VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00893
Package ID: USCOURTS-cofc-1_17-vv-00893
Petitioner: Katie R. Peterson
Filed: 2018-02-13
Decided: 2018-08-29
Vaccine: influenza
Vaccination date: 2016-09-30
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 187615

AI-assisted case summary:
Katie R. Peterson filed a petition for compensation under the National Vaccine Injury Compensation Program alleging she suffered a Shoulder Injury Related to Vaccine Administration (SIRVA) after receiving an influenza vaccination in her left arm on September 30, 2016. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report conceding that Ms. Peterson is entitled to compensation, stating that she suffered a Table SIRVA and met all legal prerequisites. The respondent also confirmed that no other causes for her SIRVA were identified and that the statutory six-month sequela requirement was satisfied. Subsequently, a ruling on entitlement was issued on February 13, 2018, finding Ms. Peterson entitled to compensation. On April 26, 2018, the respondent filed a proffer on award of compensation, recommending an award of $172,500.00 for pain and suffering and $15,115.52 for lost wages, totaling $187,615.52. Ms. Peterson agreed with this proffered award. Based on the record and the proffer, the Chief Special Master issued a decision awarding Ms. Peterson a lump sum payment of $187,615.52 on August 29, 2018. This amount was intended to compensate for all damages available under the Vaccine Act, including pain and suffering and lost wages.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00893-0
Date issued/filed: 2018-05-10
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 2/13/2018) 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-00893-UNJ Document 37 Filed 05/10/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-0893V
Filed: February 13, 2018
UNPUBLISHED
KATIE R. PETERSON,
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.
Steven I. Kastner, San Diego, CA, for petitioner.
Lara Ann Englund, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 30, 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
arm on September 30, 2016. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On February 13, 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 petitioner “suffered a Table
SIRVA” and “has satisfied all legal prerequisites for compensation under the [Vaccine]
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-00893-UNJ Document 37 Filed 05/10/18 Page 2 of 2
Act.” Id. at 4. Respondent agrees that no other causes for petitioner’s SIRVA were
identified and that the statutory six-month sequela requirement has been satisfied. 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

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DOCUMENT 2: USCOURTS-cofc-1_17-vv-00893-1
Date issued/filed: 2018-08-29
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/26/2018) regarding 30 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00893-UNJ Document 40 Filed 08/29/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-0893V
Filed: April 26, 2018
UNPUBLISHED
KATIE R. PETERSON,
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.
Steven I. Kastner, San Diego, CA, for petitioner.
Lara Ann Englund, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On June 30, 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
arm on September 30, 2016. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On February 13, 2018, a ruling on entitlement was issued, finding petitioner
entitled to compensation for her SIRVA. On April 26, 2018, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded $172,500.00
for pain and suffering and $15,115.52 for lost wages, for a total amount of $187,615.52.
Proffer at 1. In the Proffer, respondent represented that petitioner agrees with the
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-00893-UNJ Document 40 Filed 08/29/18 Page 2 of 4
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 $187,615.52, which represents $172,500.00 for
pain and suffering and $15,115.52 for lost wages, in the form of a check payable
to petitioner, Katie R. Peterson. 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-00893-UNJ Document 40 Filed 08/29/18 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
KATIE R. PETERSON, )
)
Petitioner, )
)
v. ) No. 17-893V
) Chief Special Master Nora Beth Dorsey
SECRETARY OF )
HEALTH AND HUMAN SERVICES, )
)
Respondent. )
)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On February 13, 2018, respondent filed a Vaccine Rule 4(c) report concluding that
petitioner suffered an injury that is compensable under the National Childhood Vaccine Injury
Act of 1986, as amended, 42 U.S.C. §§300aa-10 to -34. Accordingly, on February 13, 2018, the
Chief Special Master issued a Ruling on Entitlement.
I. Compensation for Vaccine Injury-Related Items
Respondent proffers that, based on the evidence of record, petitioner should be awarded
$172,500.00 for pain and suffering and $15,115.52 for lost wages. These amounts represent all
elements of compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).
Petitioner agrees.
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made as a
lump sum payment of $187,615.52, in the form of a check payable to petitioner.1 Petitioner is a
1 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-00893-UNJ Document 40 Filed 08/29/18 Page 4 of 4
competent adult. Evidence of guardianship is not required in this case. This amount accounts
for all elements of compensation under 42 U.S.C. § 300aa-15(a) to which petitioner would be
entitled.
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/ LARA A. ENGLUND
LARA A. ENGLUND
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) 307-3013
E-mail: lara.a.englund@usdoj.gov
Dated: April 26, 2018
2