VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00234
Package ID: USCOURTS-cofc-1_18-vv-00234
Petitioner: Ivy Lopez
Filed: 2018-02-15
Decided: 2019-11-27
Vaccine: influenza
Vaccination date: 2013-11-06
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 55000

AI-assisted case summary:
Petitioner Ivy Lopez filed a petition for compensation under the National Vaccine Injury Compensation Program on February 15, 2018, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 6, 2013. The respondent denied that petitioner sustained a SIRVA Table injury or that the vaccine caused her alleged injury and its residual effects. Despite these denials, the parties filed a joint stipulation agreeing to a settlement. Chief Special Master Nora Beth Dorsey reviewed the stipulation and adopted it as the decision of the Court. The decision awarded Ivy Lopez $55,000.00 in compensation, payable as a lump sum check to the petitioner, to cover all damages available under the program. The decision was issued on November 27, 2019. Petitioner was represented by Bruce William Slane of the Law Office of Bruce W. Slane, P.C., and respondent was represented by Adriana Ruth Teitel of the U.S. Department of Justice. The public decision does not describe the specific onset, symptoms, medical tests, or treatments related to Ms. Lopez's alleged injury, nor does it name any medical experts.

Theory of causation field:
Petitioner Ivy Lopez received an influenza vaccine on November 6, 2013, and alleged a shoulder injury related to vaccine administration (SIRVA). Respondent denied that petitioner sustained a SIRVA Table injury or that the vaccine caused her alleged SIRVA and its residual effects. The parties reached a joint stipulation for settlement. The Special Master adopted the stipulation, awarding $55,000.00 as a lump sum. The public text indicates the theory of causation was related to the Vaccine Injury Table (SIRVA), but the respondent denied causation. No specific medical experts or detailed causation mechanism were described in the public text. The award was for all damages available under 42 U.S.C. § 300aa-15(a). The decision was issued by Chief Special Master Nora Beth Dorsey on November 27, 2019. Petitioner's counsel was Bruce William Slane, and respondent's counsel was Adriana Ruth Teitel.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00234-0
Date issued/filed: 2019-11-27
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 09/27/2019) regarding 41 DECISION Stipulation/Proffer Signed by Special Master Nora Beth Dorsey. (sw) Service on parties made.
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Case 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-234V
Filed: September 27, 2019
UNPUBLISHED
IVY LOPEZ,
Petitioner,
Special Processing Unit (SPU); Joint
v.
Stipulation on Damages; Influenza
(Flu) Vaccine; Shoulder Injury
SECRETARY OF HEALTH AND
Related to Vaccine Administration
HUMAN SERVICES,
(SIRVA)
Respondent.
Bruce William Slane, Law Office of Bruce W. Slane, P.C., White Plains, NY, for
petitioner.
Adriana Ruth Teitel, U.S. Department of Justice, Washington, DC, for respondent.
DECISION ON JOINT STIPULATION1
Dorsey, Chief Special Master:
On February 15, 2018, 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”) as a result of an influenza (“flu”) vaccine administered on
November 6, 2013. Petition at 1; Stipulation, filed September 26, 2019, at ¶¶ 1-2, 4.
Petitioner further alleges that the vaccine was administered within the United States,
that she suffered the residual effects of her injury for more than six months, and that
there has been no prior award or settlement of a civil action on her behalf as a result of
her injury. Petition at 1, 5-6; Stipulation at ¶¶ 3-5. “Respondent denies that petitioner
sustained a SIRVA Table injury and denies that petitioner’s alleged SIRVA and its
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 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 2 of 7
residual effects were caused-in-fact by her flu vaccine. Respondent further denies that
the flu vaccine caused petitioner any other injury or her current condition.” Stipulation at
¶ 6.
Nevertheless, on September 26, 2019, the parties filed the attached joint
stipulation, stating that a decision should be entered awarding compensation. The
undersigned finds the stipulation reasonable and adopts it as the decision of the Court
in awarding damages, on the terms set forth therein.
Pursuant to the terms stated in the attached Stipulation, the undersigned
awards the following compensation:
A lump sum of $55,000.00 in the form of a check payable to petitioner.
Stipulation at ¶ 8. This amount represents compensation for all items of
damages that would be available under § 15(a). Id.
The undersigned approves the requested amount for petitioner’s compensation.
In the absence of a motion for review filed pursuant to RCFC Appendix B, 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 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
IVY LOPEZ,
Petitioner,
No. 18-234V
v.
Chief Special Master Dorsey
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
l. Petitioner Ivy Lopez ("petitioner") filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 to 34 (the "Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of an influenza ("flu") vaccine, which vaccine is contained in the Vaccine Injury Table (the
"Table"), 42 C.F.R. § 100.3(a).
2. Petitioner received her flu immunization on November 6, 2013.
3. The vaccine was administered within the United States.
4. Petitioner alleges that she suffered a shoulder injury related to vaccine administration
("SIRVA") within the time period set forth in the Table, or in the alternative, that her alleged
shoulder injury was caused by the flu vaccine she received, and further alleges that she
experienced the residual effects of her injury for more than six months.
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages as a result of her condition.

