VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01379
Package ID: USCOURTS-cofc-1_16-vv-01379
Petitioner: Amy Komaki
Filed: 2016-10-21
Decided: 2017-12-08
Vaccine: Prevnar 13
Vaccination date: 2015-11-20
Condition: shoulder injury related to vaccine administration (SIRVA) and adhesive capsulitis
Outcome: compensated
Award amount USD: 100425

AI-assisted case summary:
Amy Komaki filed a petition for compensation under the National Vaccine Injury Compensation Program on October 21, 2016. She alleged that she suffered a shoulder injury related to vaccine administration (SIRVA) and adhesive capsulitis as a result of her November 20, 2015, Prevnar 13 vaccination. The case was assigned to the Special Processing Unit. On March 13, 2017, the respondent filed a Rule 4(c) report conceding entitlement. The respondent concluded that petitioner suffered a non-Table injury of left-side adhesive capsulitis, that the injury was causally related to the Prevnar vaccination received on November 20, 2015, 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 March 13, 2017, finding petitioner entitled to compensation. Subsequently, on April 17, 2017, the respondent filed a proffer on award of compensation, proposing a total lump sum of $100,425.36, which petitioner agreed to. Chief Special Master Dorsey issued a decision on December 8, 2017, awarding petitioner a lump sum payment of $100,425.36, payable to Amy Komaki, representing compensation for all damages available under 42 U.S.C. § 300aa-15(a). Petitioner was represented by John Robert Howie, Jr. of Howie Law, PC. Respondent was represented by Douglas Ross of the U.S. Department of Justice.

Theory of causation field:
Petitioner Amy Komaki received a Prevnar 13 vaccination on November 20, 2015. She alleged and was found to have suffered a shoulder injury related to vaccine administration (SIRVA) and adhesive capsulitis. The respondent conceded entitlement, finding that the injury was a non-Table injury causally related to the vaccination and that petitioner met the statutory requirements. The public decision does not describe the specific mechanism of injury, onset, symptoms, diagnostic tests, or treatments. The case proceeded to a damages decision based on a proffer. Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on March 13, 2017, and a decision awarding damages on December 8, 2017. Petitioner was awarded a lump sum of $100,425.36. Petitioner was represented by John Robert Howie, Jr. (Howie Law, PC), and respondent was represented by Douglas Ross (U.S. Department of Justice).

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-01379-0
Date issued/filed: 2017-09-29
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/13/2017) regarding 16 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Copy to parties.
--------------------------------------------------------------------------------
Case 1:16-vv-01379-UNJ Document 29 Filed 09/29/17 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1379 V
Filed: March 13, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
AMY KOMAKI, *
*
Petitioner, * Ruling on Entitlement; Concession;
v. * Prevnar 13 (Pneumococcal Conjugate)
* Vaccination; Adhesive Capsulitis;
SECRETARY OF HEALTH * Special Processing Unit (“SPU”)
AND HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
John Robert Howie, Jr., Howie Law, PC, for petitioner.
Douglas Ross, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On October 21, 2017, 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 shoulder injury related to vaccine
administration (SIRVA) and adhesive capsulitis as a result of her November 20, 2015
Prevnar 13 (pneumococcal conjugate) vaccination. Petition at 1, ¶¶ 6, 15. The case
was assigned to the Special Processing Unit of the Office of Special Masters.
On March 13, 2017, respondent filed his Rule 4(c) report in which he concedes
that petitioner is entitled to compensation in this case. Respondent’s Rule 4(c) Report
at 1. Specifically, respondent has “concluded that petitioner suffered a non-Table injury
of left-side adhesive capsulitis and that the preponderance of the medical evidence
indicates that the injury was causally related to the Prevnar vaccination she received on
November 20, 2015.” Id. at 4. Respondent further indicates that he “did not identify any
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 1:16-vv-01379-UNJ Document 29 Filed 09/29/17 Page 2 of 2
other causes for petitioner’s adhesive capsulitis, and based on the medical records
outlined above, petitioner met the statutory requirements by suffering the condition for
more than six months.” Id. Accordingly, respondent states that “based on the record as
it now stands, compensation is appropriate, as petitioner has satisfied all legal
prerequisites for compensation under the 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
2

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DOCUMENT 2: USCOURTS-cofc-1_16-vv-01379-1
Date issued/filed: 2017-12-08
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/17/2017) 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-01379-UNJ Document 30 Filed 12/08/17 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1379V
Filed: April 17, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
AMY KOMAKI, *
*
Petitioner, * Damages Decision Based on Proffer;
v. * Prevnar 13 (Pneumococcal Conjugate)
* Vaccination; Adhesive Capsulitis;
SECRETARY OF HEALTH * Special Processing Unit (“SPU”)
AND HUMAN SERVICES, *
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
John Robert Howie, Jr., Howie Law, PC, Dallas, TX, for petitioner.
Douglas Ross, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On October 21, 2016, 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 shoulder injury related to vaccine
administration (SIRVA) and adhesive capsulitis as a result of her November 20, 2015
Prevnar 13 (pneumococcal conjugate) vaccination. Petition at 1, ¶¶ 6, 15. The case
was assigned to the Special Processing Unit of the Office of Special Masters.
On March 13, 2017, a ruling on entitlement was issued, finding petitioner entitled
to compensation for left-side adhesive capsulitis. On April 17, 2017, respondent filed a
proffer on award of compensation (“Proffer”) indicating petitioner should be awarded
$100,425.36. Proffer at 1. In the Proffer, respondent represented that petitioner agrees
with the proffered award.
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-01379-UNJ Document 30 Filed 12/08/17 Page 2 of 4
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 $100,425.36 in the form of a check payable to
petitioner, Amy Komaki. 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-01379-UNJ Document 30 Filed 12/08/17 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
*
AMY KOMAKI, *
Petitioner, *
*
v. * No. 16-1379V (ECF)
* CHIEF SPECIAL MASTER
* NORA BETH DORSEY
SECRETARY OF HEALTH *
AND HUMAN SERVICES, *
*
Respondent. *
* * * * * * * * * * * * * * * * * * * * * * * * * * * * *
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
In her March 13, 2017 Ruling on Entitlement, the Chief 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 Prevnar 13 vaccination
she received on November 20, 2015. 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 petitioner should be awarded
a total lump sum of $100,425.36, which amount represents all elements of compensation to
which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).1 Petitioner agrees.
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.

Case 1:16-vv-01379-UNJ Document 30 Filed 12/08/17 Page 4 of 4
II. Form of the Award
Petitioner is a competent adult. Accordingly, the parties recommend that the
compensation provided should be made through a lump sum payment in the form of a check for
$100,425.36, payable to petitioner.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
Civil Division
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
MICHAEL P. MILMOE
Senior Trial Counsel
Torts Branch, Civil Division
/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: April 17, 2017
2