VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-00877
Package ID: USCOURTS-cofc-1_18-vv-00877
Petitioner: Tiffany Wilson
Filed: 2018-06-20
Decided: 2019-08-01
Vaccine: influenza
Vaccination date: 2017-10-24
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 82160

AI-assisted case summary:
Tiffany Wilson filed a petition for compensation under the National Vaccine Injury Compensation Program on June 20, 2018, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine received on October 24, 2017. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on May 9, 2019, conceding that petitioner's alleged injury was consistent with SIRVA as defined on the Vaccine Injury Table and that she satisfied all legal prerequisites for compensation. On May 10, 2019, Chief Special Master Nora Beth Dorsey issued a ruling on entitlement, finding petitioner entitled to compensation. Subsequently, on August 1, 2019, the respondent filed a proffer on award of compensation, indicating that the parties had agreed to an award. The decision awarding damages, also issued by Chief Special Master Nora Beth Dorsey on August 1, 2019, detailed the agreed-upon compensation. The award consisted of a lump sum payment of $80,000.00 for pain and suffering, and a lump sum payment of $2,160.96 to satisfy a Medicaid lien held by Mercy Maricopa Integrated Care (MMIC). The total award amounted to $82,160.96. Petitioner was represented by Andrew Donald Downing of Van Cott & Talamante, PLLC, and respondent was represented by Sarah Christina Duncan of the U.S. Department of Justice. The public decision does not describe the specific onset of symptoms, medical tests, treatments, or the mechanism of injury beyond its classification as SIRVA.

Theory of causation field:
Petitioner Tiffany Wilson alleged a Shoulder Injury Related to Vaccine Administration (SIRVA) following an influenza vaccine on October 24, 2017. The respondent conceded that the alleged injury was consistent with SIRVA as defined on the Vaccine Injury Table and that petitioner met all legal prerequisites for compensation. The case was resolved via stipulation. Chief Special Master Nora Beth Dorsey issued a ruling on entitlement on May 10, 2019, and a decision awarding damages on August 1, 2019. The award totaled $82,160.96, comprising $80,000.00 for pain and suffering and $2,160.96 to satisfy a Medicaid lien. Petitioner was represented by Andrew Donald Downing, and respondent was represented by Sarah Christina Duncan. The public text indicates the theory of causation is based on the Vaccine Injury Table (SIRVA).

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-00877-0
Date issued/filed: 2019-08-14
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 05/10/2019) regarding 31 Ruling on Entitlement ( Signed by Chief Special Master Nora Beth Dorsey. )(mpj) Service on parties made.
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Case 1:18-vv-00877-UNJ Document 45 Filed 08/14/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-877V
Filed: May 10, 2019
UNPUBLISHED
TIFFANY WILSON,
Special Processing Unit (SPU);
Petitioner, Ruling on Entitlement; Concession;
v. Table Injury; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
SECRETARY OF HEALTH AND Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Andrew Donald Downing, Van Cott & Talamante, PLLC, Phoenix, AZ, for petitioner.
Sarah Christina Duncan, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Dorsey, Chief Special Master:
On June 20, 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 the influenza (“flu”) vaccine she received on
October 24, 2017. Petition at 1, 3. 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).

Case 1:18-vv-00877-UNJ Document 45 Filed 08/14/19 Page 2 of 2
On May 9, 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’s alleged injury is consistent with SIRVA
as defined on the Vaccine Injury Table.” Id. at 6. Respondent further agrees that
petitioner suffered the residual effects of her condition for more than six months and 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

