VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01061
Package ID: USCOURTS-cofc-1_16-vv-01061
Petitioner: William Staak, Jr.
Filed: 2017-02-17
Decided: 2017-12-05
Vaccine: influenza
Vaccination date: 2015-09-29
Condition: shoulder pain
Outcome: compensated
Award amount USD: 55000

AI-assisted case summary:
William Staak, Jr. filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that within two hours of receiving an influenza vaccination on September 29, 2015, he developed severe left shoulder pain. The respondent, the Secretary of Health and Human Services, conceded that Mr. Staak, Jr.'s alleged injury was consistent with Shoulder Injury Related to Vaccine Administration (SIRVA) and that it was caused in fact by the flu vaccine. The respondent further indicated that Mr. Staak, Jr. had satisfied all legal prerequisites for compensation. Based on the respondent's concession and the evidence, the court found Mr. Staak, Jr. entitled to compensation. Subsequently, the parties submitted a proffer on award of compensation. The respondent recommended an award of $55,000.00, representing all elements of compensation to which Mr. Staak, Jr. would be entitled under the Act, and Mr. Staak, Jr. agreed with this amount. The court awarded Mr. Staak, Jr. a lump sum payment of $55,000.00.

Theory of causation field:
Off-Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-01061-0
Date issued/filed: 2017-09-19
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/17/2017) regarding 17 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:16-vv-01061-UNJ Document 30 Filed 09/19/17 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1061V
Filed: February 17, 2017
Unpublished
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
WILLIAM STAAK, JR., *
*
Petitioner, * Ruling on Entitlement; Concession;
v. * Influenza Vaccination;
* Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH * Administration (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Jeffrey S. Pop, Jeffrey S. Pop, Attorney at Law, Beverly Hills, CA, for petitioner.
Sarah C. Duncan, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On August 25, 2016, William Staak, Jr. (“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 within two
hours of the influenza vaccination on September 29, 2015, he developed severe left
shoulder pain and that his injuries were caused by the influenza vaccination. Petition at
1, ¶¶ 5, 6, 14. Petitioner further alleges that he received the vaccination in the United
States, has suffered the residual effects of his injury for more than six months, and has
not filed a civil action or received compensation for his injuries alleged as vaccine
caused. Id. at ¶¶ 5, 14, 16. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
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 (2012)). 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 1:16-vv-01061-UNJ Document 30 Filed 09/19/17 Page 2 of 2
On February 17, 2017, 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 “has concluded that petitioner’s alleged injury
is consistent with SIRVA, and that it was caused in fact by the flu vaccine he received
on September 29, 2015.” Id. at 4. Respondent further indicates that “based on the
record as it now stands, petitioner has satisfied all legal prerequisites for compensation
under the Act.” Id.
In view of respondent’s concession and the evidence before me, I find 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_16-vv-01061-1
Date issued/filed: 2017-12-05
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/03/2017) regarding 20 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
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Case 1:16-vv-01061-UNJ Document 31 Filed 12/05/17 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1061V
Filed: April 3, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
WILLIAM STAAK, JR., *
*
Petitioner, *
* Damages Decision Based on Proffer;
v. * Influenza Vaccine (“Flu Vaccine”);
* Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH * Administration (“SIRVA”);
AND HUMAN SERVICES, * Special Processing Unit (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Jeffrey S. Pop, Jeffrey S. Pop, Attorney at Law, Beverly Hills, CA, for petitioner.
Sarah C. Duncan, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On August 25, 2016, William Staak, Jr. (“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 within two
hours of the influenza vaccination on September 29, 2015, he developed severe left
shoulder pain and that his injuries were caused by the influenza vaccination. Petition at
1, ¶¶ 5, 6, 14. The case was assigned to the Special Processing Unit of the Office of
Special Masters.
On February 17, 2017, the undersigned issued a ruling on entitlement, finding
petitioner entitled to compensation. (ECF No. 17). On April 3, 2017, respondent filed a
proffer on award of compensation (“Proffer”) indicating petitioner should be awarded
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 1:16-vv-01061-UNJ Document 31 Filed 12/05/17 Page 2 of 4
$55,000.00. Proffer at 1. In the Proffer, respondent represented that petitioner agrees
with the proffered award. Id. 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 $55,000.00 in the form of a check payable to
petitioner, William Staak, Jr. 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 1:16-vv-01061-UNJ Document 31 Filed 12/05/17 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
WILLIAM STAAK, JR., )
)
Petitioner, )
) No. 16-1061V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND HUMAN )
SERVICES, )
)
Respondent. )
)
PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$55,000.00, 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
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner should be made through a
lump sum payment of $55,000.00, in the form of a check payable to petitioner. Petitioner agrees.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
1 Should petitioner die prior to the 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.
1

Case 1:16-vv-01061-UNJ Document 31 Filed 12/05/17 Page 4 of 4
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
ALTHEA WALKER DAVIS
Senior Trial Counsel
Torts Branch, Civil Division
s/ Sarah C. Duncan
Sarah C. Duncan
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) 514-9729
Fax: (202) 616-4310
DATED: April 3, 2017
2