VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00776
Package ID: USCOURTS-cofc-1_17-vv-00776
Petitioner: Diane Fedorchak
Filed: 2017-06-12
Decided: 2019-09-18
Vaccine: influenza
Vaccination date: 2015-12-08
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 127063

AI-assisted case summary:
Diane Fedorchak filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of her December 8, 2015 influenza vaccination. The respondent, the Secretary of Health and Human Services, reviewed the petition and medical records and conceded that Ms. Fedorchak is entitled to compensation. The respondent confirmed that her injury met the criteria for SIRVA as defined by the Vaccine Injury Table, noting no prior history of shoulder issues, onset of pain within 48 hours of the vaccination, pain limited to the injection site, and no other identified cause. The injury also resulted in residual effects for more than six months. Based on the respondent's concession and the evidence, the court found Ms. Fedorchak entitled to compensation. Subsequently, a decision awarding damages was issued. The respondent proffered an award of $631.02 for unreimbursable medical expenses, $100,000.00 for pain and suffering, and $26,432.92 for lost earnings, totaling $127,063.94. Ms. Fedorchak agreed with this proffered award. The court awarded her the total lump sum of $127,063.94.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00776-0
Date issued/filed: 2019-09-17
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 06/26/2019) regarding 40 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00776-UNJ Document 45 Filed 09/17/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-776V
Filed: June 26, 2019
UNPUBLISHED
DIANE FEDORCHAK,
Special Processing Unit (SPU);
Petitioner,
Ruling on Entitlement; Concession;
v.
Table Injury; Influenza (Flu) Vaccine;
SECRETARY OF HEALTH AND Shoulder Injury Related to Vaccine
HUMAN SERVICES, Administration (SIRVA)
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Robert Paul Coleman, III, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 12, 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”) as a result of her December 8, 2015 influenza (“Flu”)
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
1 The undersigned intends to post this ruling on the United States Court of Federal Claims' website. This
means the ruling 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 ruling 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.

Case 1:17-vv-00776-UNJ Document 45 Filed 09/17/19 Page 2 of 2
On June 24, 2019, 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
and Proffer on Award of Compensation at 1. Specifically, respondent indicates that
[m]edical personnel at DICP have reviewed the Petition and medical
records filed in this case. Based on that review, DICP has concluded that
petitioner suffered SIRVA as defined by the Vaccine Injury Table.
Specifically, petitioner had no recent history of pain, inflammation, or
dysfunction of her left shoulder; the onset of pain occurred within 48 hours
after receipt of an intramuscular vaccination; the pain was limited to the
shoulder where the vaccine was administered; and, no other condition or
abnormality has been identified to explain petitioner’s left shoulder pain.
42 C.F.R. §§ 100.3(a), (c)(10). In addition, petitioner suffered the residual
effects of her condition for more than six months. 42 U.S.C. § 300aa-
11(c)(1)(D)(i). Therefore, based on the record as it now stands, petitioner
has satisfied all legal prerequisites for compensation under the Act. 42
U.S.C. § 300aa-13.
Id. at 2-3.
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

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DOCUMENT 2: USCOURTS-cofc-1_17-vv-00776-1
Date issued/filed: 2019-09-18
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 06/26/2019) regarding 41 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00776-UNJ Document 46 Filed 09/18/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-776V
Filed: June 26, 2019
UNPUBLISHED
DIANE FEDORCHAK,
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.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Robert Paul Coleman, III, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On June 12, 2017, petitioner filed a petition for compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq., (the “Vaccine
Act”). Petitioner alleges that she suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of her December 8, 2015 influenza (“Flu”)
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On June 26, 2019, a ruling on entitlement was issued, finding petitioner entitled
to compensation for SIRVA. On June 24, 2019, respondent filed a proffer on award of
compensation indicating petitioner should be awarded $631.02 in compensation for
unreimbursable medical expenses, $100,000.00 in compensation for petitioner’s actual
and projected pain and suffering, and $26,432.92 for petitioner’s lost earnings, for a
total award of $127,063.94. Respondent’s Rule 4(c) Report and Proffer on Award of
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).

Case 1:17-vv-00776-UNJ Document 46 Filed 09/18/19 Page 2 of 2
Compensation (“Proffer”) at 3-4. In the Proffer, respondent 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 Proffer, the undersigned awards petitioner
a lump sum payment of $127,063.94 (representing $631.02 in compensation for
unreimbursable medical expenses, $100,000.00 in compensation for petitioner’s
actual and projected pain and suffering, and $26,432.92 in compensation for
petitioner’s lost wages) in the form of a check payable to petitioner, Diane
Fedorchak. 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.2
IT IS SO ORDERED.
s/Nora Beth Dorsey
Nora Beth Dorsey
Chief Special Master
2 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