VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-00936
Package ID: USCOURTS-cofc-1_15-vv-00936
Petitioner: Jennifer Siekierski
Filed: 2015-08-26
Decided: 2016-05-13
Vaccine: influenza
Vaccination date: 2014-11-04
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 185000

AI-assisted case summary:
Jennifer Siekierski filed a petition for compensation on August 26, 2015, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 4, 2014. The case was assigned to the Special Processing Unit. On November 23, 2015, respondent filed a Rule 4(c) report conceding that the alleged injury was consistent with SIRVA and that petitioner met the statutory requirements, including suffering the condition for more than six months. Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on November 23, 2015, finding petitioner entitled to compensation. Subsequently, on May 13, 2016, respondent filed a proffer on award of compensation, proposing an award of $185,000.00, which petitioner agreed to. Chief Special Master Dorsey awarded Jennifer Siekierski a lump sum payment of $185,000.00 for all damages. Petitioner was represented by Katheryn Lee Bruns of Faraci Lange, LLP, and respondent was represented by Julia Wernett McInerny of the U.S. Department of Justice. The public decision does not describe the specific onset, symptoms, medical tests, treatments, or expert witnesses involved in this case.

Theory of causation field:
Petitioner Jennifer Siekierski alleged a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccination on November 4, 2014. The respondent conceded that the alleged injury was consistent with SIRVA and that petitioner met the statutory requirements, including suffering the condition for more than six months. The case was decided based on this concession and a proffer on award of compensation. Chief Special Master Nora Beth Dorsey ruled on entitlement on November 23, 2015, finding petitioner entitled to compensation. On May 13, 2016, a decision was issued awarding petitioner a lump sum payment of $185,000.00 for all damages, as agreed upon by the parties. The theory of causation is based on the "Table" for SIRVA. Petitioner was represented by Katheryn Lee Bruns (Faraci Lange, LLP), and respondent was represented by Julia Wernett McInerny (U.S. Department of Justice). The public decision does not detail the specific mechanism of injury or name any medical experts.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-00936-0
Date issued/filed: 2016-09-26
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/23/2016) regarding 16 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-00936-UNJ Document 40 Filed 09/26/16 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-936V
Filed: November 23, 2015
Unpublished
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
JENNIFER SIEKIERSKI, *
*
Petitioner, * Ruling on Entitlement; Concession;
* Influenza;
* Shoulder Injury (“SIRVA”);
SECRETARY OF HEALTH * Special Processing Unit (“SPU”)
AND HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Katheryn Lee Bruns, Faraci Lange, LLP, Rochester, NY, for petitioner.
Julia Wernett McInerny, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On August 26, 2015, 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 she experienced a shoulder injury
related to vaccine administration (“SIRVA”) as a result of her receipt of an influenza
vaccine on November 4, 2014. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On November 23, 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 1. Specifically, respondent “believes that the alleged injury is consistent
with SIRVA. Based on the medical records outlined above, petitioner met the statutory
requirements by suffering the condition for more than six months.” Id. at 5. Respondent
1 Because this unpublished ruling 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, 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, 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-00936-UNJ Document 40 Filed 09/26/16 Page 2 of 2
further agrees that petitioner has satisfied all legal prerequisites for compensation under
the Vaccine Act. Id.
In view of respondent’s concession and the evidence before me, the
undersigned finds that petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_15-vv-00936-1
Date issued/filed: 2016-09-26
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 05/13/2016) regarding 35 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-00936-UNJ Document 41 Filed 09/26/16 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-936V
Filed: May 13, 2016
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
JENNIFER SIEKIERSKI, *
*
Petitioner, * Damages Decision Based on Proffer;
v. * Influenza;
* Shoulder Injury (“SIRVA”);
SECRETARY OF HEALTH * Special Processing Unit (“SPU”)
AND HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Katheryn Lee Bruns, Faraci Lange, LLP, Rochester, NY, for petitioner.
Julia Wernett McInerny, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On August 26, 2015, 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 experienced a shoulder injury related to
vaccine administration (“SIRVA”) as a result of her receipt of an influenza vaccine on
November 4, 2014. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On November 23, 2015, a ruling on entitlement was issued, finding petitioner
entitled to compensation for SIRVA. On May 13, 2016, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded $185,000.00.
Proffer at 1. In the Proffer, respondent represented that petitioner agrees with the
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-00936-UNJ Document 41 Filed 09/26/16 Page 2 of 4
proffered award. Based on the record as a whole, the undersigned finds that petitioner
is entitled to an award as stated in the Proffer.
Pursuant to the terms stated in the attached Proffer, the undersigned awards
petitioner a lump sum payment of $185,000.00 in the form of a check payable to
petitioner, Jennifer Siekierski. This amount represents 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-00936-UNJ Document 41 Filed 09/26/16 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
JENNIFER SIEKIERSKI, ) No. 15-936
) ECF
Petitioner, ) Chief Special Master Dorsey
)
v. )
)
SECRETARY OF HEALTH )
AND HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$185,000.00, which represents all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a).1 Petitioner agrees.
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made
through a lump sum payment of $185,000.00 in the form of a check payable to petitioner.
Petitioner agrees.
Respectfully submitted,
BENJAMIN C. MIZER
Principal Deputy Assistant Attorney General
RUPA BHATTACHARYYA
Director
Torts Branch, Civil Division
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-00936-UNJ Document 41 Filed 09/26/16 Page 4 of 4
VINCENT J. MATANOSKI
Deputy Director
Torts Branch, Civil Division
LISA A. WATTS
Senior Trial Attorney
Torts Branch, Civil Division
/s/ Julia W. McInerny
JULIA W. MCINERNY
Senior Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
DATED: May 13, 2016 (202) 353-3919
2