VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-00971
Package ID: USCOURTS-cofc-1_17-vv-00971
Petitioner: Mary Jane de la Pena
Filed: 2017-07-20
Decided: 2018-08-22
Vaccine: influenza
Vaccination date: 2016-09-22
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 100000

AI-assisted case summary:
Mary Jane De La Pena filed a petition for compensation under the National Vaccine Injury Compensation Program on July 20, 2017, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on September 22, 2016. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on March 23, 2018, conceding that petitioner was entitled to compensation. The respondent concluded that the alleged injury was consistent with SIRVA caused by the influenza vaccine administered on September 22, 2016, and that petitioner had met all legal prerequisites for compensation. Based on the respondent's concession and the evidence of record, Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on March 23, 2018, finding petitioner entitled to compensation. Subsequently, on April 23, 2018, the respondent filed a proffer on the award of compensation. The proffer stated that the petitioner should be awarded $100,000.00 for past and future pain and suffering, and that the petitioner agreed with this proffered award. The public decision does not describe the specific onset of symptoms, medical examinations, diagnostic tests, or treatments. On August 22, 2018, Chief Special Master Nora Beth Dorsey issued a decision awarding Mary Jane De La Pena a lump sum payment of $100,000.00, representing compensation for all damages available under 42 U.S.C. § 300aa-15(a). Petitioner was represented by Leah VaSahnja Durant of the Law Offices of Leah V. Durant, PLLC, and the respondent was represented by Debra A. Filteau Begley of the U.S. Department of Justice.

Theory of causation field:
Petitioner Mary Jane De La Pena alleged a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccine on September 22, 2016. The respondent conceded that the injury was consistent with SIRVA caused by the flu vaccine and that all legal prerequisites for compensation were met. The public decision does not detail the specific mechanism of injury, expert testimony, or diagnostic findings. The case proceeded as a concession by the respondent, leading to a ruling on entitlement on March 23, 2018, by Chief Special Master Nora Beth Dorsey. A subsequent proffer on award of compensation was filed on April 23, 2018, by respondent Debra A. Filteau Begley, agreeing to a $100,000.00 award for past and future pain and suffering, which petitioner Mary Jane De La Pena, represented by Leah VaSahnja Durant, accepted. Chief Special Master Nora Beth Dorsey issued the final decision awarding $100,000.00 on August 22, 2018. The theory of causation was based on the respondent's concession that the injury was a "Table Injury" consistent with SIRVA caused by the influenza vaccine.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-00971-0
Date issued/filed: 2018-07-31
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/23/2018) regarding 25 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey.)(mpj) Service on parties made.
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Case 1:17-vv-00971-UNJ Document 31 Filed 07/31/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-971V
Filed: March 23, 2018
UNPUBLISHED
MARY JANE DE LA PENA,
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.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On July 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”) following receipt of her September 22, 2016 influenza (“flu”
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On March 23, 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 “concludes that the alleged injury is consistent with
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-00971-UNJ Document 31 Filed 07/31/18 Page 2 of 2
SIRVA that was caused by the administration of petitioner’s flu vaccine on September
22, 2016.” Id. at 3. Respondent further agrees that petitioner suffered her condition for
more than six months and that all legal prerequisites to compensation under the
Vaccine Act have 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-00971-1
Date issued/filed: 2018-08-22
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/23/2018) regarding 28 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-00971-UNJ Document 32 Filed 08/22/18 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-971V
Filed: April 23, 2018
UNPUBLISHED
MARY JANE DE LA PENA,
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.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Debra A. Filteau Begley, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On July 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”) following receipt of her September 22, 2016 influenza (“flu”
vaccination. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On March 23, 2018, a ruling on entitlement was issued, finding petitioner entitled
to compensation for SIRVA. On April 23, 2018, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $100,000.00. Proffer
at 1. In the Proffer, respondent represented that petitioner agrees with the proffered
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-00971-UNJ Document 32 Filed 08/22/18 Page 2 of 4
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 $100,000.00 in the form of a check payable to
petitioner, Mary Jane De La Pena. 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-00971-UNJ Document 32 Filed 08/22/18 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
*************************************
MARY JANE DE LA PENA, *
*
Petitioner, * No. 17-971V
* CHIEF SPECIAL MASTER
v. * NORA BETH DORSEY
*
SECRETARY OF HEALTH AN *
HUMAN SERVICES, *
*
Respondent. *
*************************************
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
The Court issued a Ruling on Entitlement on March 23, 2018. Based upon the evidence
of record, respondent proffers that petitioner should be awarded $100,000.00, which represents
compensation for past and future pain and suffering. This amount represents all elements of
compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).1 Petitioner
agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that petitioner be awarded a lump sum payment of $100,000.00 in the
form of a check payable to petitioner. Petitioner agrees.
Respectfully submitted,
CHAD A. READLER
Acting Assistant Attorney General
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.

Case 1:17-vv-00971-UNJ Document 32 Filed 08/22/18 Page 4 of 4
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/ DEBRA A. FILTEAU BEGLEY
DEBRA A. FILTEAU BEGLEY
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Phone: (202) 616-4181
Dated: April 23, 2018
2