VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_18-vv-01457
Package ID: USCOURTS-cofc-1_18-vv-01457
Petitioner: Dale Jacoby
Filed: 2018-09-21
Decided: 2019-12-23
Vaccine: influenza
Vaccination date: 2017-10-30
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 98275

AI-assisted case summary:
Dale Jacoby filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccination on October 30, 2017. The respondent, the Secretary of Health and Human Services, conceded that Mr. Jacoby's claim met the Table criteria for SIRVA. The respondent also agreed that the case was timely filed, the vaccine was received in the United States, and that Mr. Jacoby satisfied the statutory severity requirement by suffering residual effects for more than six months. Based on the respondent's concession and the evidence, the court found Mr. Jacoby entitled to compensation. Subsequently, a decision awarding damages was issued. The parties stipulated to an award of $98,275.00, which included $97,500.00 for actual and projected pain and suffering and $775.00 for past unreimbursable expenses. This amount was awarded as a lump sum payment to Mr. Jacoby.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_18-vv-01457-0
Date issued/filed: 2019-12-20
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/21/2019) regarding 20 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (ypb) Service on parties made.
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Case 1:18-vv-01457-UNJ Document 24 Filed 12/20/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-1457V
Filed: October 21, 2019
UNPUBLISHED
DALE JACOBY,
Petitioner, Special Processing Unit (SPU);
v. Ruling on Entitlement; Concession;
Table Injury; Influenza (Flu) Vaccine;
SECRETARY OF HEALTH AND Shoulder Injury Related to Vaccine
HUMAN SERVICES, Administration (SIRVA)
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
Corcoran, Chief Special Master:
On September 21, 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of receiving an influenza (“flu”) vaccination on
October 30, 2017. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
1 I intend 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, I agree that the identified
material fits within this definition, I will redact such material from public access. 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).
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-01457-UNJ Document 24 Filed 12/20/19 Page 2 of 2
On October 17, 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 has concluded that petitioner’s claim meets the Table
criteria for SIRVA. Id. at 6. Respondent further agrees that “the case was timely filed,
that the vaccine was received in the United States, and that the petitioner satisfies the
statutory severity requirement by suffering the residual effects or complications of his
injury for more than six months after vaccine administration.” Id.
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 2: USCOURTS-cofc-1_18-vv-01457-1
Date issued/filed: 2019-12-23
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 10/21/2019) regarding 21 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:18-vv-01457-UNJ Document 25 Filed 12/23/19 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 18-1457V
Filed: October 21, 2019
UNPUBLISHED
DALE JACOBY,
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.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
petitioner.
Claudia Barnes Gangi, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
Corcoran, Chief Special Master:
On September 21, 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of receiving an influenza (“flu”) vaccination on
October 30, 2017. Petition at 1. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On October 21, 2019, a ruling on entitlement was issued, finding petitioner
entitled to compensation for SIRVA. On October 17, 2019, respondent filed a combined
Rule 4/proffer on award of compensation (“Rule 4/Proffer”) indicating petitioner should
1 I intend 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, I agree that the identified
material fits within this definition, I will redact such material from public access. 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).
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-01457-UNJ Document 25 Filed 12/23/19 Page 2 of 2
be awarded $98,275.00 (comprised of $97,500.00 for actual and projected pain and
suffering, and $775.00 for past unreimbursable expenses) . Rule 4/Proffer at 7. In the
Rule 4/Proffer, respondent represented 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 Rule 4/Proffer.
Pursuant to the terms stated in the Rule 4/Proffer, I award petitioner a lump
sum payment of $98,275.00 (comprised of $97,500.00 for actual and projected
pain and suffering and $775.00 for past unreimbursable expenses) in the form of
a check payable to petitioner, Dale Jacoby. 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