VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-00097
Package ID: USCOURTS-cofc-1_16-vv-00097
Petitioner: Jackie Evans
Filed: 2016-01-19
Decided: 2016-07-11
Vaccine: influenza
Vaccination date: 2013-09-28
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 57647

AI-assisted case summary:
Jackie Evans filed a petition for compensation under the National Vaccine Injury Compensation Program on January 19, 2016, alleging that an influenza vaccination administered on September 28, 2013, caused her to suffer from a shoulder injury related to vaccine administration (SIRVA). The respondent, the Secretary of Health and Human Services, filed a report on April 18, 2016, conceding that the petitioner was entitled to compensation and that her alleged injury was consistent with SIRVA. The respondent concluded that the petitioner had satisfied all legal prerequisites for compensation under the Act. Special Master Lisa Hamilton-Fieldman reviewed the record and, based on the respondent's concession, ruled that the petitioner was entitled to compensation. The case then proceeded to the damages phase. On June 17, 2016, the respondent filed a Proffer on Award of Compensation, stating that the petitioner agreed with the proffered award. Special Master Hamilton-Fieldman reviewed the proffer and found it reasonable, adopting it as the decision of the court. The award included a lump sum payment of $2,647.30, in the form of a check jointly payable to the petitioner and the Illinois Department of Healthcare and Family Services to reimburse a State of Illinois Medicaid lien. The petitioner was to endorse this payment to the appropriate state agency. Additionally, a lump sum payment of $55,000.00 was awarded, payable solely to the petitioner, representing all other elements of compensation. The total award amounted to $57,647.30. Petitioner's counsel was Jeffrey S. Pop. Respondent's counsel was Douglas Ross. The decision was issued by Special Master Lisa Hamilton-Fieldman.

Theory of causation field:
Petitioner Jackie Evans alleged that an influenza vaccination administered on September 28, 2013, caused a shoulder injury related to vaccine administration (SIRVA). The respondent conceded entitlement, agreeing that the injury was consistent with SIRVA. The public decision does not describe the specific mechanism of injury, medical experts, or detailed clinical facts. The case proceeded to damages based on the respondent's concession. The award was determined via a Proffer on Award of Compensation filed by the respondent on June 17, 2016, and adopted by Special Master Lisa Hamilton-Fieldman on July 11, 2016. The award consisted of a $55,000.00 lump sum for the petitioner and $2,647.30 to reimburse a State of Illinois Medicaid lien, totaling $57,647.30. Petitioner was represented by Jeffrey S. Pop, and respondent was represented by Douglas Ross. The theory of causation is based on the respondent's concession and is consistent with the Vaccine Injury Table (SIRVA).

