VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00660
Package ID: USCOURTS-cofc-1_18-vv-00660
Petitioner: Judy Welch
Filed: 2018-05-10
Decided: 2021-10-06
Vaccine: influenza (flu)
Vaccination date: 2016-08-31
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 55459

AI-assisted case summary:
Judy Welch filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine she received on August 31, 2016. The Chief Special Master issued a Ruling on Entitlement on November 18, 2020, finding that the flu vaccine was administered in Petitioner's right deltoid, her pain and reduced range of motion were limited to that shoulder, and the onset of SIRVA-related pain occurred within 48 hours of vaccination. Respondent filed an Amended Rule 4(c) Report on February 26, 2021, indicating that he did not dispute that Petitioner had satisfied all legal prerequisites for compensation under the Act, as the injury was a Table injury and the residual effects lasted more than six months. Consequently, entitlement to compensation was granted. A subsequent Decision Awarding Damages was issued on October 6, 2021. The parties disputed the amount of damages for pain and suffering, with Petitioner requesting $75,000.00 and Respondent proposing no more than $25,000.00. The court considered the severity and duration of Petitioner's injury, noting a delay in seeking treatment and a relatively mild course of conservative treatment. The court awarded $55,000.00 for actual pain and suffering and $459.00 for past unreimbursable expenses, for a total award of $55,459.00.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00660-0
Date issued/filed: 2020-12-18
Pages: 10
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/18/2020) regarding 32 Findings of Fact & Conclusions of Law Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-660V
UNPUBLISHED
JUDY WELCH, Chief Special Master Corcoran
Petitioner, Filed: November 18, 2020
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Findings of Fact; Onset and Site of
HUMAN SERVICES, Vaccination; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
Respondent. Administration (SIRVA)
Shealene Priscilla Mancuso, Muller Brazil, LLP, Dresher, PA, for petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for respondent.
FINDINGS OF FACT1
On May 10, 2018, Judy Welch 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 Table shoulder injury related to vaccine
administration (“SIRVA”) resulting from the adverse effects of the influenza (“flu”) vaccine
she received on August 31, 2016. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
For the reasons discussed below, I find the flu vaccine alleged as causal was
administered in Petitioner’s right deltoid; that her pain and reduced range of motion were
1 Because this unpublished fact ruling contains a reasoned explanation for the action in this case, I am
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). This means the fact 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, I agree that the identified material fits within this definition, I 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 2 of 10
limited to the shoulder in which the intramuscular vaccine was administered; and that the
onset of Petitioner’s SIRVA-related pain occurred within 48 hours of vaccination.
I. Relevant Procedural History
Ms. Welch filed her petition for compensation on May 10, 2018. ECF No. 1.
Petitioner filed relevant medical records and a Statement of Completion by May 15, 2018.
On April 1, 2019, Respondent filed a status report indicating that he was not able to
engage in settlement discussions at that time, and requesting 60 days to file a Rule 4(c)
Report. ECF No. 18.
On July 8, 2019, Respondent filed his Rule 4(c) Report recommending that
entitlement to compensation be denied under the terms of the Vaccine Act. Respondent’s
Report at 1. ECF No. 22. Respondent argued that the contemporaneous records
established the the vaccine was administered in Petitioner’s left deltoid – not her right
shoulder as alleged. Id. at 4-5. Additionally, Respondent asserted that Petitioner did not
seek treatment for right shoulder pain until nearly four months after her vaccination, which
“is well outside a medically appropriate interval to ascribe causation to immunization.” Id.
at 7. Finally, Respondent maintained that the Table criterion that pain and reduced range
of motion are limited to the shoulder in which the intramuscular vaccine was administered
has not been met, “given that [P]etitioner’s vaccination record lists her left arm as the site
of administration.” Id. at 6-7.
In a Scheduling Order filed on November 14, 2019, I expressed my view that based
on review of the existing record, a hearing would not be necessary, and that I intended to
issue a fact finding as to the onset of Petitioner’s alleged injury, the site of vaccine
administration, and limitation of Petitioner’s range of motion after providing the parties an
opportunity to file briefs and any evidence they wish to have considered. ECF No. 26. On
December 16, 2019, Petitioner filed a Motion for a Ruling on the Record. ECF No. 27. On
January 14, 2020, Respondent filed a response brief. ECF No. 29. On January 21, 2020,
Petitioner filed a reply to Respondent’s response brief. ECF No. 30. The matter is now
ripe for adjudication.
II. Issue
The following issues are contested: whether (1) Petitioner received the vaccine
alleged as causal in her right arm; (2) Petitioner’s pain and reduced range of motion were
limited to the shoulder in which the intramuscular vaccine was administered; and (3)
Petitioner’s first symptom or manifestation of onset after vaccine administration
(specifically pain) occurred within 48 hours as set forth in the Vaccine Injury Table and
Qualifications and Aids to Interpretation (“QAI”) for a Table SIRVA. 42 C.F.R. § 100.3(a)
XIV.B. (2017) (influenza vaccination); 42 C.F.R. § 100.3(c)(10)(ii)-(iii) (required onset for
pain listed in the QAI; pain and range of motion limited to vaccinated arm requirement).
