VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00775
Package ID: USCOURTS-cofc-1_18-vv-00775
Petitioner: Scott Kelbick
Filed: 2018-05-31
Decided: 2020-04-29
Vaccine: influenza
Vaccination date: 2017-10-02
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 139566

AI-assisted case summary:
Scott Kelbick filed a petition for compensation on May 31, 2018, alleging that he suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine he received on October 2, 2017. The respondent conceded that Mr. Kelbick is entitled to compensation, agreeing that his medical course was consistent with SIRVA as defined by the Vaccine Injury Table. The respondent noted that Mr. Kelbick had no pre-vaccination history of shoulder pain, the pain occurred within 48 hours after vaccination, and the pain and reduced range of motion were limited to the shoulder where the vaccine was administered. The respondent also agreed that Mr. Kelbick suffered residual effects for more than six months. A ruling on entitlement was issued on May 7, 2019, finding Mr. Kelbick entitled to compensation. On March 27, 2020, the respondent filed a proffer on award of compensation, proposing an award of $139,566.06, comprised of $135,000.00 for pain and suffering and $4,566.06 for past unreimbursed medical expenses. Mr. Kelbick, identified as a competent adult, agreed with the proffered award. The court awarded Mr. Kelbick the stipulated amount of $139,566.06.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00775-0
Date issued/filed: 2019-08-14
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 05/07/2019) regarding 29 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:18-vv-00775-UNJ Document 38 Filed 08/14/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0775V
Filed: May 7, 2019
UNPUBLISHED
SCOTT KELBICK,
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.
Kristina E. Grigorian, Jeffrey S. Pop & Associates, Beverly Hills, CA, for petitioner.
Adriana Ruth Teitel, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On May 31, 2018, Scott Kelbick (“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”) as a result of an influenza (“flu”) vaccine he received
on October 2, 2017. Petition at 1. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On May 6, 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 “DICP concludes that petitioner’s medical course is
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.
1

Case 1:18-vv-00775-UNJ Document 38 Filed 08/14/19 Page 2 of 2
consistent with a shoulder injury related to vaccine administration SIRVA as defined by
the Vaccine Injury Table and corresponding Qualifications and Aids to Interpretation.
Specifically, petitioner had no pre-vaccination history of pain, inflammation, or
dysfunction of his left shoulder; pain occurred within 48 hours after receipt of an
intramuscular vaccination; pain and reduced range of motion was limited to the shoulder
where 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 5-6.
Respondent further agrees that petitioner suffered the residual effects of his condition
for more than six months. 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-00775-1
Date issued/filed: 2020-04-29
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 03/30/2020) regarding 53 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-00775-UNJ Document 57 Filed 04/29/20 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-0775V
UNPUBLISHED
SCOTT KELBICK, Chief Special Master Corcoran
Petitioner, Filed: March 30, 2020
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Damages Decision Based on Proffer;
HUMAN SERVICES, Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
Respondent. Administration (SIRVA)
Kristina E. Grigorian, Jeffrey S. Pop & Associates, Beverly Hills, CA, for petitioner.
Adriana Ruth Teitel, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
On May 31, 2018, Scott Kelbick 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”) as a result of an influenza (“flu”) vaccine he received on
October 2, 2017. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On May 7, 2019, a ruling on entitlement was issued finding Petitioner entitled to
compensation. On March 27, 2020, Respondent filed a proffer on award of
compensation (“Proffer”) indicating Petitioner should be awarded $139,566.06
(comprised of $135,000.00 for pain and suffering and $4,566.06 for past unreimbursed
out-of-pocket medical expenses). Proffer at 1. In the Proffer, Respondent represented
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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:18-vv-00775-UNJ Document 57 Filed 04/29/20 Page 2 of 4
that Petitioner agrees with the proffered award. Id. Based on the record as a whole, I
find that Petitioner is entitled to an award as stated in the Proffer.
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $139,566.06, in the form of a check payable to Petitioner. 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/Brian H. Corcoran
Brian H. Corcoran
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-00775-UNJ Document 57 Filed 04/29/20 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
SCOTT KELBICK,
Petitioner,
No. 18-775V
v.
Chief Special Master Corcoran (SPU)
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Compensation for Vaccine Injury-Related Items
On May 6, 2019, respondent filed a Rule 4(c) Report conceding that petitioner is entitled
to vaccine compensation for his Shoulder Injury Related to Vaccine Administration (“SIRVA”)
injury suffered following receipt of an influenza vaccination on October 2, 2017. On May 7,
2019, Ruling on Entitlement, adopting respondent’s recommendation, was issued.
Based upon the evidence of record, respondent proffers that petitioner1 should be
awarded $139,566.06. This is comprised of pain and suffering ($135,000.00) and past
unreimbursed out-of-pocket medical expenses ($4,566.06), and represents all elements of
compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).2 Petitioner
agrees.
1 Petitioner is a competent adult, therefore evidence of guardianship is not required in this case.
2 Should Petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief.

Case 1:18-vv-00775-UNJ Document 57 Filed 04/29/20 Page 4 of 4
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through:
a lump sum of $139,566.06 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).
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/ Adriana Teitel
ADRIANA TEITEL
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146, Benjamin Franklin Station
Washington, DC 20044-0146
Tel: (202) 616-3677
Dated: March 27, 2020