VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00626
Package ID: USCOURTS-cofc-1_17-vv-00626
Petitioner: Mary Havener
Filed: 2017-05-09
Decided: 2018-09-12
Vaccine: Tdap
Vaccination date: 
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 80287

AI-assisted case summary:
Mary Havener filed a petition for compensation under the National Vaccine Injury Compensation Program on May 9, 2017, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) following a tetanus, diphtheria, acellular pertussis (Tdap) vaccination. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on December 19, 2017, conceding that petitioner's claim met the Table criteria for SIRVA and that she satisfied the statutory requirements of the Vaccine Act. Based on the respondent's concession, Chief Special Master Nora Beth Dorsey issued a Ruling on Entitlement on January 4, 2018, finding petitioner entitled to compensation. Subsequently, on May 31, 2018, the parties submitted a proffer on the award of damages. The respondent proffered that petitioner should be awarded a lump sum of $80,287.00 for all elements of compensation under 42 U.S.C. § 300aa-15(a), and a lump sum of $5,432.57 for attorneys' fees and costs, payable jointly to petitioner and her counsel. Petitioner agreed with the proffered award. Chief Special Master Dorsey issued a Decision Awarding Damages on September 12, 2018, awarding Mary Havener a lump sum of $80,287.00 payable to her, and $5,432.57 for attorneys' fees and costs. The decision noted that petitioner is a competent adult and no guardianship was required. Petitioner was represented by Braden Andrew Blumenstiel of Blumenstiel Falvo, LLC, and respondent was represented by Voris Edward Johnson, Jr. of the U.S. Department of Justice.

Theory of causation field:
Mary Havener filed a petition alleging a shoulder injury related to vaccine administration (SIRVA) following a tetanus, diphtheria, acellular pertussis (Tdap) vaccination. The respondent conceded that the claim met the Table criteria for SIRVA and satisfied the statutory requirements of the Vaccine Act. The public decision does not describe the specific vaccination date, onset of symptoms, medical history, clinical findings, diagnostic tests, or treatments. No specific medical experts were named in the public text. The theory of causation is based on the "Table" injury category for SIRVA. The outcome was compensated. The award consisted of a lump sum of $80,287.00 for all damages and $5,432.57 for attorneys' fees and costs. The decision was issued by Chief Special Master Nora Beth Dorsey, with petitioner represented by Braden Andrew Blumenstiel and respondent represented by Voris Edward Johnson, Jr. The Ruling on Entitlement was dated January 4, 2018, and the Decision Awarding Damages was dated September 12, 2018.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00626-0
Date issued/filed: 2018-04-17
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 1/4/2018) regarding 17 Ruling on Entitlement. Signed by Chief Special Master Nora Beth Dorsey. (rp) Service on parties made.
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Case 1:17-vv-00626-UNJ Document 26 Filed 04/17/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-626V
Filed: January 4, 2018
UNPUBLISHED
MARY HAVENER,
Special Processing Unit (SPU);
Petitioner, Ruling on Entitlement; Concession;
v. Table Injury; Tetanus Diphtheria
acellular Pertussis (Tdap) Vaccine;
SECRETARY OF HEALTH AND Shoulder Injury Related to Vaccine
HUMAN SERVICES, Administration (SIRVA)
Respondent.
Braden Andrew Blumenstiel, Blumenstiel Falvo, LLC, Dublin, OH, for petitioner.
Douglas Ross, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On May 9, 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”) following a tetanus, diphtheria, acellular pertussis (“Tdap”)
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On December 19, 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 concluded that petitioner’s claim meets the
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-00626-UNJ Document 26 Filed 04/17/18 Page 2 of 2
Table criteria for a SIRVA Id. at 6. Respondent further agrees that petitioner satisfied
the statutory requirements of 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

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_17-vv-00626-1
Date issued/filed: 2018-09-12
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 06/01/2018) regarding 31 DECISION Stipulation/Proffer (Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00626-UNJ Document 34 Filed 09/12/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-626V
Filed: June 1, 2018
UNPUBLISHED
MARY HAVENER,
Special Processing Unit (SPU);
Damages Decision Based on Proffer;
Petitioner,
Tetanus Diphtheria acellular
v.
Pertussis (Tdap) Vaccine; Shoulder
Injury Related to Vaccine
SECRETARY OF HEALTH AND
Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Braden Andrew Blumenstiel, Blumenstiel Falvo, LLC, Dublin, OH, for petitioner.
Voris Edward Johnson, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On May 9, 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”) following a tetanus, diphtheria, acellular pertussis (“Tdap”)
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On January 4, 2018, a ruling on entitlement was issued, finding petitioner entitled
to compensation for a SIRVA. On May 31, 2018, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $80,287.00. 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 1:17-vv-00626-UNJ Document 34 Filed 09/12/18 Page 2 of 4
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 $80,287.00 in the form of a check payable to
petitioner, Mary Havener. 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 1:17-vv-00626-UNJ Document 34 Filed 09/12/18 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
__________________________________________
)
MARY HAVENER, )
)
Petitioner, )
) No. 17-626V (ECF)
v. ) Chief Special Master Dorsey
)
SECRETARY OF HEALTH )
AND HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
RESPONDENT’S PROFFER ON AWARD OF DAMAGES
On December 19, 2017, respondent, the Secretary of Health and Human Services, filed
his Rule 4(c) Report conceding entitlement to compensation in this matter, and on January 4,
2018, the Court entered its Ruling on Entitlement, finding petitioner Mary Havener entitled to
Vaccine Act compensation. Respondent now proffers that petitioner receive a compensation
award consisting of:
a. A lump sum of $80,287.00 in the form of a check payable to petitioner, Mary
Havener,1 which amount represents compensation for all elements of compensation
under 42 U.S.C. § 300aa-15(a) to which petitioner is entitled;2 and,
b. A lump sum of $5,432.57, in the form of a check payable jointly to petitioner and her
counsel, which amount represents compensation for petitioner’s attorneys’ fees and
costs under 42 U.S.C. § 300aa-15(e).
1 Petitioner is a competent adult. No guardianship is required.
2 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 1:17-vv-00626-UNJ Document 34 Filed 09/12/18 Page 4 of 4
Petitioner agrees with the proffered award of $80,287.00 for her compensation, and
$5,432.57 for her attorneys’ fees and costs, and has further represented in compliance with
General Order No. 9 that she has incurred no personal litigation costs.
Respectfully submitted,
CHAD A. READLER
Principal Deputy Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
ALEXIS B. BABCOCK
Assistant Director
Torts Branch, Civil Division
s/Voris E. Johnson, Jr.
VORIS E. JOHNSON, JR.
Senior Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Ben Franklin Station
Washington, D.C. 20044-0146
Direct dial: (202) 616-4136
Dated: May 31, 2018
2