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 3 of 10
III. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy
evidence. The records contain information supplied to or by health professionals to
facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in
the balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Human Servs.,
993 F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Human Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. In Lowrie, the special master wrote that “written records which
are, themselves, inconsistent, should be accorded less deference than those which are
internally consistent.” Lowrie, at *19.
The United States Court of Federal Claims has recognized that “medical records
may be incomplete or inaccurate.” Camery v. Sec’y of Health & Human Servs., 42 Fed.
Cl. 381, 391 (1998). The Court later outlined four possible explanations for
inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Human Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery, 42 Fed.
Cl. at 391 (citing Blutstein v. Sec’y of Health & Human Servs., No. 90-2808, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The credibility of the individual
offering such testimony must also be determined. Andreu v. Sec’y of Health & Human
Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Human Servs.,
991 F.2d 1570, 1575 (Fed. Cir. 1993).
3

Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 4 of 10
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 3(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing § 12(d)(3); Vaccine Rule 8); see also Burns v. Sec’y of
Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within the
special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
IV. Finding of Fact
A. Site of Vaccination
Based upon a review of the entire record, I find that Petitioner’s August 31, 2016
flu vaccine was likely administered in her right arm, as she contends. Specifically, I base
my finding on the following evidence:
• At Petitioner’s initial treatment visit with her primary care physician on
December 19, 2016, she complained of right arm pain “since she had her
flu shot on 8/31/2016.” Ex. 2 at 8
• Petitioner had a follow-up visit with her primary care physician on February
27, 2017. Petitioner’s history of present illness states Petitioner as having
right arm pain since August, which “improved after she had the injection but
it came back and feels like an ache.” Ex. 2 at 7
• On March 13, 2017, Petitioner had an appointment with an orthopedist. The
orthopedist noted that Petitioner “had a flu vaccination in August of 2016-
the injection was given into her right shoulder and she’s noted increased
right shoulder pain since that time.” Ex. 4 at 4.
• Petitioner had an initial physical therapy (PT) evaluation on March 22, 2017.
At this visit, Petitioner reported that “she has had progressive right
shoulder/arm pain since a flu injection in August, 2016” and she complained
of “transient, but daily right shoulder/arm pain rated at 8/10.” Ex. 5 at 13.
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 5 of 10
• On April 13, 2017, Petitioner had a follow-up visit with Petitioner’s
orthopedist. Petitioner’s “Chief Complaint” was “Right Shoulder Follow Up.”
The orthopedist documented, “64 year-old left-hand-dominant white female
returns to the office today-[s]he had an injection-flu vaccination back in
August of 2016 and unfortunately has continued right shoulder/deltoid pain
since that injection.” Ex. 2 at 3. This record confirms that Petitioner is left
hand dominant. Id.
• On July 6, 2017, Petitioner had a right shoulder MRI with contrast. The MRI
revealed “1. There is essentially full-thickness slightly retracted rotator cuff
tear at the distal insertional articular surface fibers of the mid through
posterior. 2. Amorphous intrasubstance superior labral tear. 3. Mild to
moderate intra-articular biceps tendinosis with extraarticular tenosynovitis.”
Ex. 6 at 1-2
The above-referenced evidence supports a finding that Petitioner’s August 31,
2016 vaccine was likely administered in her right shoulder. In the context of seeking care,
Petitioner consistently reported that the vaccine had been administered in her right arm,
and that the injury was associated with the vaccination. Accordingly, there is record
support for her contention about the situs of administration, beyond her own allegations.
Although there was some delay from the August 2016 vaccination to the first doctor’s visit
when right arm pain was discussed in December 2016, there are no intervening records
that would contradict the situs conclusion.
In addition, Petitioner’s physician has provided a logical explanation for why the
vaccine would likely have been administered in her right arm. In her affidavit, Petitioner
asserts that she requested that the flu vaccine be administered in her “non-dominant right
arm.” Ex. 8 at 1. On December 21, 2017 (several months before this case was initiated),
Petitioner visited her physician “to have a correction on the documentation that was
entered regarding her flu vaccine in 2016. She states that it was administered in her right
arm but was charted here as in the left arm [s]he has ongoing pain in the right arm and
wants something in writing to states this was an error.” As Petitioner’s physician further
explained:
“We had a significant discussion with the patient stating that documentation
is stating that it was done in the left shoulder. Unfortunately all of her
subsequent visits reference the right shoulder as the site where she had her
flu shot. We discussed with her the possibilities for this discrepancy. The
most likely explanation is that as is standard policy developed in our office,
all flu shots are given in the left arm. This helps standardize the
documentation when we are giving upwards to 30 or 40 shots a day to
patients. If the shot were given in the other arm it would be not a routine
procedure. Therefore there would be the possibility that it could be
documented as the standard left side. In discussing with the patient she
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 6 of 10
does remember requesting this shot be given in her right arm because she
is left handed. This would make logical sense. Based on the fact that all of
the subsequent visits referenced the right arm in relation to her flu shot, it
would seem reasonable that that was the explanation for the discrepancy in
the documentation.”
