitled to an award as stated in the
Proffer (attached as Appendix A).
Pursuant to the terms stated in the attached Proffer, the undersigned awards
petitioner the following:
(1) A lump sum payment of $100,000.00, in the form of a check payable to
petitioner, Carrie Payne, and
(2) A lump sum payment of $3,793.34, representing compensation for
satisfaction of the State of Pennsylvania Medicaid lien, payable jointly to
petitioner and the Department of Human Services:
Karen H. Peterson
Claims Investigation Agent
Commonwealth of Pennsylvania
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
Petitioner agrees to endorse this payment to Pennsylvania Medicaid.
These amounts represent compensation for all damages that would be available
under § 300aa-15(a).
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.
2

Case 1:15-vv-00771-UNJ Document 35 Filed 05/19/16 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
CARRIE PAYNE, )
)
Petitioner, )
) No. 15-771V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
Respondent hereby submits the following proffer for the award on compensation.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded a lump sum of $100,000.00 for
petitioner’s actual and projected pain and suffering as provided under the Vaccine Act, 42 U.S.C.
§ 300aa-15(a)(4).1 Petitioner agrees.
B. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy the State of
Pennsylvania Medicaid lien in the amount of $3,793.34, which represents full satisfaction of any
right of subrogation, assignment, claim, lien, or cause of action the State of Pennsylvania may
have against any individual as a result of any Medicaid payments the State of Pennsylvania has
made to or on behalf of petitioner from the date of her eligibility for benefits through the date of
1 Should petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future medical
expenses, future lost earnings, and future pain and suffering.

Case 1:15-vv-00771-UNJ Document 35 Filed 05/19/16 Page 4 of 5
judgment in this case as a result of her vaccine-related injury suffered on or about October 14,
2014, under Title XIX of the Social Security Act.
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made
through a lump sum payment of $100,000.00 in the form of a check payable to petitioner. In
addition, a lump sum payment should be made of $3,793.34, representing compensation for
satisfaction of the State of Pennsylvania Medicaid lien, payable jointly to petitioner and
Department of Human Services:
Karen H. Peterson
Claims Investigation Agent
Commonwealth of Pennsylvania
Bureau of Program Integrity
Division of Third Party Liability
Recovery Section
P.O. Box 8486
Harrisburg, PA 17105-8486
Petitioner agrees to endorse this payment to Pennsylvania Medicaid.
Respectfully submitted,
BENJAMIN C. MIZER
Principal Deputy Assistant Attorney General
RUPA BHATTACHARYYA
Director
Torts Branch, Civil Division
VINCENT J. MATANOSKI
Deputy Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Senior Trial Attorney
Torts Branch, Civil Division
2

Case 1:15-vv-00771-UNJ Document 35 Filed 05/19/16 Page 5 of 5
s/Christine Mary Becer
CHRISTINE MARY BECER
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Date: March 30, 2016
3