Case 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 4 of 7
6. Respondent denies that petitioner sustained a SIRVA Table injury and denies that
petitioner's alleged SIRVA and its residual effects were caused-in-fact by her flu vaccine.
Respondent further denies that the flu vaccine caused petitioner any other injury or her current
condition.
7. Maintaining their above-stated positions, the parties nevertheless now agree that the
issues between them shall be settled and that a decision should be entered awarding the
compensation described in paragraph 8 of this Stipulation.
8. As soon as practicable after an entry ofj udgment reflecting a decision consistent with
tlie terms of this Stipulation, and after petitioner has filed an election to receive compensation
pursuant to 42 U.S.C. § 300aa-2l(a)(l), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of$55,000.00 in the form of a check payable to petitioner. This
amount represents compensation for all damages that would be available under 42
U.S.C. § 300aa-15(a).
9. As soon as practicable after the entry of judgment on entitlement in this case, and after
petitioner has filed both a proper and timely election to receive compensation pursuant to 42
U.S.C. § 300aa-2 I (a)( I), and an application, the parties will submit to further proceedings before
the special master to award reasonable attorneys' fees and costs incurred in proceeding upon this
petition.
10. Petitioner and her attorney represent that they have identified to respondent all ·
known sources of payment for items or services for which the Program is not primarily liable
under 42 U.S.C. § 300aa-l .S(g), including State compensation programs, insurance policies,
Federal or State health benefits programs (o ther than Title XIX of the Social Security Act (4 2
U.S.C. § 1396 et seq.)), or entities that provide health services on a pre-paid basis.
2

Case 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 5 of 7
11. Payment made pursuant to paragraph 8 and any amounts awarded pursuant to
paragraph 9 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-15(i), subject
to the availability of sufficient statutory funds.
12. J'he parties and their attorneys further agree and stipulate that, except for any award
for attorneys' fees and litigation costs and past unreimbursable expenses, the money provided
pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a
strict construction of 42 U.S.C. § 300aa-15(a) and (d), and subject to the conditions of 42 U.S.C.
§ 300aa-15(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in her
individual capacity, and on behalf of her heirs, executors, administrators, successors or assigns,
does forever irrevocably and unconditionally release, acquit and discharge the United States and
the Secretary of Health and Human Services from any and all actions or causes of action
(including agreements, judgments, claims, damages, loss of services, expenses and all demands
of whatever kind or nature) that have been brought, could have been brought, or could be timely
brought in the Court of Federal Claims, under the National Vaccine Injury Compensation
Program, 42 U.S.C. § 300aa-10 et seq., on account of, or in any way growing out of, any and all
known or unknown, suspected or unsuspected personal injuries to or death of petitioner resulting
from, or alleged to have resulted from, the flu vaccination administered on November 6, 2013, as
alleged by petitioner in her petition for vaccine compensation filed on February 15, 2018, in the
United States Court of Federal Claims as petition No. 18-234V.
14. If petitioner should die prior to entry ofj udgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
3

Case 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 6 of 7
15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in confonnity with a
decision that is in complete conformity with the terms of this Stipulation, then the parties'
settlement and this Stipulation shall be voidable at the sole discretion of either party.
16. This Stipulation expresses a full and complete negotiated settlement of liability and
damages claimed under the National Childhood Vaccine Injury Act of 1986, as amended, except
as otherwise noted in paragraph 9 above. There is absolutely no agreement on the part of the
parties hereto to make any payment or to do any act or thing other than is herein expressly stated
and clearly agreed to. The parties further agree and understand that the award described in this
Stipulation may reflect a compromise of the parties' respective positions as to liability and/or
amount of damages, and further, that a change in the nature of the injury or condition or in the
items of compensation sought, is not grounds to modify or revise this agreement.
17. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the flu vaccination caused petitioner to suffer a
shoulder injury or any other injury.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
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Case 1:18-vv-00234-UNJ Document 48 Filed 11/27/19 Page 7 of 7
Respectfully submitted,
ATTORNEY OF RECORD FOR
PETITIONER:
_,~_-_;{J_L,
BRUCE W. SLANE
The Law Office of Bruce W. Slane, P.C. De uty Director
188 East Post Road, Suite 205 Torts Branch
White Plains, NV 10601 Civil Division
(914) 269-2010 U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEALTH RESPONDENT:
AND HUMAN SERVICES:
TAMARA OVERBY
Acting Director, Division of Trial Attorney
Injury Compensation Programs Torts Branch
Healthcare Systems Bureau Civil Division
U.S. Department of Health U.S. Department of Justice
and Human Services P.O. Box 146
5600 Fishers Lane Benjamin Franklin Station
Parklawn Building, Mail Stop 08-Nl46B Washington, DC 20044-0146
Rockville, MO 20857 (202) 616-3677
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