VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00332
Package ID: USCOURTS-cofc-1_18-vv-00332
Petitioner: Derek Clark
Filed: 2018-03-05
Decided: 2019-05-29
Vaccine: influenza
Vaccination date: 2016-11-15
Condition: right shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 57239

AI-assisted case summary:
Derek Clark filed a petition for compensation under the National Vaccine Injury Compensation Program alleging that he suffered a right shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine administered on November 15, 2016. The respondent conceded that Mr. Clark is entitled to compensation, as his condition met the criteria for SIRVA on the Vaccine Injury Table. The respondent further agreed that Mr. Clark suffered residual effects for more than six months, satisfying all legal prerequisites for compensation. A ruling on entitlement was issued on February 27, 2019, finding Mr. Clark entitled to compensation. Subsequently, on March 27, 2019, the respondent filed a proffer on award of compensation, recommending an award of $57,239.95, which included $52,500.00 for pain and suffering and $4,739.95 for past unreimbursable expenses. Mr. Clark agreed with this proffered award. The Chief Special Master issued a decision awarding Mr. Clark a lump sum payment of $57,239.95.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00332-0
Date issued/filed: 2019-04-17
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/27/2019) regarding 22 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:18-vv-00332-UNJ Document 32 Filed 04/17/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0332V
Filed: February 27, 2019
UNPUBLISHED
DEREK CLARK,
Petitioner, Special Processing Unit (SPU);
v. Ruling on Entitlement; Concession;
Table Injury; Influenza (Flu) Vaccine;
SECRETARY OF HEALTH Shoulder Injury Related to Vaccine
AND HUMAN SERVICES, Administration (SIRVA)
Respondent.
Paul R. Brazil, Muller Brazil, LLP, Dresher, PA, for petitioner.
Meredith Burns Healy, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master
On March 5, 2018, Derek Clark (“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 right shoulder injury
related to vaccine administration (“SIRVA”) as a result of an influenza (“flu”) vaccine
administered to his right shoulder on November 15, 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).
1

Case 1:18-vv-00332-UNJ Document 32 Filed 04/17/19 Page 2 of 2
On February 27, 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 states that “petitioner has satisfied the criteria
for SIRVA set forth in the recently revised Vaccine Injury Table (‘Table’) and the
Qualifications and Aids to Interpretation (‘QAI’), which afford petitioner a presumption of
causation if petitioner had no recent history of pain, inflammation, or dysfunction of his
right shoulder, pain occurred within 48 hours after receipt of an intramuscularly-
administered vaccination, pain was limited to the shoulder in which the vaccine was
administered, and no other condition or abnormality, such as brachial neuritis, has been
identified to explain petitioner’s shoulder pain.” Id. at 4. Respondent further agrees that
“based on the medical records outlined above, petitioner suffered the residual effects of
his condition for more than six months. Therefore, based on the record as it now stands,
petitioner 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
2

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DOCUMENT 2: USCOURTS-cofc-1_18-vv-00332-1
Date issued/filed: 2019-05-29
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 03/27/2019) regarding 26 DECISION Stipulation/Proffer ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:18-vv-00332-UNJ Document 36 Filed 05/29/19 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0332V
Filed: March 27, 2019
UNPUBLISHED
DEREK CLARK,
Petitioner,
Special Processing Unit (SPU);
v.
Damages Decision Based on Proffer;
Influenza (Flu) Vaccine; Shoulder
SECRETARY OF HEALTH
Injury Related to Vaccine
AND HUMAN SERVICES,
Administration (SIRVA)
Respondent.
Paul R. Brazil, Muller Brazil, LLP, Dresher, PA, for petitioner.
Meredith Burns Healy, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On March 5, 2018, Derek Clark (“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 right shoulder injury
related to vaccine administration (“SIRVA”) as a result of an influenza (“flu”) vaccine
administered to his right shoulder on November 15, 2016. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On February 27, 2019, a ruling on entitlement was issued, finding petitioner
entitled to compensation for SIRVA. On March 27, 2019, respondent filed a proffer on
award of compensation (“Proffer”) indicating petitioner should be awarded $57,239.95
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-00332-UNJ Document 36 Filed 05/29/19 Page 2 of 4
(representing $52,500.00 in pain and suffering and $4,739.95 in 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 $57,239.95 (representing $52,500.00 in pain and
suffering and $4,739.95 in past unreimbursable expenses) in the form of a check
payable to petitioner, Derek Clark. 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 1:18-vv-00332-UNJ Document 36 Filed 05/29/19 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DEREK CLARK,
Petitioner, No. 18-332V
Chief Special Master Dorsey
v. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On March 5, 2018, Derek Clark (“petitioner”) filed a petition for vaccine injury
compensation alleging that he suffered a right shoulder injury related to vaccine administration
(“SIRVA”), a Table injury, following receipt of an influenza (“flu”) vaccination administered on
November 15, 2016. Respondent filed his Rule 4(c) Report conceding entitlement to
compensation on February 27, 2019. The Chief Special Master issued a Ruling on Entitlement
that same day.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $52,500.00 in pain and suffering.
Petitioner agrees.
B. Past Unreimbursable Expenses
Evidence supplied by petitioner documents his expenditure of past unreimbursable
expenses related to his vaccine-related injury. Respondent proffers that petitioner should be
awarded past unreimbursable expenses in the amount of $4,739.95. Petitioner agrees.
1

Case 1:18-vv-00332-UNJ Document 36 Filed 05/29/19 Page 4 of 4
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through a lump sum payment of $57,239.95 in the form of a check payable to petitioner.1,2
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
GABRIELLE M. FIELDING
Assistant Director
Torts Branch, Civil Division
s/ Meredith B. Healy
MEREDITH B. HEALY
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel.: 202.616.4187
DATED: March 27, 2019 E-mail: meredith.b.healy@usdoj.gov
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 Petitioner is a competent adult. Proof of guardianship is not required in this case.
2