Ex. 2 at 3. Thus, in effect the documented situs was a product of general office policy,
rather than a reflection of what actually occurred, This explanation is also consistent with
the medical records documenting that Petitioner is left hand dominant, and therefore
reasonably did not want the vaccine administered there despite office policy.
I acknowledge that the vaccine administration record itself memorializes
administration of the flu vaccine in Petitioner’s left deltoid. Ex. 1 at 2. However, all other
medical records support a finding that the vaccine was actually administered in
Petitioner’s right arm, and the statements of Petitioner and her physician amplify reasons
to find the latter conclusion persuasive. I therefore find it more likely than not that the
vaccination alleged as causal in this case was administered to Petitioner in the right
arm/shoulder on August 31, 2016.
B. Pain and Reduced Range of Motion Limited to Right Arm
Based upon a review of the entire record, I find that Petitioner’s pain and reduced
range of motion were limited to her right shoulder. In the Respondent’s Report,
Respondent asserts that Petitioner’s “pain and reduced range of motion” were not “limited
to the shoulder in which the intramuscular vaccine was administered” given that
Petitioner’s vaccination record lists her left arm as the site of administration. Respondent’s
Report at 6-7 citing 42 C.F.R. § 100.3(c)(10)(iii). However, in his brief, Respondent avers
that Petitioner did not “address the factual issue of whether she displayed limitations in
her range of motion, likely because her range of motion has consistently been normal.”
Resp. at 8.
Respondent advances two distinct arguments in the Respondent’s Report and in
is his response brief, respectively. The first argument is that Petitioner’s pain was not
limited to the shoulder in which Petitioner received the vaccine. Respondent’s Report at
6-7. This argument, however, was predicated on acceptance of Respondent’s contention
that Petitioner received the vaccine in her left shoulder. Based on my finding herein, that
argument is moot.
Respondent’s second argument is that Petitioner did not have reduced range of
motion. Resp. at 8. In response, Petitioner asserts that “Respondent ignored Petitioner’s
physical therapy records which indicate decreased range of motion and later
improvement as a result of physical therapy treatment.” Reply at 5. Petitioner notes PT
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 7 of 10
records which indicate goals of improved range of motion, as well as noting that after PT
concluded, Petitioner’s range of motion had increased. Id. citing Ex. 5 at 6, 13. Petitioner
has the better of this fact argument. Although at times Petitioner is noted to have full range
of motion in her right shoulder, there are several instances where her right shoulder pain
and stiffness are mentioned, in addition to references to exercises and goals to increase
Petitioner’s range of motion. See Ex. 2 at 3, 6; Ex. 5 at 13. The degree of reduced range
of motion may bear on the damages Petitioner should receive (as her SIRVA may be less
severe than other cases), but there is sufficient evidence of reduced range of motion in
the record to decide this issue for Petitioner.
C. Onset
Based upon a review of the entire record, I find that the onset of Petitioner’s pain
occurred within 48 hours. Specifically, I base my finding on the following evidence:
• Petitioner was administered a flu vaccine in her right deltoid on August 31,
2016. Ex. 1 at 3; See discussion supra Part IV.A.
• In her affidavit, Petitioner stated that at the time of vaccine administration,
the administrator of the shot was standing, and she was sitting. Ex. 8 at 1.
Petitioner asserted the evening of her vaccination she “felt a soreness and
a lingering ache at the site of the injection.” Id. Petitioner described the
“effect of the shot as being progressive. It began at the site of the injection,
becoming more severe and noticeable in [her] right shoulder.” Id.
• On December 19, 2017, three months and nineteen days after vaccination,
Petitioner presented to her primary care physician, with a complaint of “right
ar[m] hurting since she had her flu shot on 8/31/16. She states that it felt
like an ache but there was no redness, swelling or itching. The ache just did
not go away. She has never had this before with the flu shot.” Ex. 2 at 10.
Petitioner’s symptoms were noted as “an off-and-on discomfort . . . . [i]t is
distinctly related to the timing of her flu shot.” Id.
• In a follow-up visit with her primary care physician on February 27, 2017,
the physician indicated, “Patient is still having [right] arm pain since
[A]ugust. She states it improved after she had the injection but it came back
and feels like an ache.” Id. at 7. Petitioner’s diagnosis was pain in right
shoulder secondary to flu shot 12/16. Id. at 8. Petitioner was referred to
orthopedics. Id.