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-00097-0
Date issued/filed: 2016-05-09
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 4/18/2016) regarding 14 Ruling on Entitlement. Signed by Special Master Lisa Hamilton-Fieldman. (mb) Copy to parties.
--------------------------------------------------------------------------------
Case 1:16-vv-00097-UNJ Document 16 Filed 05/09/16 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
Filed: April 18, 2016
* * * * * * * * * * * * * * * UNPUBLISHED
JACKIE EVANS, *
* No. 16-97
Petitioner, *
*
v. * Special Master Hamilton-Fieldman
*
SECRETARY OF HEALTH *
AND HUMAN SERVICES, * Ruling on Entitlement; Conceded;
* Influenza (Flu) Vaccine; Shoulder Injury
Respondent. * Related to Vaccine Administration
* (SIRVA).
* * * * * * * * * * * * * * *
Jeffrey S. Pop, Jeffrey S. Pop, Attorney at Law, Beverly Hills, CA, for Petitioner.
Douglas Ross, United States Department of Justice, Washington, D.C., for Respondent.
RULING ON ENTITLEMENT1
On January 19, 2016, Jackie Evans (“Petitioner”) filed a petition for compensation under
the National Vaccine Injury Compensation Program (“the Program”).2 Petitioner alleged that an
influenza (“flu”) vaccination administered on September 28, 2013 caused her to suffer from a
shoulder injury related to vaccine administration (“SIRVA”).
On April 18, 2016, Respondent filed a report pursuant to Vaccine Rule 4(c) in which she
concedes that Petitioner is entitled to compensation in this case. Specifically, Respondent agrees
1 Because this unpublished ruling contains a reasoned explanation for the action in this case, the
undersigned intends to post this decision on the website of the United States Court of Federal
Claims, in accordance with the E-Government Act of 2002 § 205, 44 U.S.C. § 3501 (2012). In
accordance with the Vaccine Rules, each party has 14 days within which to request redaction “of
any information furnished by that party: (1) that is a trade secret or commercial or financial in
substance and is privileged or confidential; or (2) that includes medical files or similar files, the
disclosure of which would constitute a clearly unwarranted invasion of privacy.” Vaccine Rule
18(b). Further, consistent with the rule requirement, a motion for redaction must include a
proposed redacted decision. If, upon review, the undersigned agrees that the identified material
fits within the requirements of that provision, such material will be deleted from public access.
2 The Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, 42
U.S.C. §§ 300aa-10 et seq. (hereinafter “Vaccine Act” or “the Act”). Hereafter, individual
section references will be to 42 U.S.C. § 300aa of the Act.

Case 1:16-vv-00097-UNJ Document 16 Filed 05/09/16 Page 2 of 2
that Petitioner’s alleged injury is consistent with SIRVA. Based on a review of the medical
records, Respondent concludes that Petitioner has satisfied all legal prerequisites for
compensation under the Act.
A special master may determine whether a petitioner is entitled to compensation based
upon the record. A hearing is not required. §300aa-13; Vaccine Rule 8(d). In light of
Respondent’s concession and a review of the record, the undersigned finds that Petitioner is
entitled to compensation. This matter shall now proceed to the damages phase.
IT IS SO ORDERED.
s/ Lisa Hamilton-Fieldman
Lisa Hamilton-Fieldman
Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_16-vv-00097-1
Date issued/filed: 2016-07-11
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 6/20/2016) regarding 21 DECISION Stipulation/Proffer. Signed by Special Master Lisa Hamilton-Fieldman. (mb) Copy to parties.
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Case 1:16-vv-00097-UNJ Document 26 Filed 07/11/16 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-97V
Filed: June 20, 2016
* * * * * * * * * * * * * * *
JACKIE EVANS, * UNPUBLISHED
*
Petitioner, * Special Master Hamilton-Fieldman
*
v. *
* Decision on Proffer; Influenza
SECRETARY OF HEALTH AND * (“Flu”) Vaccine; Shoulder Injury
HUMAN SERVICES, * Related to Vaccine Administration
* (“SIRVA”).
Respondent. *
* * * * * * * * * * * * * * *
Jeffrey S. Pop, Jeffrey S. Pop, Attorney at Law, Beverly Hills, CA, for Petitioner.
Douglas Ross, United States Department of Justice, Washington, D.C., for Respondent.
DECISION AWARDING DAMAGES1
On January 19, 2016, Jackie Evans (“Petitioner”) filed a petition for compensation under
the National Vaccine Injury Compensation Program (“the Program”).2 Petitioner alleged that an
influenza (“flu”) vaccination administered on September 28, 20133 caused her to suffer from a
shoulder injury related to vaccine administration (“SIRVA”). On April 18, 2016, the
undersigned ruled that Petitioner is entitled to compensation for her injury.
1 Because this unpublished decision contains a reasoned explanation for the undersigned’s action
in this case, the undersigned intends to post this decision 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 (2012)). As provided by
Vaccine Rule 18(b), each party has 14 days within which to request redaction “of any
information furnished by that party: (1) that is a trade secret or commercial or financial in
substance and is privileged or confidential; or (2) that includes medical files or similar files, the
disclosure of which would constitute a clearly unwarranted invasion of privacy.” Otherwise,
“the entire” decision will be available to the public. Id.
2 The Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, 42
U.S.C. §§ 300aa-10 et seq. (hereinafter “Vaccine Act” or “the Act”). Hereafter, individual
section references will be to 42 U.S.C. § 300aa of the Act.
3 The attached Proffer identifies the date of vaccination as September 18, 2013. However, the
petition, Respondent’s Rule 4(c) Report, and the entitlement ruling identify the date of
vaccination as September 28, 2013.
1

