VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01147
Package ID: USCOURTS-cofc-1_17-vv-01147
Petitioner: Jesse Lubin
Filed: 2019-03-13
Decided: 2019-05-01
Vaccine: Tdap
Vaccination date: 2016-09-21
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 90000

AI-assisted case summary:
Jesse Lubin filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) after receiving a tetanus diphtheria and acellular pertussis (Tdap) vaccine on September 21, 2016. The case was assigned to the Special Processing Unit. Respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report conceding that Mr. Lubin is entitled to compensation. The respondent agreed that Mr. Lubin suffered SIRVA as defined in the Vaccine Injury Table, that he experienced residual effects for more than six months, and that he satisfied all legal prerequisites for compensation. Based on the respondent's concession and the evidence, the court found Mr. Lubin entitled to compensation. Subsequently, a decision awarding damages was issued. The respondent filed a proffer indicating that Mr. Lubin should be awarded $90,000.00, and Mr. Lubin agreed with this proffered award. The court awarded Mr. Lubin a lump sum payment of $90,000.00 as compensation for all damages.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-01147-0
Date issued/filed: 2019-05-01
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/13/2019) regarding 48 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-01147-UNJ Document 56 Filed 05/01/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1147V
Filed: March 13, 2019
UNPUBLISHED
JESSE LUBIN,
Petitioner, Special Processing Unit (SPU);
v. Ruling on Entitlement; Concession;
Table Injury; Tetanus Diphtheria
SECRETARY OF HEALTH AND acellular Pertussis (Tdap) Vaccine;
HUMAN SERVICES, Shoulder Injury Related to Vaccine
Administration (SIRVA)
Respondent.
Robert Joel Krakow, Law Office of Robert J. Krakow, P.C., New York, NY, for petitioner.
Robert Paul Coleman, III, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On August 24, 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of a tetanus diphtheria and acellular pertussis
(“Tdap”) vaccine administered on September 21, 2016. 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. 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-01147-UNJ Document 56 Filed 05/01/19 Page 2 of 2
On March 13, 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
at 1. Specifically, respondent agrees that petitioner suffered SIRVA as defined in the
Vaccine Injury Table. Id. at 2. Respondent further agrees that petitioner suffered the
residual effects of his condition for more than six months and has satisfied all legal
prerequisites for compensation under the Act. 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-01147-1
Date issued/filed: 2019-05-02
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 03/13/2019) regarding 49 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-01147-UNJ Document 57 Filed 05/02/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1147V
Filed: March 13, 2019
UNPUBLISHED
JESSE LUBIN,
Petitioner,
Special Processing Unit (SPU);
v.
Damages Decision Based on Proffer;
Tetanus Diphtheria acellular
SECRETARY OF HEALTH AND
Pertussis (Tdap) Vaccine; Shoulder
HUMAN SERVICES,
Injury Related to Vaccine
Administration (SIRVA)
Respondent.
Robert Joel Krakow, Law Office of Robert J. Krakow, P.C., New York, NY, for petitioner.
Robert Paul Coleman, III, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On August 24, 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of a tetanus diphtheria and acellular pertussis
(“Tdap”) vaccine administered on September 21, 2016. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On March 13, 2019, a ruling on entitlement was issued, finding petitioner entitled
to compensation for his SIRVA. On March 13, 2019, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded $90,000.00.
Proffer at 3. In the Proffer, respondent represented that petitioner agrees with the
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-01147-UNJ Document 57 Filed 05/02/19 Page 2 of 2
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 $90,000.00 in the form of a check payable to petitioner,
Jesse Lubin. 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