• On March 13, 2017, Petitioner presented to her orthopedist. Ex. 4 at 4. The
orthopedist noted that Petitioner “had a flu vaccination in August of 2016-
the injection was given into her right shoulder and she’s noted increased
right shoulder pain since that time.” Id.
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 8 of 10
• Petitioner underwent a PT evaluation on March 22, 2017. Ex. 5 at 13. The
physical therapist reported that “she has had progressive right shoulder/arm
pain since a flu injection in August, 2016. Id. Petitioner complained of
transient, but daily right shoulder/arm pain rated at 8/10. Id.
• On April 13, 2017, Petitioner had a follow-up visit with Petitioner’s
orthopedist. Petitioner’s “Chief Complaint” was “Right Shoulder Follow Up.”
The orthopedist documented, “64 year-old left-hand-dominant white female
returns to the office today-[s]he had an injection-flu vaccination back in
August of 2016 and unfortunately has continued right shoulder/deltoid pain
since that injection.” Ex. 2 at 3.
• Petitioner’s son, Sirius Welch, submitted an affidavit dated September 17,
2019, in which he recalled Petitioner “complaining of pains in her right arm
from her vaccination earlier that day.” Ex. 9 at 1. Although Mr. Welch did not
recall the exact day he spoke to Petitioner, he did recall that it was the week
before Labor Day and was in 2016. Id. Mr. Welch indicated that Petitioner
is not the type of person to complain about pain, so when she did complain,
“it seemed reasonable to conclude that these pains must have been severe
enough for her to mention them out loud.” Id.
The above items of evidence collectively establish that Petitioner’s shoulder pain
most likely began within 48 hours of receiving the August 31, 2016 flu vaccine. I recognize
that Petitioner’s medical records do not reflect a precise date of onset, and also that the
vague temporal references to onset (i.e., “after receiving a flu shot . . .”) allow for the
possibility that onset occurred more than 48 hours from vaccination. However, there is no
counterevidence undercutting Petitioner’s contention that her pain began close-in-time to
vaccination, and she consistently attributed her shoulder symptoms to her flu shot.
Admittedly, there is evidence of an intervening medical appointment, but I do not
find that it rebuts this onset conclusion. Petitioner had one intervening appointment on
October 4, 2016, where she complained of great toe pain. Ex. 2 at 12. Petitioner explained
that she did not disclose her right shoulder pain at this visit because her “primary care
doctor requests a single medical concern per appointment. In fact, he has a sign on the
patient room’s wall to this effect.” Ex. 8 at 1; Mot. at 2 n. 1. Respondent contends that
there is no evidence to support this assertion, and that this is inconsistent with some of
Petitioner’s other encounters with her primary care physician. See Resp. at 7. Although
Respondent’s point is reasonable, a single intervening medical encounter where only one
issue was addressed is not enough to disprove onset, especially given the
overwhelmingly consistent assertions at all subsequent medical encounters.
Furthermore, the affidavits submitted by Petitioner and her witness are consistent with
the medical evidence, and I have found no reason not to deem them credible otherwise.
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 9 of 10
I also do not conclude that Petitioner’s treatment delay undermines her onset
assertions. Petitioner’s medical records and affidavits reflect a pattern similar to other
SIRVA claims, in which injured parties reasonably delay treatment, often based on the
assumption that their pain is likely transitory. See, e.g., Tenneson v. Sec’y of Health &
Human Servs., No. 16-1664V, 2018 WL 3083140, at *5 (Fed. Cl. Spec. Mstr. Mar. 30,
2018), mot. for review denied, 142 Fed. Cl. 329 (2019), (finding a 48-hour onset of
shoulder pain despite a nearly six-month delay in seeking treatment); Williams v. Sec’y
of Health & Human Servs., 17-830V, 2019 WL 1040410, at *9 (Fed. Cl. Spec. Mstr. Jan.
31, 2019) (noting a delay in seeking treatment for five-and-a-half months because
petitioner underestimated the severity of her shoulder injury); Knauss v. Sec’y of Health
& Human Servs., 16-1372V, 2018 WL 3432906 (Fed. Cl. Spec. Mstr. May 23, 2018)
(noting a three-month delay in seeking treatment). Here, the temporal delay is not lengthy
enough to cast doubt on a shorter onset.
Finally, Respondent maintains that the medical records do not corroborate
Petitioner’s argument that her pain began as a soreness and ache at the site of injection
on the evening of the vaccination, and then progressed becoming more severe and
noticeable, but rather reveal only “off-and-on discomfort.” Resp. at 8 citing Mot. at 8; Ex.
