VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_16-vv-01653
Package ID: USCOURTS-cofc-1_16-vv-01653
Petitioner: Shelly A. Chmielewski
Filed: 2017-06-16
Decided: 2018-10-31
Vaccine: pneumococcal conjugate vaccine
Vaccination date: 2016-01-27
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 135000

AI-assisted case summary:
Shelly A. Chmielewski filed a petition for compensation under the National Vaccine Injury Compensation Program on June 16, 2017, alleging that she received a pneumococcal conjugate vaccine on January 27, 2016, and subsequently suffered a shoulder injury related to vaccine administration (SIRVA). The case was assigned to the Special Processing Unit. In a Rule 4(c) report filed on June 13, 2017, the respondent conceded that Ms. Chmielewski was entitled to compensation. The respondent stated that her injury was consistent with SIRVA, specifically a significant aggravation of a pre-existing right shoulder condition, and that the evidence established it was caused-in-fact by the vaccine. No other causes were identified, and the statutory six-month sequela requirement was met. Based on the respondent's concession and the evidence, a ruling on entitlement was issued on June 16, 2017, finding Ms. Chmielewski entitled to compensation. Subsequently, on September 12, 2018, the respondent filed a proffer on award of compensation, indicating that Ms. Chmielewski should be awarded $135,000.00 and that she agreed with this amount. The Chief Special Master issued a decision awarding Ms. Chmielewski a lump sum payment of $135,000.00 on October 31, 2018, as compensation for all available damages.

Theory of causation field:
Off-Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_16-vv-01653-0
Date issued/filed: 2018-04-30
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 06/16/2017) regarding 15 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:16-vv-01653-UNJ Document 36 Filed 04/30/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1653V
Filed: June 16, 2017
UNPUBLISHED
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
SHELLY A. CHMIELEWSKI, *
*
Petitioner, * Ruling on Entitlement; Concession;
v. * Pneumococcal Conjugate Vaccine
* (Prevnar); Shoulder Injury Related to
SECRETARY OF HEALTH * Vaccine Injury; Special Processing Unit
AND HUMAN SERVICES, * (“SPU”)
*
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * * * * *
Leah VaSahnja Durant, Law Offices, Washington, DC, for petitioner.
Ryan Daniel Pyles, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On December 15, 2016, Shelly A. Chmielewski (“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 received a
pneumococcal conjugate vaccine on January 27, 2016 and thereafter suffered from a
shoulder injury related to vaccine injury (“SIRVA”). Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On June 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 states that petitioner’s alleged injury is “consistent with
SIRVA (in this case, a significant aggravation of a preexisting right shoulder condition)’
that a preponderance of the evidence establishes that her SIRVA was caused-in-fact by
the pneumococcal vaccination she received on January 27, 2016; and that no other
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-01653-UNJ Document 36 Filed 04/30/18 Page 2 of 2
causes for petitioner’s SIRVA were identified.” Id. at 3. Respondent further agrees that
the statutory six month sequela requirement has been satisfied. 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-01653-1
Date issued/filed: 2018-10-31
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 09/13/2018) regarding 45 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:16-vv-01653-UNJ Document 48 Filed 10/31/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 16-1653V
Filed: September 13, 2018
UNPUBLISHED
SHELLY A. CHMIELEWSKI,
Special Processing Unit (SPU);
Damages Decision Based on Proffer;
Petitioner,
Pneumococcal Conjugate Vaccine
v.
(Prevnar); Shoulder Injury Related to
Vaccine Administration (SIRVA)
SECRETARY OF HEALTH
AND HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Ryan Daniel Pyles, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On December 15, 2016, Shelly A Chmielewski (“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 received a
pneumococcal conjugate vaccine on January 27, 2016, and thereafter suffered a
shoulder injury related to vaccine administration (“SIRVA”). Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On June 16, 2017, a ruling on entitlement was issued, finding petitioner entitled
to compensation. On September 12, 2018, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $135,000.00. Proffer
at 1. In the Proffer, respondent represented that petitioner agrees with the proffered
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-01653-UNJ Document 48 Filed 10/31/18 Page 2 of 2
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 $135,000.00, in the form of a check payable to
petitioner, Shelly A. Chmielewski. 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