VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-01629
Package ID: USCOURTS-cofc-1_17-vv-01629
Petitioner: Kenneth L. Niemczyk
Filed: 2017-10-30
Decided: 2019-01-15
Vaccine: influenza
Vaccination date: 2015-10-16
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 132204

AI-assisted case summary:
Kenneth Niemczyk filed a petition for compensation under the National Vaccine Injury Compensation Program on October 30, 2017, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccination on October 16, 2015. The respondent conceded that petitioner was entitled to compensation, agreeing that the alleged injury was consistent with SIRVA and that petitioner met all legal prerequisites. A ruling on entitlement was issued on September 24, 2018, finding Niemczyk entitled to compensation. Subsequently, on January 15, 2019, a decision awarding damages was issued based on a proffer filed by the respondent. The parties agreed to an award of $132,204.82, which included $130,000.00 for pain and suffering and $2,204.82 for past out-of-pocket medical expenses. This amount represented all elements of compensation available under the Vaccine Act. The case was treated 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-01629-0
Date issued/filed: 2018-10-24
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 09/24/2018) regarding 22 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-01629-UNJ Document 26 Filed 10/24/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1629V
Filed: September 24, 2018
UNPUBLISHED
KENNETH L. NIEMCZYK,
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.
David Michael Crocco, Jr., Sabbeth Law, Woodstock, VT, for petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On October 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) following receipt of his October 16, 2015 influenza (“flu”)
vaccination. Petition at 1, 3. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On September 14, 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 the alleged injury is
consistent with SIRVA.” Id. at 4. Respondent further agrees that no other cause for
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-01629-UNJ Document 26 Filed 10/24/18 Page 2 of 2
petitioner’s injury has been identified, that petitioner suffered the condition for more than
six months, and that petitioner has satisfied all legal prerequisites for compensation
under the Vaccine 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-01629-1
Date issued/filed: 2019-01-15
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 11/26/2018) 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-01629-UNJ Document 32 Filed 01/15/19 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-1629V
Filed: November 26, 2018
UNPUBLISHED
KENNETH NIEMCZYK,
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.
David Michael Crocco, Jr. Sabbeth Law, Woodstock, VT, for petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On October 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) following receipt of his October 16, 2015 influenza (“flu)
vaccination. Petition at 1, 3. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On September 24, 2018, a ruling on entitlement was issued, finding petitioner
entitled to compensation for SIRVA. On November 26, 2018, respondent filed a proffer
on award of compensation (“Proffer”) indicating petitioner should be awarded
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-01629-UNJ Document 32 Filed 01/15/19 Page 2 of 4
$132,204.82, representing $130,000.00 in compensation for pain and suffering and
$2,204.82 in compensation for past out-of-pocket medical expenses. Proffer at 1. In
the Proffer, respondent represented that 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. Id.
Pursuant to the terms stated in the attached Proffer, the undersigned awards
petitioner a lump sum payment of $132, 204.82, representing $130,000.00 in
compensation for pain and suffering and $2,204.82 in compensation for past out-
of-pocket medical expenses, in the form of a check payable to petitioner, Kenneth
Niemczyk. 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-01629-UNJ Document 32 Filed 01/15/19 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
_________________________________________
)
KENNETH NIEMCZYK, )
)
Petitioner, )
) No. 17-1629V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Items of Compensation
On September 14, 2018, respondent conceded that entitlement to compensation was
appropriate under the terms of the Vaccine Act. On September 24, 2018, Chief Special Master
Dorsey issued a Ruling on Entitlement, finding that petitioner was entitled to vaccine
compensation for her Shoulder Injury Related to Vaccine Administration (“SIRVA”). Based
upon the evidence of record, respondent proffers that petitioner should be awarded $132,204.82.
The award is comprised of the following: $130,000.00 for pain and suffering, and $2,204.82 for
past out-of-pocket medical expenses. This amount represents 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 compensation provided to petitioner should be made through

Case 1:17-vv-01629-UNJ Document 32 Filed 01/15/19 Page 4 of 4
a lump sum payment of $132,204.82, in the form of a check payable to petitioner.1 Petitioner
agrees.
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
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
HEATHER L. PEARLMAN
Assistant Director
Torts Branch, Civil Division
/s/Claudia B. Gangi
CLAUDIA B. GANGI
Senior Trial Attorney
Torts Branch, Civil Division
U. S. Department of Justice
P.O. Box l46, Benjamin Franklin Station
Washington, D.C. 20044-0146
Direct dial: (202) 616-4138
Email: claudia.gangi@usdoj.gov
Dated: November 26, 2018
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 pain and
suffering.
2