VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01359
Package ID: USCOURTS-cofc-1_17-vv-01359
Petitioner: Mary Perry
Filed: 2017-09-27
Decided: 2019-11-18
Vaccine: influenza
Vaccination date: 2016-11-02
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 52500

AI-assisted case summary:
Mary Perry filed a petition for compensation under the National Vaccine Injury Compensation Program on September 27, 2017, alleging she suffered a left shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 2, 2016. The respondent, represented by Christine Mary Becer of the U.S. Department of Justice, conceded that Ms. Perry's claim met the Table criteria for SIRVA and satisfied the statutory severity requirement of suffering residual effects for more than six months. On April 30, 2019, Chief Special Master Nora Beth Dorsey issued a ruling on entitlement, finding Ms. Perry entitled to compensation. Subsequently, on August 30, 2019, the respondent filed a proffer recommending an award of $50,053.96 for pain and suffering and unreimbursed expenses, plus $2,446.70 to satisfy a Pennsylvania Medicaid lien. The petitioner, represented by Leah VaSahnja Durant of the Law Offices of Leah V. Durant, PLLC, agreed to this award. On November 18, 2019, Chief Special Master Dorsey issued a decision awarding Ms. Perry a total of $52,500.56 in compensation. This amount included a lump sum payment of $2,446.70, payable jointly to Ms. Perry and the Department of Human Services to satisfy the Pennsylvania Medicaid lien, and a lump sum payment of $50,053.96, payable to Ms. Perry, comprising $50,000.00 for pain and suffering and $53.96 for unreimbursed expenses. The public decision does not describe the specific onset of symptoms, medical tests, or treatments. The theory of causation is based on the respondent's concession that the claim met the Table criteria for SIRVA.

Theory of causation field:
Petitioner Mary Perry received an influenza vaccine on November 2, 2016. She alleged a left shoulder injury related to vaccine administration (SIRVA). The respondent conceded that the claim met the Table criteria for SIRVA and satisfied the statutory severity requirement. The public text does not describe specific medical experts, the mechanism of injury, or detailed clinical findings. Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on April 30, 2019, finding petitioner entitled to compensation. On November 18, 2019, Chief Special Master Dorsey awarded petitioner $52,500.56, consisting of $50,053.96 for pain and suffering and unreimbursed expenses, and $2,446.70 to satisfy a Pennsylvania Medicaid lien. Petitioner was represented by Leah VaSahnja Durant and respondent by Christine Mary Becer.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-01359-0
Date issued/filed: 2019-08-07
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/30/2019) regarding 34 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-01359-UNJ Document 40 Filed 08/07/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1359V
Filed: April 30, 2019
UNPUBLISHED
MARY PERRY,
Petitioner, Special Processing Unit (SPU);
v. Ruling on Entitlement; Concession;
Table Injury; Influenza (Flu) Vaccine;
SECRETARY OF HEALTH AND Shoulder Injury Related to Vaccine
HUMAN SERVICES, Administration (SIRVA)
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On September 27, 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 from a left shoulder injury related to
vaccine administration (“SIRVA”) as a result of receiving the influenza (“flu”) vaccine on
November 2, 2016. Petition at 1. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On April 19, 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
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.

Case 1:17-vv-01359-UNJ Document 40 Filed 08/07/19 Page 2 of 2
at 1. Specifically, respondent states that “petitioner’s claim meets the Table criteria for
SIRVA.” Id. at 3. Respondent further agrees that “petitioner satisfies the statutory
severity requirement by suffering the residual effects or complications of her injury for
more than six months after vaccine administration.” Id at 3-4 (citing 42 U.S.C. §§
300aa-11(c)(1)(D)(i)).
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
2

