VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00147
Package ID: USCOURTS-cofc-1_19-vv-00147
Petitioner: Lisa M. Jackson
Filed: 2019-01-29
Decided: 2020-06-05
Vaccine: Tdap
Vaccination date: 2016-02-04
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 165850

AI-assisted case summary:
Lisa Jackson filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of a Tetanus, Diphtheria, acellular Pertussis (Tdap) vaccine administered on February 4, 2016. The respondent conceded that Petitioner is entitled to compensation, agreeing that her medical course was consistent with SIRVA as defined by the Vaccine Injury Table and that she suffered residual effects for more than six months. Following the ruling on entitlement, the parties submitted a proffer on award of compensation. The court awarded Lisa Jackson a lump sum payment of $165,850.07, which included $162,500.00 for pain and suffering, $1,514.05 for past lost wages, and $1,836.02 for past unreimbursed expenses. This award represented all elements of compensation to which she would be entitled.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_19-vv-00147-0
Date issued/filed: 2020-05-13
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/13/2020) regarding 29 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-00147-UNJ Document 38 Filed 05/13/20 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-147V
UNPUBLISHED
LISA M. JACKSON Chief Special Master Corcoran
p/k/a Lisa M. Gilbertson,
Filed: April 13, 2020
Petitioner,
v. Special Processing Unit (SPU);
Ruling on Entitlement; Concession;
SECRETARY OF HEALTH AND Table Injury; Tetanus Diphtheria
HUMAN SERVICES, acellular Pertussis (Tdap) Vaccine;
Shoulder Injury Related to Vaccine
Respondent. Administration (SIRVA)
Kate Gerayne Westad, SiebenCarey, Minneapolis, MN, for petitioner.
Adriana Ruth Teitel, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On January 29, 2019, Lisa Jackson 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 a Tetanus, Diphtheria, acellular Pertussis
(“Tdap”) vaccine administered on February 4, 2016. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On April 10, 2020, 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
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 1:19-vv-00147-UNJ Document 38 Filed 05/13/20 Page 2 of 2
at 1. Specifically, Respondent concludes that Petitioner’s “medical course is consistent
with SIRVA as defined by the Vaccine Injury Table and corresponding Qualifications
and Aids to Interpretation.” Id. at 6. Respondent further agrees that Petitioner “suffered
the residual effects of her condition for more than six months.” 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

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_19-vv-00147-1
Date issued/filed: 2020-06-05
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 05/06/2020) regarding 34 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-00147-UNJ Document 39 Filed 06/05/20 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-147V
UNPUBLISHED
LISA M. GILBERTSON, Chief Special Master Corcoran
Petitioner, Filed: May 6, 2020
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Damages Decision Based on Proffer;
HUMAN SERVICES, Tetanus Diphtheria acellular
Pertussis (Tdap) Vaccine; Shoulder
Respondent. Injury Related to Vaccine
Administration (SIRVA)
Kate Gerayne Westad, SiebenCarey, Minneapolis, MN, for petitioner.
Adriana Ruth Teitel, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
On January 29, 2019, Lisa Gilbertson 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 a Tetanus, Diphtheria, acellular Pertussis
(“Tdap”) vaccine administered on February 4, 2016. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On April 13, 2020, a ruling on entitlement was issued, finding Petitioner entitled
to compensation for her SIRVA. On May 5, 2020, Respondent filed a proffer on award
of compensation (“Proffer”) indicating Petitioner should be awarded $165,850.07.
Proffer at 1. In the Proffer, Respondent represented that Petitioner agrees with the
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 1:19-vv-00147-UNJ Document 39 Filed 06/05/20 Page 2 of 4
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 $165,850.07 (representing compensation in the amount of
$162,500.00 for pain and suffering, $1,514.05 for past lost wages, and $1,836.02
for past unreimbursed expenses) 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 1:19-vv-00147-UNJ Document 39 Filed 06/05/20 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
LISA M. GILBERTSON,
Petitioner,
No. 19-147V
v. Chief Special Master Corcoran (SPU)
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RRESPONDENT’S PROFFER ON AWARD OF COMPENSATION
I. Compensation for Vaccine Injury-Related Items
On April 10, 2020, respondent filed a Rule 4(c) Report conceding that petitioner is
entitled to vaccine compensation for her Shoulder Injury Related to Vaccine Administration
(“SIRVA”) injury suffered following receipt of a Tdap vaccination on February 4, 2016. A
Ruling on Entitlement was issued on April 13, 2020.
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$165,850.07.1 This award is comprised of pain and suffering ($162,500.00), past lost wages
($1,514.05), and past unreimbursed expenses ($1,836.02), and represents all elements of
compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a).2 Petitioner
agrees.
1 This proffer does not include any award for attorneys’ fees and costs that may be awarded
pursuant to 42 U.S.C. § 300aa-15(e).
2 Should Petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief.
1

Case 1:19-vv-00147-UNJ Document 39 Filed 06/05/20 Page 4 of 4
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through a lump sum payment of $165,850.07 in the form of a check payable to petitioner.3
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
HEATHER L. PEARLMAN
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: May 5, 2020
3 Petitioner is a competent adult, therefore evidence of guardianship is not required in this case.
2