Case 1:16-vv-00097-UNJ Document 26 Filed 07/11/16 Page 2 of 5
On June 17, 2016, Respondent filed a Proffer on Award of Compensation (“Proffer”),
attached hereto as Appendix A. In the Proffer, Respondent represents that Petitioner agrees with
the proffered award. The undersigned finds the Proffer reasonable and adopts it as the decision
of the Court in awarding damages, on the terms set forth therein.
Pursuant to the terms stated in the attached Proffer, the undersigned awards the
following:
A lump sum payment of $2,647.30, in the form of a check jointly payable
to Petitioner and to
Illinois Department of Healthcare and Family Services
Bureau of Collections
Technical Recovery System
PO Box 19174
Springfield, Illinois 62794-9174
Case No. 03-108-0000007716
Petitioner agrees to endorse the payment to the appropriate state agency;
and
A lump sum payment of $55,000.00, in the form of a check payable solely
to Petitioner.
Proffer Section II.
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 herewith.4
IT IS SO ORDERED.
s/Lisa D. Hamilton-Fieldman
Lisa D. Hamilton-Fieldman
Special Master
4 Pursuant to Vaccine Rule 11(a), entry of judgment is expedited by the parties’ joint filing of
notice renouncing the right to seek review.
2

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IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
*
JACKIE EVANS, *
*
Petitioner, *
*
v. * No. 16-97V (ECF)
* SPECIAL MASTER
* HAMILTON-FIELDMAN
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
In her April 18, 2016 decision, the Special Master found that a preponderance of the
medical evidence indicates that petitioner suffered a shoulder injury related to vaccine
administration (“SIRVA”), which was causally related to the flu vaccination he received on
September 18, 2013. The parties have now addressed the amount of compensation to be
awarded in this case.
I. Compensation
Based upon the evidence of record, respondent proffers that a lump sum of $2,647.30,
which amount represents reimbursement of a State of Illinois Medicaid lien, should be jointly
awarded petitioner, who will endorse the payment to the appropriate state agency, and the Illinois
Department of Healthcare and Family Services. In addition, petitioner should be awarded a lump
sum of $55,000.00, which amount represents all other elements of compensation to which

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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 should be made through lump
sum payments as follows:
a) in the form of a check for $2,647.30, payable jointly to petitioner and to:
Illinois Department of Healthcare and Family Services
Bureau of Collections
Technical Recovery Section
PO Box 19174
Springfield, Illinois 62794-9174
Case No. 03-108-0000007716
Petitioner agrees to endorse the payment to the appropriate state agency; AND
b) in the form of a check for $55,000.00, payable to petitioner.
Respectfully submitted,
BENJAMIN C. MIZER
Principal Deputy Assistant Attorney General
RUPA BHATTACHARYYA
Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Acting Deputy Director
Torts Branch, Civil Division
GLENN A. MACLEOD
Senior Trial Counsel
Torts Branch, Civil Division
1 Should petitioner die prior to entry of judgment, respondent would oppose any award for future
medical expenses, future lost earnings, and future pain and suffering, and the parties reserve the
right to move the Court for appropriate relief.
2

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/s/ DOUGLAS ROSS
DOUGLAS ROSS
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146, Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel.: (202) 616-3667
DATE: June 17, 2016
3