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DOCUMENT 2: USCOURTS-cofc-1_18-vv-00877-1
Date issued/filed: 2019-10-28
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 08/01/2019) regarding 39 DECISION Stipulation/Proffer Signed by Special Master Nora Beth Dorsey. (sw) Service on parties made.
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In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-877V
Filed: August 1, 2019
UNPUBLISHED
TIFFANY WILSON,
Petitioner,
Special Processing Unit (SPU);
v.
Damages Decision Based on Proffer;
Influenza (Flu) Vaccine; Shoulder
SECRETARY OF HEALTH AND
Injury Related to Vaccine
HUMAN SERVICES,
Administration (SIRVA)
Respondent.
Andrew Donald Downing, Van Cott & Talamante, PLLC, for petitioner.
Sarah Christina Duncan, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Dorsey, Chief Special Master:
On June 20, 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 the influenza (“flu”) vaccine she received on
October 24, 2017. Petition at 1, 3. The case was assigned to the Special Processing
Unit of the Office of Special Masters.
On May 10, 2019, a ruling on entitlement was issued, finding petitioner entitled to
compensation for her SIRVA. On August 1, 2019, respondent filed a proffer on award
of compensation (“Proffer”) indicating petitioner should be awarded $80,000.00, as well
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).

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as $2,160.96 to satisfy a Medicaid lien. Proffer at 1-2. 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
the following compensation, which represents compensation for all damages that
would be available under § 15(a):
1. A lump sum payment of $80,000.00, representing compensation for
actual and projected pain and suffering, in the form of a check payable
to Tiffany Wilson; and
2. A lump sum payment of $2,160.96, representing compensation for
satisfaction of the Mercy Maricopa Integrated Care Medicaid lien, in the
form of a check payable jointly to petitioner and to:
Equian, LLC
PO Box 32140
Louisville, KY 40232-2140
File No.: 970539-175418
Petitioner agrees to endorse this payment to Equian, LLC.
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

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IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
TIFFANY WILSON, )
)
Petitioner, )
) No. 18-877V
v. ) Chief Special Master Dorsey
) ECF
SECRETARY OF HEALTH AND HUMAN )
SERVICES, )
)
Respondent. )
)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On June 20, 2018, Tiffany Wilson (“petitioner”) filed a petition for compensation under
the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act”
or “Act”), alleging that she suffered a Shoulder Injury Related to Vaccine Administration
(“SIRVA”) as a result of an influenza vaccine she received on October 24, 2017. Petition at 1, ¶
11. On May 9, 2019, the Secretary of Health and Human Services (“respondent”) filed a Rule
4(c) Report indicating that this case is appropriate for compensation under the terms of the Act,
and the Chief Special Master issued a Ruling on Entitlement finding petitioner entitled to
compensation on May 10, 2019. ECF No. 30; ECF No. 31.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that Tiffany Wilson should be awarded $80,000.00 in actual and
projected pain and suffering. This amount reflects that the award for projected pain and
suffering has been reduced to net present value. See 42 U.S.C. § 300aa-15(a)(4). Petitioner
agrees.

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B. Satisfaction of Medicaid Lien
Respondent further proffers that Tiffany Wilson should be awarded funds to satisfy a
Mercy Maricopa Integrated Care (“MMIC”) Medicaid lien in the amount of $2,160.96, which
represents full satisfaction of any right of subrogation, assignment, claim, lien, or cause of action
MMIC may have against any individual as a result of any Medicaid payments that MMIC has
made to or on behalf of Tiffany Wilson from the date of her eligibility for benefits through the
date of judgment in this case as a result of her vaccine-related injury suffered on or about
October 24, 2017, under Title XIX of the Social Security Act. Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner be made through two
lump sum payments as described below:
1) A lump sum payment of $80,000.00 in the form of a check payable to petitioner.1
2) A lump sum payment of $2,160.96, representing compensation for satisfaction of
the MMIC Medicaid lien, payable jointly to petitioner and to:
Equian, LLC
PO Box 32140
Louisville, KY 40232-2140
File No.: 970539-175418
Petitioner agrees to endorse this payment to Equian, LLC.
Respectfully submitted,
JOSEPH H. HUNT
Assistant Attorney General
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 lost earnings
and future pain and suffering.
2

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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/ Sarah C. Duncan
Sarah C. Duncan
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) 514-9729
Fax: (202) 616-4310
DATED: August 1, 2019
3