VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_17-vv-02016
Package ID: USCOURTS-cofc-1_17-vv-02016
Petitioner: Jacqueline Pohlman
Filed: 2017-12-21
Decided: 2019-04-17
Vaccine: Tdap
Vaccination date: 2017-05-22
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 110004

AI-assisted case summary:
Jacqueline Pohlman filed a petition for vaccine injury compensation on December 21, 2017, alleging that she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine on May 22, 2017. She claimed this was a Table injury, meaning it is presumed to be caused by the vaccine. The respondent, the Secretary of Health and Human Services, conceded entitlement to compensation in a Rule 4(c) report filed on October 30, 2018. The Chief Special Master issued a ruling on entitlement that same day, finding that Ms. Pohlman was entitled to compensation. Subsequently, on February 19, 2019, the respondent filed a proffer on award of compensation, which Ms. Pohlman agreed to. The court awarded her a total of $110,004.42. This amount included $108,000.00 for pain and suffering, $1,062.43 for past lost earnings, and $941.99 for past unreimbursable expenses. The award was to be paid as a lump sum check to Ms. Pohlman.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_17-vv-02016-0
Date issued/filed: 2018-12-12
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/30/2018) regarding 23 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-02016-UNJ Document 28 Filed 12/12/18 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-2016V
Filed: October 30, 2018
UNPUBLISHED
JACQUELINE POHLMAN,
Special Processing Unit (SPU);
Petitioner, Ruling on Entitlement; Concession;
v. Table Injury; Tetanus Diphtheria
acellular Pertussis (Tdap) Vaccine;
SECRETARY OF HEALTH AND Shoulder Injury Related to Vaccine
HUMAN SERVICES, Administration (SIRVA)
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for petitioner.
Lisa Ann Watts, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On December 21, 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 after receiving the tetanus, diphtheria, and
acellular pertussis vaccination on May 22, 2017, she suffered a shoulder injury related
to vaccine administration (“SIRVA”) as listed on the Vaccine Injury Table or that was
caused-in-fact by the vaccination she received. Petition at 1, ¶¶ 6, 27. Petitioner further
alleges that she received the vaccination alleged in the United States, continues to
suffer from her injury, and that neither she nor any other party has filed a civil action or
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-02016-UNJ Document 28 Filed 12/12/18 Page 2 of 2
received compensation for her injury, alleged as vaccine caused. Id. at 1, ¶¶ 6, 26, 28-
29. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On October 30, 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 concluded that petitioner suffered SIRVA as defined
by the Vaccine Injury Table.” Id. at 4. Respondent further agrees that “based on the
records as it stands, petitioner has satisfied all legal prerequisites for compensation
under the Act.” Id. at 4-5
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-02016-1
Date issued/filed: 2019-04-17
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 02/19/2019) regarding 32 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:17-vv-02016-UNJ Document 41 Filed 04/17/19 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 17-2016V
Filed: February 19, 2019
UNPUBLISHED
JACQUELINE POHLMAN,
Special Processing Unit (SPU);
Petitioner,
Damages Decision Based on Proffer;
v.
Tetanus Diphtheria acellular
Pertussis (Tdap) Vaccine; Shoulder
SECRETARY OF HEALTH AND
Injury Related to Vaccine
HUMAN SERVICES,
Administration (SIRVA)
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for petitioner.
Lisa Ann Watts, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On December 21, 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 after receiving the tetanus, diphtheria, and
acellular pertussis vaccination on May 22, 2017, she suffered a shoulder injury related
to vaccine administration (“SIRVA”) as listed on the Vaccine Injury Table or that was
caused-in-fact by the vaccination she received. Petition at 1, ¶¶ 6, 27. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On October 30, 2018, a ruling on entitlement was issued, finding petitioner
entitled to compensation for her SIRVA. On February 19, 2019, 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-02016-UNJ Document 41 Filed 04/17/19 Page 2 of 4
$110,004.42, representing compensation in the amount of $108,000.00 for pain and
suffering, $1,062.43 for past lost earnings, and $941.99 for past unreimbursable
expenses. Proffer at 1. 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 lump sum payment of $110,004.42, representing compensation in the
amount of $108,000.00 for pain and suffering, $1,062.43 for past lost earnings,
and $941.99 for past unreimbursable expenses in the form of a check payable to
petitioner, Jacqueline Pohlman. 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-02016-UNJ Document 41 Filed 04/17/19 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
JACQUELINE POHLMAN,
Petitioner,
v. No. 17-2016V
Chief Special Master Dorsey
SECRETARY OF HEALTH AND ECF
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On December 21, 2017, Jacqueline Pohlman (“petitioner”) filed a petition for vaccine
injury compensation alleging that she suffered a left shoulder injury related to vaccine
administration (“SIRVA”), a Table injury, following receipt of a tetanus, diphtheria,
acellular-pertussis (“Tdap”) vaccine administered on May 22, 2017. Respondent filed his Rule
4(c) Report conceding entitlement to compensation on October 30, 2018. The Chief Special
Master issued a Ruling on Entitlement that same day.
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$110,004.42 consisting of $108,000.00 for her pain and suffering, $1,062.43 for documented past
lost earnings, and $941.99 for past unreimbursable expenses. This represents all elements of
compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).1 Petitioner
agrees.
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 damages.
1

Case 1:17-vv-02016-UNJ Document 41 Filed 04/17/19 Page 4 of 4
II. Form of the Award
The parties recommend that the compensation provided to petitioner should be made
through a lump sum payment of $110,004.42 in the form of a check payable to petitioner.2
Petitioner agrees.
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/Lisa A. Watts
LISA A. WATTS
Senior 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) 616-4099
DATED: February 19, 2019
2 Petitioner is a competent adult. Proof of guardianship is not required in this case.
2