2 at 10; Ex. 8. I find, however, that the record is consistent with Petitioner’s contention. At
her initial appointment, Petitioner described her initial pain as an ache, and that “the ache
just did not go away.” Ex. 2 at 10. Then, at her February 27, 2017 appointment, Petitioner
again noted the onset of her pain to be in August 2016, which had improved “but it came
back and feels like an ache.” Id. at 7. In her other follow-up appointments with the
orthopedist, and at the initial PT evaluation, Petitioner also described her symptoms as
progressive and increasing. See Ex. 4 at 4 and Ex. 5 at 13. And Petitioner described her
pain as transient, but daily. Ex. 5 at 13. Therefore, I find it credible that the onset of
Petitioner’s pain was as she described, beginning as a soreness and aching, but also that
it persisted and progressed, rather than waxing and waning.
Accordingly, I find there is preponderant evidence to establish that the onset of
Petitioner’s left shoulder pain occurred within 48 hours of the August 31, 2016 flu
vaccination.
V. Conclusion
In light of all of the above and after a review of the record as a whole, I find that (1)
the August 31, 2016 flu vaccine was likely administered into Petitioner’s right arm; (2)
Petitioner’s pain and reduced range of motion were limited to the shoulder/arm in which
the intramuscular vaccine was administered; and (3) that the onset of petitioner’s shoulder
pain occurred within 48 hours of her vaccination.
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Case 1:18-vv-00660-UNJ Document 34 Filed 12/18/20 Page 10 of 10
VI. Scheduling Order
Given my finding of fact regarding onset – and specifically that it is consistent with
the Table requirements for a SIRVA claim - Respondent should evaluate and provide his
current position regarding the merits of Petitioner’s case.
Respondent shall file, by no later than Monday, January 18, 2021, an amended Rule
4(c) Report reflecting Respondent’s position in light of the above fact-finding.
Any questions about this order or about this case may be directed to OSM staff
attorney Reiko Suber at (202) 357-6378 or Reiko_Suber@cfc.uscourts.gov.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
10

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DOCUMENT 2: USCOURTS-cofc-1_18-vv-00660-1
Date issued/filed: 2021-03-31
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/01/2021) regarding 38 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-00660-UNJ Document 40 Filed 03/31/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0660V
UNPUBLISHED
JUDY WELCH, Chief Special Master Corcoran
Petitioner, Filed: March 1, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Table Injury;
HUMAN SERVICES, Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
Respondent. Administration (SIRVA)
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Amanda Pasciuto, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On May 10, 2018, Judy Welch 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 that she suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine she received on August
31, 2016. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On November 18, 2020, I issued Findings of Fact in which I determined that “the
flu vaccine alleged as causal was administered in Petitioner’s right deltoid; that her pain
and reduced range of motion were limited to the shoulder in which the intramuscular
vaccine was administered; and that the onset of Petitioner’s SIRVA-related pain occurred
1 Because this unpublished ruling contains a reasoned explanation for the action in this case, I am 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). 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, I agree that
the identified material fits within this definition, I 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 1:18-vv-00660-UNJ Document 40 Filed 03/31/21 Page 2 of 2
within 48 hours of vaccination.” ECF No. 32 at 1-2. In reaction, on February 26, 2021,
Respondent filed an Amended Rule 4(c) Report indicating that while preserving his right
to appeal the November 18, 2020 Fact Finding, he “does not dispute that [P]etitioner has
satisfied all legal prerequisites for compensation under the Act.” Respondent’s Rule 4(c)
Report at 6 (citing 42 U.S.C. § 300aa-13).
Specifically, Respondent stated as follows:
In light of the Chief Special Master’s fact finding, and medical record
evidence submitted in this case, [the Secretary] will not continue to contest
that petitioner suffered SIRVA as defined by the Vaccine Injury Table . . . In
addition, petitioner suffered the residual effects of her condition for more
than six months. 42 U.S.C. § 300aa-11(c)(1)(D)(i). Therefore, based on the
record as it stands and subject to his right to appeal the Findings of Fact,
respondent does not dispute that petitioner has satisfied all legal perquisites
for compensation under the Act. 42 U.S.C. § 300aa-13.
Id. at 5-6.
In view of Respondent’s position and the evidence of record, I find that
Petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
2

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DOCUMENT 3: USCOURTS-cofc-1_18-vv-00660-2
Date issued/filed: 2021-10-06
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 09/02/2021) regarding 50 DECISION of Special Master Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0660V
UNPUBLISHED
JUDY WELCH, Chief Special Master Corcoran
Petitioner, Filed: September 2, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Decision Awarding Damages; Pain
HUMAN SERVICES, and Suffering; Influenza (Flu)
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Administration (SIRVA)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Amanda Pasciuto, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On May 10, 2018, Judy Welch 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 she received on August
31, 2016. Petition at 1. The case was assigned to the Special Processing Unit (“SPU”) of
the Office of Special Masters. Because the parties could not agree on all damages
components, the matter was designated for SPU “Motions Day,” and argument was heard
on August 27, 2021.
