VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00162
Package ID: USCOURTS-cofc-1_17-vv-00162
Petitioner: Raymonde L. Forjette
Filed: 2017-02-03
Decided: 2019-05-29
Vaccine: influenza
Vaccination date: 2015-10-15
Condition: right shoulder injury
Outcome: compensated
Award amount USD: 101626

AI-assisted case summary:
Raymonde L. Forjette filed a petition for compensation under the National Vaccine Injury Compensation Program on February 3, 2017, alleging that an influenza vaccination received on October 15, 2015, caused her to suffer a right shoulder injury. The respondent conceded that petitioner's injury was consistent with shoulder injury related to vaccine administration (SIRVA) and that she met all legal prerequisites for compensation. A ruling on entitlement was issued on October 17, 2018, finding her entitled to compensation. Subsequently, on March 19, 2019, the respondent filed a proffer on award of damages, recommending a total award of $101,626.30. This amount included $95,000 for pain and suffering and $6,626.30 for past unreimbursable expenses. Petitioner agreed with the proffered award. The Chief Special Master issued a decision awarding the full proffered amount of $101,626.30 as a lump sum payment to Raymonde L. Forjette on May 29, 2019. The case was treated as a Table claim, and entitlement was conceded by the respondent.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00162-0
Date issued/filed: 2018-12-12
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 10/17/2018) regarding 49 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00162-UNJ Document 53 Filed 12/12/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-162V
Filed: October 17, 2018
UNPUBLISHED
RAYMONDE L. FORJETTE,
Special Processing Unit (SPU);
Petitioner, Ruling on Entitlement; Concession;
v. Causation-In-Fact; Influenza (Flu)
Vaccine; Shoulder Injury Related to
SECRETARY OF HEALTH AND Vaccine Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Sylvia Chin-Caplan, Law Office of Sylvia Chin-Caplan, Boston, MA, for petitioner.
Jennifer Leigh Reynaud, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On February 3, 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 an influenza (“flu”) vaccination she received on
October 15, 2015 caused her to suffer a right shoulder injury. Petition at 1. The case
was assigned to the Special Processing Unit of the Office of Special Masters.
On October 15, 2018, 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 the Division of Injury Compensation Programs
(“DICP”) at the Department of Health and Human Services has determined that
“petitioner’s alleged injury is consistent with shoulder injury related to vaccine
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 1:17-vv-00162-UNJ Document 53 Filed 12/12/18 Page 2 of 2
administration (“SIRVA”).” Id. at 4. Respondent further agrees that “petitioner has
satisfied all legal prerequisites for compensation under the [Vaccine] Act.” Id.
In view of respondent’s position 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_17-vv-00162-1
Date issued/filed: 2019-05-29
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 03/20/2019) regarding 59 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00162-UNJ Document 63 Filed 05/29/19 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-162V
Filed: March 20, 2019
UNPUBLISHED
RAYMONDE L. FORJETTE,
Petitioner,
Special Processing Unit (SPU);
v.
Damages Decision Based on Proffer;
Influenza (Flu) Vaccine; Shoulder
SECRETARY OF HEALTH AND
Injury Related to Vaccine
HUMAN SERVICES,
Administration (SIRVA)
Respondent.
Sylvia Chin-Caplan, Law Office of Sylvia Chin-Caplan, Boston, MA, for petitioner.
Jennifer Leigh Reynaud, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On February 3, 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 an influenza (“flu”) vaccination she received on
October 15, 2015 caused her to suffer a right shoulder injury. Petition at 1. The case
was assigned to the Special Processing Unit of the Office of Special Masters.
On October 17, 2018, a ruling on entitlement was issued, finding petitioner
entitled to compensation for her shoulder injury. On March 19, 2019, respondent filed a
proffer on award of compensation (“Proffer”) indicating petitioner should be awarded
$101,626.30, including $95,000 in actual in projected pain and suffering and $6,626.30
in past unreimbursable expenses. Proffer at 1-2. In the Proffer, respondent
1 The undersigned intends to post this decision on the United States Court of Federal Claims' website.
This means the decision will be available to anyone with access to the internet. 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. Because this unpublished decision contains a reasoned explanation for the
action in this case, undersigned is required 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).
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 1:17-vv-00162-UNJ Document 63 Filed 05/29/19 Page 2 of 4
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 $101,626.30 in the form of a check payable to
petitioner, Raymonde L. Forjette. This amount represents compensation for all
damages that would be available under § 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 1:17-vv-00162-UNJ Document 63 Filed 05/29/19 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
RAYMONDE L. FORJETTE,
Petitioner, No. 17-162V
v. Chief Special Master Dorsey
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
PROFFER ON AWARD OF DAMAGES
On February 3, 2017, Raymonde L. Forjette (“petitioner”) filed a petition for
compensation (“Petition”) under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C.
§§ 300aa-1 to -34 (“Vaccine Act” or “Act”), as amended. Respondent conceded petitioner’s
entitlement to compensation in his Rule 4(c) Report filed on October 15, 2018. Based on
Respondent’s Rule 4(c) Report the Chief Special Master found petitioner entitled to
compensation.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $95,000.00 in actual and projected
pain and suffering. This amount reflects that any award for projected pain and suffering has
been reduced to net present value. See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.
B. Past Unreimbursable Expenses
Evidence supplied by petitioner documents her expenditure of past unreimbursable
expenses related to her vaccine-related injury. Respondent proffers that petitioner should be
awarded past unreimbursable expenses in the amount of $6,626.30. Petitioner agrees.
1

Case 1:17-vv-00162-UNJ Document 63 Filed 05/29/19 Page 4 of 4
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through a lump sum payment of $101,626.30, in the form of a check made payable to petitioner.
1 This lump sum payment represents all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respectfully submitted,
JOSEPH H. HUNT
Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
GABRIELLE M. FIELDING
Assistant Director
Torts Branch, Civil Division
s/Jennifer L. Reynaud
JENNIFER L. REYNAUD
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) 305-1586
Date: March 19, 2019
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.
2