VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00832
Package ID: USCOURTS-cofc-1_17-vv-00832
Petitioner: Deborah Forbes
Filed: 2017-06-20
Decided: 2019-10-17
Vaccine: influenza
Vaccination date: 2016-10-04
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 159581

AI-assisted case summary:
Deborah Forbes 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 an influenza vaccination received on October 4, 2016. She alleged the injury occurred in the United States, that its residual effects lasted more than six months, and that she had not previously received compensation. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report conceding that Ms. Forbes was entitled to compensation. The respondent specifically stated that her alleged injury was consistent with SIRVA as defined on the Vaccine Injury Table and that she had satisfied all legal prerequisites for compensation. A ruling on entitlement was issued on March 16, 2018, finding Ms. Forbes entitled to compensation. Subsequently, on July 2, 2019, the respondent filed a proffer on award of compensation, proposing an award of $159,581.87, which included $150,000.00 for pain and suffering and $9,581.87 for unreimbursed medical expenses. Ms. Forbes agreed with this proffered award. The Chief Special Master issued a decision awarding Ms. Forbes a lump sum payment of $159,581.87 on October 17, 2019.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_17-vv-00832-0
Date issued/filed: 2018-05-31
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 3/16/2018) regarding 34 Ruling on Entitlement. Signed by Chief Special Master Nora Beth Dorsey. (rp) Service on parties made.
--------------------------------------------------------------------------------
Case 1:17-vv-00832-UNJ Document 41 Filed 05/31/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-0832V
Filed: March 16, 2018
UNPUBLISHED
DEBORAH FORBES,
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.
Ann Mayhew Golski, Maglio Christopher & Toale, PA, Washington, DC, for petitioner.
Mallori Browne Openchowski, U.S. Department of Justice, Washington, DC, for
respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 20, 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 an influenza vaccination she received in her left
deltoid on October 4, 2016. Petition at 1-2. Petitioner further alleges that she received
the vaccine in the United States, suffered the residual effects of her injury for more than
six months and has never received compensation for her injury, alleged as vaccine
caused. Petition at 1-2. 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).

Case 1:17-vv-00832-UNJ Document 41 Filed 05/31/18 Page 2 of 2
On March 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,
Department of Health of Human Services “believes that petitioner’s alleged injury is
consistent with a shoulder injury related to vaccine administration (“SIRVA”), as defined
on the Vaccine Injury Table.” Id. at 4-5. Respondent further agrees that “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

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_17-vv-00832-1
Date issued/filed: 2019-10-17
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 07/05/2019) regarding 66 DECISION Stipulation/Proffer Signed by Special Master Nora Beth Dorsey. (sw) Service on parties made.
--------------------------------------------------------------------------------
Case 1:17-vv-00832-UNJ Document 76 Filed 10/17/19 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-0832V
Filed: July 5, 2019
UNPUBLISHED
DEBORAH FORBES,
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.
Diana Lynn Stadelnikas, Maglio Christopher & Toale, PA, Sarasota, FL, for petitioner.
Mallori Browne Openchowski, U.S. Department of Justice, Washington, DC, for
respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On June 20, 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 an influenza vaccination she received in her left
deltoid on October 4, 2016. Petition at 1-2. Petitioner further alleges that she received
the vaccine in the United States, suffered the residual effects of her injury for more than
six months and has never received compensation for her injury, alleged as vaccine
caused. Petition at 1-2. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
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-00832-UNJ Document 76 Filed 10/17/19 Page 2 of 4
On March 16, 2018, a ruling on entitlement was issued, finding petitioner entitled
to compensation for her SIRVA. On July 2, 2019, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $159,581.87. Proffer
at 2. 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 attached Proffer, the undersigned awards
petitioner a lump sum payment of $159,581.87 (comprised of damages for pain
and suffering in the amount of $150,000.00 and damages for unreimbursed
medical expenses in the amount of $9,581.87) in the form of a check payable to
petitioner, Deborah Forbes. 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-00832-UNJ Document 76 Filed 10/17/19 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DEBORAH FORBES,
Petitioner,
No. 17-832V
v. Chief Special Master Dorsey
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Compensation for Vaccine Injury-Related Items
On March 15, 2018, respondent concededed that entitlement to compensation was
appropriate under the terms of the Vaccine Act. Thereafter, on March 16, 2018, Chief Special
Master Dorsey issued a Ruling on Entitlement finding that petitioner was entitled to vaccine
compensation for her Shoulder Injury Related to Vaccine Administration(“SIRVA”). Based on
the evidence of record, respondent proffers that petitioner should be awarded $159,581.87, which
is comprised of damages for pain and suffering in the amount of $150,000.00, and damages for
unreimbursed medical expenses in the amount of $9,581.87. This amount 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 lost earnings
and future pain and suffering.

Case 1:17-vv-00832-UNJ Document 76 Filed 10/17/19 Page 4 of 4
II. Form of the Award
The parties recommend that compensation provided to petitioner should be made through
a lump sum payment of $159,581.87, in the form of a check payable to petitioner. 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/ Mallori B. Openchowski
MALLORI B. OPENCHOWSKI
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146, Ben Franklin Station
Washington, DC 20044-0146
Tel.: (202) 305-0660
DATED: July 2, 2019