1 Because this unpublished Decision contains a reasoned explanation for the action in this case, I am
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). 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, I agree that the identified material fits within this definition, I 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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 2 of 7
For the reasons set forth below, and as represented during the hearing,3 I find that
Petitioner is entitled to compensation in the amount $55,459.00, representing
$55,000.00 for actual pain and suffering, plus $459.00 for past unreimbursed
expenses.
I. Relevant Procedural History
On July 8, 2019, Respondent filed his Rule 4(c) Report recommending that
entitlement to compensation be denied under the terms of the Vaccine Act. Respondent’s
Report at 1. ECF No. 22. However, on February 26, 2021, Respondent filed an Amended
Rule 4(c) Report indicating that he “does not dispute that [P]etitioner has satisfied all legal
prerequisites for compensation under the Act.” Respondent’s Rule 4(c) Report at 6 (citing
42 U.S.C. § 300aa-13).4 ECF No. 37 at 6. Thereafter, the parties attempted to informally
resolve the issue of damages but were able to agree only to a sum for past unreimbursed
out-of-pocket expenses to be paid to Petitioner. ECF No. 42. I subsequently proposed
that the parties be given the opportunity to argue their positions at a motions hearing, at
which time I would decide the disputed damages issue. ECF No. 47.
Prior to hearing, both sides filed briefs setting forth their respective positions. The
hearing was held on August 27, 2021. Petitioner’s Brief in Support of Damages, dated
May 19, 2021 (“Br.”), ECF No. 44; Respondent’s Brief on Damages, dated June 18, 2021
(“Opp.”), ECF No. 45; Reply, dated July 1, 2021 (“Reply”), ECF No. 46.
Petitioner requests $75,000.00 in actual pain and suffering, arguing that her course
of treatment (including an MRI and 6 sessions of physical therapy) was severe and
warrants an award at that level. Br. at 1, 8. She also maintains that she continued to seek
care for her injury nearly twelve months post-vaccination, suffered from the symptoms of
SIRVA for almost sixteen months, and rated her pain as a seven on a ten-point scale
more than six months after her injury. Id. at 8. Respondent, by contrast, proposes an
award of no more than $25,000.00. Opp. at 2. He argues that “the record . . . reflects a
petitioner who sustained a relatively minor SIRVA injury and received relatively little
treatment for her SIRVA.” Id.
3 See Minute Entry dated August 27, 2021. The transcript of this hearing, which was not yet filed as of the
date of this Decision, is hereby incorporated into this Damages Decision by reference.
4 Respondent’s Amended Rule 4(c) Report was in response to my November 18, 2020 Findings of Fact in
which I determined that “the flu vaccine alleged as causal was administered in Petitioner’s right deltoid; that
her pain and reduced range of motion were limited to the shoulder in which the intramuscular vaccine was
administered; and that the onset of Petitioner’s SIRVA-related pain occurred within 48 hours of vaccination.”
ECF No. 32 at 1-2.
2

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 3 of 7
II. Legal Standard
Compensation awarded pursuant to the Vaccine Act shall include an award “[f]or
actual and projected pain and suffering and emotional distress from the vaccine-related
injury, an award not to exceed $250,000.” Section 15(a)(4). Additionally, a petitioner may
recover “actual unreimbursable expenses incurred before the date of judgment awarding
such expenses which (i) resulted from the vaccine-related injury for which petitioner seeks
compensation, (ii) were incurred by or on behalf of the person who suffered such injury,
and (iii) were for diagnosis, medical or other remedial care, rehabilitation . . . determined
to be reasonably necessary.” Section 15(a)(1)(B). Petitioner bears the burden of proof
with respect to each element of compensation requested. Brewer v. Sec’y of Health &
Human Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec. Mstr. Mar. 18,
1996).
There is no precise formula for assigning a monetary value to a person’s pain and
suffering and emotional distress. I.D. v. Sec’y of Health & Human Servs., No. 04-1593V,
2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr. May 14, 2013) (“Awards for emotional
distress are inherently subjective and cannot be determined by using a mathematical
formula”); Stansfield v. Sec’y of Health & Human Servs., No. 93-0172V, 1996 WL 300594,
at *3 (Fed. Cl. Spec. Mstr. May 22, 1996) (“the assessment of pain and suffering is
inherently a subjective evaluation.”). Factors to be considered when determining an
award for pain and suffering include: 1) awareness of the injury; 2) severity of the injury;
and 3) duration of the suffering. I.D., 2013 WL 2448125, at *9 (quoting McAllister v. Sec’y
of Health & Human Servs., No 91-1037V, 1993 WL 777030, at *3 (Fed. Cl. Spec. Mstr.
Mar. 26, 1993), vacated and remanded on other grounds, 70 F.3d 1240 (Fed. Cir. 1995)).