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DOCUMENT 2: USCOURTS-cofc-1_17-vv-01359-1
Date issued/filed: 2019-11-18
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 09/04/2019) regarding 42 DECISION Stipulation/Proffer Signed by Special Master Nora Beth Dorsey. (ypb) Service on parties made.
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Case 1:17-vv-01359-UNJ Document 46 Filed 11/18/19 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1359V
Filed: September 4, 2019
UNPUBLISHED
MARY PERRY,
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.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Christine Mary Becer, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On September 27, 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 from a left shoulder injury related to
vaccine administration (“SIRVA”) as a result of receiving the influenza (“flu”) vaccine on
November 2, 2016. Petition at 1. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On April 30, 2019, a ruling on entitlement was issued, finding petitioner entitled to
compensation for SIRVA. On August 30, 2019, respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $$50,053.96
($50,000.00 for pain and suffering and $53.96 for unreimbursed expenses) and funds to
satisfy the State of Pennsylvania Medicaid lien in the amount of $2,446.70. Proffer at 1-
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.

Case 1:17-vv-01359-UNJ Document 46 Filed 11/18/19 Page 2 of 5
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. A lump sum payment of $2,446.70, representing compensation for
satisfaction of the State of Pennsylvania Medicaid lien, payable jointly to
petitioner and
The Department of Human Services
Attention: Jessica L. Frederick
Bureau of Program Integrity
Division of Third Party Liability, Recovery Section
P.O. Box 8486
Harrisburg, Pennsylvania 17105-8486
Petitioner agrees to endorse this payment to the Department of Human
Services; and
B. A lump sum payment of $ $50,053.96 (comprising of $50,000.00 for pain
and suffering and $53.96 for unreimbursed expenses), in the form of a
check payable to petitioner, Mary Perry. 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-01359-UNJ Document 46 Filed 11/18/19 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
MARY PERRY, )
)
Petitioner, )
) No. 17-1359V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER OF DAMAGES
I. Procedural History
On April 19, 2019, 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 April 30, 2019, the Chief Special
Master issued a Ruling on Entitlement, finding that petitioner was entitled to vaccine
compensation for her Shoulder Injury Related to Vaccine Administration (“SIRVA”) as a result
of the influenza vaccine she received on November 2, 2016.
II. Items of Compensation and Form of the Award
Based upon the evidence of record, respondent proffers, and the parties recommend, that
compensation be made through a lump sum as described below, and request that the Chief
Special Master's decision and the Court's judgment award the following:
A. Medicaid Lien
Respondent proffers that M.P. should be awarded funds to satisfy the State of
Pennsylvania Medicaid lien in the amount of $2,446.70, which represents full satisfaction of any
1

Case 1:17-vv-01359-UNJ Document 46 Filed 11/18/19 Page 4 of 5
right of subrogation, assignment, claim, lien, or cause of action the State of Pennsylvania may
have against any individual as a result of any Medicaid payments that the State of Pennsylvania
has made to or on behalf of petitioner from the date of her eligibility for benefits through the date
of judgment in this case as a result of her vaccine-related injury suffered on or about November
2, 2016, under Title XIX of the Social Security Act. Reimbursement of the State of
Pennsylvania lien shall be made through a lump sum payment of $2,446.70, representing
compensation for satisfaction of the State of Pennsylvania lien, payable jointly to petitioner and
The Department of Human Services
Attention: Jessica L. Frederick
Bureau of Program Integrity
Division of Third Party Liability, Recovery Section
P.O. Box 8486
Harrisburg, Pennsylvania 17105-8486
Petitioner agrees to endorse this payment to the Department of Human Services.
B. Pain and Suffering and Out-of-Pocket Expenses
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$50,053.96 ($50,000.00 for pain and suffering and $53.96 for unreimbursed expenses).
This represents all elements of compensation to which petitioner would be entitled under
42 U.S.C. § 300aa-15(a).1 Petitioner agrees. Petitioner is a competent adult. Evidence of
guardianship is not required in this case.
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 medical
expenses, future lost earnings, and future pain and suffering.
2

Case 1:17-vv-01359-UNJ Document 46 Filed 11/18/19 Page 5 of 5
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
ALEXIS B. BABCOCK
Assistant Director
Torts Branch, Civil Division
/s/Christine M. Becer
CHRISTINE M. BECER
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) 616-3665
Dated: 8/28/19
3