VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00749
Package ID: USCOURTS-cofc-1_17-vv-00749
Petitioner: Ann E. Kleva
Filed: 2017-06-06
Decided: 2018-09-20
Vaccine: influenza
Vaccination date: 2011-09-28
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 187700

AI-assisted case summary:
Ann E. Kleva filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) due to an influenza vaccine administered on September 28, 2011. The respondent conceded that petitioner is entitled to compensation, agreeing that she suffered SIRVA as defined by the Vaccine Injury Table and had satisfied all legal prerequisites. A ruling on entitlement was issued on March 8, 2018, finding her entitled to compensation. Subsequently, on June 14, 2018, the respondent filed a proffer indicating that petitioner should be awarded $187,700.00, consisting of $187,500.00 for pain and suffering and $200.00 for past unreimbursable expenses. Petitioner agreed with this proffered award. The Chief Special Master issued a decision awarding damages on September 20, 2018, granting the lump sum payment of $187,700.00 to Ann E. Kleva.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00749-0
Date issued/filed: 2018-06-11
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 3/8/2018) regarding 21 Ruling on Entitlement. Signed by Chief Special Master Nora Beth Dorsey. (rp) Service on parties made.
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Case 1:17-vv-00749-UNJ Document 27 Filed 06/11/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-749V
Filed: March 8, 2018
UNPUBLISHED
ANN E. KLEVA,
Special Processing Unit (SPU);
Petitioner, Ruling on Entitlement; Concession;
v. Table Injury; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH AND Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Daniel Henry Pfeifer, Pfeifer, Morgan & Stesiak, South Bend, IN, for petitioner.
Lisa Ann Watts, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 6, 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”), a Table Injury, due to an influenza (“flu”) vaccine administered
on September 28, 2011.3 Petition at 1. 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. 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).
3 Petitioner’s September 28, 2011 SIRVA qualifies as a Table injury under the eight-year lookback
provision for the March 21, 2017 revisions to the Vaccine Injury Table. 42 U.S.C. § 300aa-16(b)(2).

Case 1:17-vv-00749-UNJ Document 27 Filed 06/11/18 Page 2 of 2
On March 7, 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 the Division of Injury Compensation Programs (“DICP”)
has concluded that “petitioner suffered SIRVA as defined by the Vaccine Injury Table.”
Id. at 4. Respondent further agrees that “based on the record as it now stands,
petitioner has satisfied all legal prerequisites for compensation under the Act”. Id. at 5.
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-00749-1
Date issued/filed: 2018-09-20
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 06/15/2018) regarding 29 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00749-UNJ Document 32 Filed 09/20/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-749V
Filed: June 15, 2018
UNPUBLISHED
ANN E. KLEVA,
Special Processing Unit (SPU);
Damages Decision Based on Proffer;
Petitioner,
Table Injury; Influenza (Flu) Vaccine;
v.
Shoulder Injury Related to Vaccine
Administration (SIRVA)
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Daniel Henry Pfeifer, Pfeifer, Morgan & Stesiak, South Bend, IN, for petitioner.
Lisa Ann Watts, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On June 6, 2018, 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”), a Table Injury, due to an influenza (“flu”) vaccine administered
on September 28, 2011. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On March 8, 2018, a ruling on entitlement was issued, finding petitioner entitled
to compensation for SIRVA. On June 14, 2018, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $187,700.00,
representing $187,500.00 for pain and suffering and $200.00 for past unreimbursable
expenses. Proffer at 1. In the Proffer, respondent represented that petitioner agrees
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-00749-UNJ Document 32 Filed 09/20/18 Page 2 of 4
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 $187,700.00, representing $187,500.00 for pain
and suffering and $200.00 for past unreimbursable expenses, in the form of a
check payable to petitioner, Ann E. Kleva. 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-00749-UNJ Document 32 Filed 09/20/18 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
ANN E. KLEVA,
Petitioner,
v. No. 17-749V
Chief Special Master Dorsey
SECRETARY OF HEALTH AND ECF-SPU
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On June 6, 2017, Ann E. Kleva (“petitioner”) filed a petition for vaccine injury
compensation alleging that she suffered a right shoulder injury related to vaccine administration
(“SIRVA”), a Table injury, following receipt of an influenza (“flu”) vaccination administered on
September 28, 2011. Respondent filed his Rule 4(c) Report conceding entitlement to
compensation on March 7, 2018. The Chief Special Master issued a Ruling on Entitlement that
same day.
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$187,700.00 consisting of $187,500.00 for her pain and suffering and $200.00 for past
unreimbursable expenses. This 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, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future damages.
1

Case 1:17-vv-00749-UNJ Document 32 Filed 09/20/18 Page 4 of 4
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made
through a lump sum payment of $187,700.00 in the form of a check payable to petitioner.2
Petitioner agrees.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
CATHARINE E. REEVES
Deputy Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Assistant Director
Torts Branch, Civil Division
s/Lisa A. Watts
LISA A. WATTS
Senior 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) 616-4099
DATED: June 14, 2018
2 Petitioner is a competent adult. Proof of guardianship is not required in this case.
2