VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00833
Package ID: USCOURTS-cofc-1_17-vv-00833
Petitioner: Audrey Rebollo
Filed: 2017-06-20
Decided: 2018-09-05
Vaccine: influenza
Vaccination date: 2015-10-10
Condition: left shoulder injury
Outcome: compensated
Award amount USD: 46417

AI-assisted case summary:
Audrey Rebollo filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a left shoulder injury following her October 10, 2015 influenza vaccination. The respondent conceded that her injury was consistent with a shoulder injury related to vaccine administration (SIRVA) and that there was no other identified cause for her condition. The medical records indicated she suffered residual effects for more than six months, satisfying the legal prerequisites for compensation. A ruling on entitlement was issued on April 27, 2018, finding her entitled to compensation. Subsequently, on September 5, 2018, a decision awarding damages was issued based on a proffer agreement between the parties. Respondent proffered an award of $45,000.00 for pain and suffering and $1,417.08 for past unreimbursable expenses, totaling $46,417.08. Petitioner agreed with this award, and the Chief Special Master granted the lump sum payment. The case proceeded as a Table injury claim, and the respondent conceded entitlement.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00833-0
Date issued/filed: 2018-08-29
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/27/2018) regarding 23 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00833-UNJ Document 30 Filed 08/29/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-833V
Filed: April 27, 2018
UNPUBLISHED
AUDREY REBOLLO,
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.
Shealene Priscilla Wasserman, Muller Brazil, LLP, Dresher, PA, for petitioner.
Jennifer Leigh Reynaud, 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 left shoulder injury following her October 10,
2015 influenza vaccination. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On April 24, 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 “has determined that petitioner’s alleged injury is
consistent with a shoulder injury related to vaccine administration (“SIRVA”) that was
caused by the administration of petitioner’s flu vaccination. Additionally, [respondent] did
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-00833-UNJ Document 30 Filed 08/29/18 Page 2 of 2
not identify any other cause for petitioner’s shoulder injury, and the medical records
outlined above demonstrate that she suffered the residual effects of her condition for
more than six months. Therefore, based on the record as it now stands, petitioner has
satisfied all legal prerequisites for compensation under the Vaccine Act.” Id. at 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-00833-1
Date issued/filed: 2018-09-05
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 05/04/2018) regarding 26 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00833-UNJ Document 31 Filed 09/05/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-833V
Filed: May 4, 2018
UNPUBLISHED
AUDREY REBOLLO,
Special Processing Unit (SPU);
Damages Decision Based on Proffer;
Petitioner,
Influenza (Flu) Vaccine; Shoulder
v.
Injury Related to Vaccine
Administration (SIRVA)
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Shealene Priscilla Wasserman, Muller Brazil, LLP, Dresher, PA, for petitioner.
Jennifer Leigh Reynaud, 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 left shoulder injury following her October 10,
2015 influenza vaccination. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On April 27, 2018, a ruling on entitlement was issued, finding petitioner entitled to
compensation for SIRVA. On May 2, 2018, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $45,000.00 in
compensation for pain and suffering and $1,417.08 for past unreimbursable expenses,
for a total of $46,417.08. Proffer at 1-2. In the Proffer, respondent represented that
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-00833-UNJ Document 31 Filed 09/05/18 Page 2 of 4
petitioner agrees with the proffered 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 $46,417.08, representing $45,000.00 in
compensation for pain and suffering and $1,417.08 in compensation for past
unreimbursable expenses related to her vaccine-related injury, in the form of a
check payable to petitioner, Audrey Rebollo. 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-00833-UNJ Document 31 Filed 09/05/18 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
AUDREY REBOLLO,
Petitioner, No. 17-833V
v. Chief Special Master Dorsey
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
PROFFER ON AWARD OF DAMAGES
On June 20, 2017, Audrey Rebollo (“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 April 24, 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 $45,000.00 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 $1,417.08. Petitioner agrees.
1

Case 1:17-vv-00833-UNJ Document 31 Filed 09/05/18 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 $46,417.08, 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,
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
ALEXIS B. BABCOCK
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: April 25, 2018
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