VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_15-vv-01125
Package ID: USCOURTS-cofc-1_15-vv-01125
Petitioner: Ellyson Ostrovsky
Filed: 2015-10-05
Decided: 2016-05-27
Vaccine: influenza
Vaccination date: 2012-10-18
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 50422

AI-assisted case summary:
Ellyson Ostrovsky, an adult, received a seasonal influenza vaccine on October 18, 2012. She subsequently filed a petition alleging a shoulder injury related to vaccine administration (SIRVA). The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report conceding that the evidence established petitioner's injury was consistent with SIRVA and was caused-in-fact by the flu vaccine. The respondent also noted that no other causes were identified and that the injury had sequelae for more than six months. Based on this concession and the record, the Chief Special Master found Ellyson Ostrovsky entitled to compensation. Subsequently, the parties submitted a proffer on award of compensation. The respondent recommended an award of $50,422.27, representing all elements of compensation available under the Vaccine Act, which petitioner agreed to. The Chief Special Master awarded Ellyson Ostrovsky a lump sum payment of $50,422.27.

Theory of causation field:
Off-Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_15-vv-01125-0
Date issued/filed: 2016-05-10
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/09/2016) regarding 19 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
--------------------------------------------------------------------------------
Case 1:15-vv-01125-UNJ Document 26 Filed 05/10/16 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-1125V
Filed: March 9, 2016
Unpublished
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
ELLYSON OSTROVSKY, *
*
Petitioner, * Ruling on Entitlement; Concession;
* Influenza (“Flu”) Vaccine; Shoulder
* Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH * Administration (“SIRVA”); Special
AND HUMAN SERVICES, * Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
John R. Howie, Jr., Howie Law, P.C., Dallas, TX, for petitioner.
Michael P. Milmoe, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On October 5, 2015, Ellyson Ostrovsky (“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
suffered a shoulder injury related to vaccine administration (“SIRVA”) as a result of
receiving a seasonal influenza (“flu”) vaccination on October 18, 2012. Petition at 1.
The case was assigned to the Special Processing Unit (“SPU”) of the Office of Special
Masters.
On March 7, 2016, 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 stated that a preponderance of the evidence establishes
that petitioner’s injury is consistent with SIRVA, and that it was caused-in-fact by the flu
vaccine she received on October 18, 2012. Id. at 4. Respondent further stated that she
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. 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-01125-UNJ Document 26 Filed 05/10/16 Page 2 of 2
did not identify any other causes for petitioner’s SIRVA, and that the records show
petitioner has suffered the sequela of this injury for more than six months. Id.
Respondent therefore agrees with petitioner that compensation should be awarded
under the Vaccine Act. Id. at 4-5.
In view of respondent’s concession and the evidence of record, the
undersigned finds that petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_15-vv-01125-1
Date issued/filed: 2016-05-27
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/22/2016) regarding 22 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:15-vv-01125-UNJ Document 31 Filed 05/27/16 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 15-1125V
Filed: April 22, 2016
Unpublished
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
ELLYSON OSTROVSKY, *
*
Petitioner, * Damages Decision Based on Proffer;
* Influenza (“Flu”) Vaccine; Shoulder
v.
* Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH * Administration (“SIRVA”); Special
AND HUMAN SERVICES, * Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
John R. Howie, Jr., Howie Law, P.C., Dallas, TX, for petitioner.
Michael P. Milmoe, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On October 5, 2015, Ellyson Ostrovsky (“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 alleged that she suffered a shoulder
injury related to vaccine administration (“SIRVA”) as a result of receiving a seasonal
influenza (“flu”) vaccination on October 18, 2012. The case was assigned to the Special
Processing Unit (“SPU”) of the Office of Special Masters.
On March 9, 2016, a ruling on entitlement was issued, finding petitioner entitled
to compensation for a shoulder injury related to vaccine administration (“SIRVA”). On
April 22, 2016, respondent filed a proffer on award of compensation (“Proffer”) indicating
petitioner should be awarded $50,422.27. 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-01125-UNJ Document 31 Filed 05/27/16 Page 2 of 4
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 $50,422.27 in the form of a check payable to
petitioner, Ellyson Ostrovsky. 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-01125-UNJ Document 31 Filed 05/27/16 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
ELLYSON OSTROVSKY, )
)
Petitioner, ) No. 15-1125V
) Chief Special Master Dorsey
v. ) ECF
)
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Compensation for Vaccine Injury-Related Items
On March 7, 2016, respondent filed a Rule 4(c) Report conceding that petitioner was
entitled to vaccine compensation for her Shoulder Injury Related to Vaccine Administration
(“SIRVA”). Respondent proffers that, based on the evidence of record, petitioner should be
awarded $50,422.27. This amount represents all elements of compensation to which petitioner
would be entitled under 42 U.S.C. § 300aa-15(a)(1); 15(a)(3)(A); and 15(a)(4). Petitioner
agrees.
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through a lump sum payment as described below, and requests that the special master’s decision
and the Court’s judgment award the following:1
A. A lump sum payment of $50,422.27 in the form of a check payable to petitioner, Ellyson
Ostrovsky. This amount accounts for all elements of compensation under 42 U.S.C.
1 Should petitioner die prior to entry of judgment, respondent reserves the right to move the Court for appropriate
relief. In particular, respondent would oppose any award for future medical expenses, future pain and suffering, and
future lost wages.

Case 1:15-vv-01125-UNJ Document 31 Filed 05/27/16 Page 4 of 4
§ 300aa-15(a) to which petitioner would be entitled.
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
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
/s/ Michael P. Milmoe
MICHAEL P. MILMOE
Senior Trial Counsel
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Phone: (202) 616-4125
Dated: April 22, 2016 Fax: (202) 616-4310