VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-00486
Package ID: USCOURTS-cofc-1_19-vv-00486
Petitioner: Jacquelyn Tracey
Filed: 2019-04-01
Decided: 2020-06-02
Vaccine: influenza
Vaccination date: 2016-09-16
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 60530

AI-assisted case summary:
Jacquelyn Tracey 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 her influenza vaccination on September 16, 2016. The respondent conceded that her injury was consistent with SIRVA and met the requirements of a Table injury claim. The respondent did not identify any other causes for her left arm injury and noted that she suffered the sequelae of this injury for more than six months. Based on the record, the court found that Ms. Tracey was entitled to compensation. Subsequently, the parties submitted a proffer on award of compensation. The respondent proffered that Ms. Tracey should be awarded a lump sum of $60,530.00, consisting of $60,000.00 for pain and suffering and $530.00 for past unreimbursed expenses. Ms. Tracey agreed with this proffered award. The court issued a decision awarding Ms. Tracey the stipulated amount of $60,530.00.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_19-vv-00486-0
Date issued/filed: 2020-05-08
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/06/2020) regarding 22 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-00486-UNJ Document 32 Filed 05/08/20 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-486V
UNPUBLISHED
JACQUELYN TRACEY, Chief Special Master Corcoran
Petitioner, Filed: April 6, 2020
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Influenza (Flu) Vaccine;
Shoulder Injury Related to Vaccine
Respondent. Administration (SIRVA)
Jessica Olins, Maglio Christopher & Toale, PA, Washington, DC, for petitioner.
Darryl R. Wishard, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On April 1, 2019, Jacquelyn Tracey 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 as a result of her September 16, 2016, influenza
(“flu”) vaccination she suffered a Shoulder Injury Related to Vaccine Administration
(“SIRVA”). See Petition. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On April 3, 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 at 1.
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-00486-UNJ Document 32 Filed 05/08/20 Page 2 of 2
Specifically, Respondent indicates that
DICP has reviewed the petition and medical records filed in the case, and
concluded that compensation is appropriate. DICP has concluded that
petitioner’s alleged injury is consistent with SIRVA of the left arm and that
it meets the requirements of a Table injury claim for SIRVA stemming from
the flu vaccination on September 16, 2016. DICP did not identify any other
causes for petitioner’s left arm injury, and records show that she suffered
the sequela of this injury for more than six months. Based on the medical
records outlined above, petitioner has met the statutory requirements for
entitlement to compensation. See 42 U.S.C. § 300aa-13(a)(1)(B); 42
U.S.C. § 300aa-11(c)(1)(D). Therefore, based on the record as it now
stands, petitioner has satisfied all legal prerequisites for compensation
under the Act.
Id. at 5.
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-00486-1
Date issued/filed: 2020-06-02
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 04/30/2020) regarding 26 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-00486-UNJ Document 33 Filed 06/02/20 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-486V
UNPUBLISHED
JACQUELYN TRACEY, Chief Special Master Corcoran
Petitioner, Filed: April 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)
Jessica Olins, Maglio Christopher & Toale, PA, Washington, DC, for petitioner.
Darryl R. Wishard, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
On April 1, 2019, Jacquelyn Tracey 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 Shoulder Injury Related to Vaccine
Administration (“SIRVA”) as a result of her September 16, 2016 influneza (“flu”)
vaccination. See Petition. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On April 6, 2020, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for SIRVA. On April 29, 2020, Respondent filed a proffer on award of
compensation (“Proffer”) indicating Petitioner should be awarded $60,530.00
($60,000.00 for pain/suffering and $530.00 for past unreimbursed expenses) for all
damages. Proffer at 1-2. In the Proffer, Respondent represented that Petitioner agrees
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-00486-UNJ Document 33 Filed 06/02/20 Page 2 of 4
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 $60,530.00 ($60,000.00 for pain/suffering and $530.00 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-00486-UNJ Document 33 Filed 06/02/20 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
___________________________________
)
JACQUELYN TRACEY, )
)
Petitioner, ) No. 19-486V ECF
)
v. ) Chief Special Master Corcoran
)
SECRETARY OF HEALTH )
AND HUMAN SERVICES, )
)
Respondent. )
___________________________________ )
PROFFER ON AWARD OF COMPENSATION1
I. Procedural History
On April 1, 2019, Jacquelyn Tracey (“petitioner”) filed a petition for compensation
(“petition”) under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -
34, as amended. She alleges that, as a result of receiving the influenza (“flu”) vaccine on
September 16, 2016, she suffered from a left shoulder injury related to vaccine administration
(“SIRVA”). See Petition. On April 3, 2020, respondent filed his Vaccine Rule 4(c) report,
conceding a Table injury for SIRVA. On April 6, 2020, Chief Special Master Corcoran issued a
ruling on entitlement, finding that petitioner was entitled to compensation for SIRVA.
II. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
a lump sum of $60,530.00 ($60,000.00 for pain/suffering and $530.00 for past unreimbursed
expenses) for all damages. This amount represents all elements of compensation to which
1 This Proffer does not include attorneys’ fees and costs, which the parties intend to
address after the Damages Decision is issued.

Case 1:19-vv-00486-UNJ Document 33 Filed 06/02/20 Page 4 of 4
petitioner is entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
III. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through a lump sum payment of $60,530.00.00, in the form of a check payable to petitioner.2
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/Darryl R. Wishard
DARRYL R. WISHARD
Senior Trial Attorney
Torts Branch, Civil Division
U. S. Department of Justice
P.O. Box l46, Benjamin Franklin Station
Washington, D.C. 20044-0146
Direct dial: (202) 616-4357
Dated: April 29, 2020 Fax: (202) 616-4310
2 Should petitioner die prior to entry of judgment, respondent would oppose any award
for future medical expenses, future lost earnings, and future pain and suffering, and the parties
reserve the right to move the Court for appropriate relief.
2