I may also consider prior pain and suffering awards to aid in the resolution of the
appropriate amount of compensation for pain and suffering in each case. See, e.g., Doe
34 v. Sec’y of Health & Human Servs., 87 Fed. Cl. 758, 768 (2009) (finding that “there is
nothing improper in the chief special master’s decision to refer to damages for pain and
suffering awarded in other cases as an aid in determining the proper amount of damages
in this case.”). And, of course, a special master may rely on his or her own experience
adjudicating similar claims. Hodges v. Sec’y of Health & Human Servs., 9 F.3d 958, 961
(Fed. Cir. 1993) (noting that Congress contemplated that special masters would use their
accumulated expertise in the field of vaccine injuries to judge the merits of individual
claims). Importantly, however, it must also be stressed that pain and suffering is not
determined based on a continuum. See Graves v. Sec’y of Health & Human Servs., 109
Fed. Cl. 579 (2013).
3

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 4 of 7
III. Appropriate Compensation for Petitioner’s Pain and Suffering
a. Severity and Duration of Pain and Suffering
Pain and suffering is the sole disputed component of damages herein, so only the
legal standards bearing on its calculation are relevant. In this case, awareness of the
injury is not contested. The record reflects that at all times Petitioner was a competent
adult with no impairments that would impact her awareness of her injury. Therefore, I
analyze principally the severity and duration of Petitioner’s injury.
When performing this analysis, I review the record as a whole, including the
medical records and affidavits filed, written briefs, and argument at the August 27th
Motions Day hearing. I have also considered prior awards for pain and suffering in both
SPU and non-SPU SIRVA cases, and rely upon my experience adjudicating these cases.
Based upon the above, I note and find the following:
• Ms. Welch received the flu vaccine alleged as causal on August 31, 2016.
Exhibit 1 at 1; Ex. 8 at 1. Despite presenting to her primary care provider
(“PCP”) on October 4, 2016, Petitioner waited until her appointment on
December 19, 2016 (110 days post-vaccination) to discuss her right arm
issues. Ex. 2 at 8-12. The medical record documenting this visit indicates that
Petitioner described an “ache” as well as “off and on discomfort.” Id. at 10.
• Petitioner presented to her PCP on February 27, 2017 and stated that she
continued to experience right arm pain that “feels like an ache.” Ex. 2 at 6-8. It
was noted that Petitioner had “full range of motion of the right arm and shoulder
without any pain or limitation.” Id. at 8. The medical record documenting this
visit indicates that Petitioner was “comfortable just using over-the-counter
[medication] until she sees orthopedics.” Id.
• On March 13, 2017, Petitioner presented to an orthopedist for an evaluation of
her right shoulder. Ex. 4 at 3-4. Petitioner stated that her pain had increased
since the date of vaccination and rated her pain as a seven on a ten-point scale.
Id. at 4. The orthopedist noted that sleeping on her right arm as well as the
performance of certain activities led to an increase in Petitioner’s pain. Id.
• Between March 22 and April 6, 2017, Petitioner completed 6 sessions of
physical therapy. Ex. 5. The note documenting her initial evaluation indicates
that Petitioner rated her pain as an eight on a ten-point scale. Id. at 13. Although
Petitioner’s active range of motion was stiff, it was within normal limits. Id.
4

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 5 of 7
Petitioner was assessed with “[r]ight shoulder/arm tendinitis/bursitis.” Id.
• At Petitioner’s fourth physical therapy visit on April 3, 2017, she rated her pain
as ranging from zero to one on a ten-point scale while at rest, and ranging from
two to six at its worse. Ex. 5 at 8.
• Petitioner presented to her orthopedist on April 13, 2017 with complaints of
continued right shoulder pain. Ex. 4 at 2. Although Petitioner stated that she
had better use of her right shoulder, it was noted that she continued to
experience “pain over the lateral aspect of her right shoulder in the area of the
deltoid.” Id.
• Petitioner underwent an MRI on July 6, 2017. Ex. 6. It showed a “full-thickness
slightly retracted rotator cuff tear,” an “amorphous intrasubstance superior
labral tear,” and “mild to moderate intra-articular biceps tendinosis with extra
articular biceps tendinosis with extraarticular tenosynovitis.” Id. at 3.
• On July 19, 2017, Petitioner returned to her orthopedist to discuss the results
of her MRI. Ex. 4 at 1. The physician’s impression was “[r]otator cuff tear right
shoulder supraspinatus with retraction, glenoid labral tear and biceps
tendinosis.” Id.
• Petitioner presented to her PCP on August 21, 2017. Ex. 2 at 4-6. Despite
articulating her own concern regarding the “tricep area of the right humerus
from the flu shot of last year,” Petitioner’s doctor determined that she had
“excellent full range of motion with abduction and internal rotation without any
pain.” Id. at 5.
• On December 21, 2017 (over one-year post-vaccination), Petitioner presented
to her PCP “simply to have a correction on the document that was entered
regarding her flu vaccine in 2016.” Ex. 1 at 2-4. During this visit, Petitioner
stated that she had ongoing pain in her right arm. Id. at 3.
• In her supplemental affidavit, signed on July 18, 2018, Petitioner states that
she initially delayed seeking medical treatment “because I felt that my right
shoulder pain would lessen and eventually go away.” Ex. 8 at 2. Petitioner
further states that she continues to have “definite soreness” in her right
shoulder and that using a computer mouse, lawn mowing, opening certain
doors, and sleeping on her right side cause pain. Id.
5

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 6 of 7
The case record overall establishes that Ms. Welch experienced a relatively mild
SIRVA, which did not necessitate immediate care, surgery, or lengthy overall treatment.
As noted above, Ms. Welch first sought care for her right shoulder on December 19, 2016
-- 110 days following her vaccination. Petitioner attributes this delay to her initial belief
that the pain would subside on its own. Ex. 8 at 2. However, had Ms. Welch’s initial pain
been notably severe, she would have likely sought medical care sooner. Indeed, when
Petitioner finally did seek treatment, she described feeling only an “ache,” further
underscoring the mild nature of her injury. Ex. 2 at 10.
Although it is true Ms. Welch reported an increase in pain during her first orthopedic
appointment on March 13, 2017, as well as in the immediately following months, it
appears that she had significantly recovered by that fall, as reflected by the lack of any
treatment after August 21, 2017. Indeed, it was on this date that Petitioner’s PCP noted
that she had “excellent full range of motion with abduction and internal rotation without
any pain.” Ex. 2 at 5.
I also note that Ms. Welch underwent entirely conservative treatment. She did not
receive any cortisone injections, and only underwent six physical therapy sessions.
Further, in February 2017, she expressed comfort in using only over-the-counter
medication for pain relief. Ex. 2 at 8.
The aforementioned factors figure into the amount to be awarded for Ms. Welch’s
pain and suffering. Based upon them, I find that Petitioner’s course of treatment is not
completely comparable to Petitioner’s proposed prior decisions, Attig, Kim, Marino and
Bordelon.5 Rather, it was similar to the experiences of petitioners in two prior cases:
Dagen v. Sec’y of Health & Human Servs., No. 18-0442V, 2019 WL 7187335, at *10 (Fed.
Cl. Spec. Mstr. November 6, 2019) (awarding $65,000.00 for pain and suffering after
finding that the claimant’s “pain was fairly significant in the first two months post-
vaccination, but progressively eased in the ensuing period, with her movement
impairment also largely (though not totally) improved within seven months of
vaccination”), and Knauss v. Sec’y of Health & Human Servs., No. 16-1372V, 2018 WL
3432906 at *7 (Fed. Cl. Spec. Mstr. May 23, 2018)(awarding $60,000 for pain and
suffering following a SIRVA wherein petitioner sought treatment three months post-
vaccination, underwent 15 physical therapy sessions, received a steroid injection, and
5 Attig v. Sec’y of Health & Human Servs., No. 17-1029V, 2019 WL 1749405 (Fed. Cl. Spec. Mstr. Feb. 19,
2019)(awarding $75,000.00 for pain and suffering and $1,386.97 in unreimbursable expenses); Kim v.
Sec’y of Health & Human Servs., No. 17-0418V, 2018 WL 3991022 (Fed. Cl. Spec. Mstr. July 20,
2018)(awarding $75,000 for pain and suffering and $520 in unreimbursable expenses); Marino v. Sec’y of
Health & Human Servs., No. 16-0622V, 2018 WL 2224736 (Fed. Cl. Spec. Mstr. Mar. 26, 2018)(awarding
$75,000.00 for pain and suffering and $88.88 in unreimbursable expenses); Bordelon v. Sec’y of Health &
Human Servs., No. 17-1892V, 2019 WL 2385896 (Fed.Cl. Spec. Mstr. Apr. 24, 2019)(awarding $75,000.00
for pain and suffering).
6

Case 1:18-vv-00660-UNJ Document 58 Filed 10/06/21 Page 7 of 7
ultimately reported a 94 percent recovery with a pain level at 1.5).
A damages award comparable to these two cases is most warranted, although
perhaps slightly less to account for the limited number of PT sessions and absence of
cortisone injections. I thus award $55,000.00 in actual pain and suffering.
b. Award for Past Unreimbursable Expenses
Ms. Welch also requests $459.00 in past unreimbursable expenses. Br. at 1.
Respondent does not dispute this sum, and therefore Petitioner is awarded this sum
without adjustment.
IV. Conclusion
Based on the record as a whole and arguments of the parties, I award Petitioner
a lump sum payment of $55,459.00, (representing $55,000.00 for Petitioner’s actual
pain and suffering, and $459.00 for unreimbursable medical expenses) in the form of a
check payable to Petitioner, Judy Welch. This amount represents compensation for all
damages that would be available under Section 15(a).
The Clerk of the Court is directed to enter judgment in accordance with this
decision.6
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
6 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.
7