VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01581
Package ID: USCOURTS-cofc-1_19-vv-01581
Petitioner: Hector Davila-Mayorga
Filed: 2021-04-01
Decided: 2021-09-15
Vaccine: influenza
Vaccination date: 2017-11-28
Condition: adhesive capsulitis and a shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 90000

AI-assisted case summary:
Hector Davila-Mayorga, also known as Ernesto Cervantes, filed a petition for compensation under the National Vaccine Injury Compensation Program alleging that he suffered from adhesive capsulitis and a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccination he received on November 28, 2017. The respondent conceded that Mr. Davila-Mayorga was entitled to compensation, stating that his case met the criteria for SIRVA under the Vaccine Injury Table. Specifically, the respondent noted that there was no prior history of shoulder issues, the onset of pain occurred within 48 hours of vaccination, the pain and reduced range of motion were limited to the vaccinated shoulder, and there was no apparent alternative cause. The respondent further agreed that Mr. Davila-Mayorga experienced residual effects for more than six months, satisfying all legal prerequisites for compensation. Based on the respondent's concession and the evidence, the Special Master ruled on entitlement, finding Mr. Davila-Mayorga entitled to compensation. Subsequently, the parties reached a stipulation for damages. The respondent proffered an award of $90,000.00 for pain and suffering related to the SIRVA, which Mr. Davila-Mayorga agreed to. The Special Master issued a decision awarding this lump sum payment to Mr. Davila-Mayorga.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01581-0
Date issued/filed: 2021-06-10
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 4/1/2021) regarding 32 Ruling on Entitlement. Signed by Special Master Daniel T. Horner. (tkp) Service on parties made.
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Case 1:19-vv-01581-UNJ Document 35 Filed 06/10/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1581V
Filed: April 1, 2021
UNPUBLISHED
HECTOR DAVILA-MAYORGA, also Special Master Daniel Horner
known as ERNESTO CERVANTES
Ruling on Entitlement; Concession;
Petitioner, Causation-In-Fact; Influenza (Flu)
v. vaccine; Shoulder Injury Related to
Vaccine Administration (SIRVA)
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, S.C., Wauwatosa, WI, for petitioner.
Mollie Danielle Gorney, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On October 10, 2019, Hector Davila-Mayorga, also known as Ernesto Cervantes,
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 from adhesive capsulitis and a shoulder injury related to vaccine administration
(“SIRVA”) as a result of an influenza (“flu”) vaccination that he received on November
28, 2017. Petition at 7.
On March 19, 2021, Respondent filed a Rule 4(c) report in which he concedes
that Petitioner is entitled to compensation in this case. Respondent’s Rule 4(c) Report at
7. Specifically, Respondent states that:
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-01581-UNJ Document 35 Filed 06/10/21 Page 2 of 2
[b]ased on the medical records . . . petitioner has satisfied the criteria set
forth in the revised Vaccine Injury Table and the Qualifications and Aids to
Interpretation, which afford petitioners a presumption of causation if there is
no prior history of pain, inflammation, or dysfunction in the affected shoulder
prior to vaccination that would explain the symptoms occurring after
vaccination; the onset of shoulder pain occurs within forty-eight hours after
receipt of an intramuscular seasonal flu vaccination; pain and reduced
range of motion are limited to the shoulder in which the vaccine was given;
and there is no apparent alternative cause”
Id. (citations omitted).
Respondent further agrees that “the medical records demonstrate that petitioner
has experienced the residual effects of his SIRVA for more than six months,” and has
therefore “satisfied all legal prerequisites for compensation under the Act. Case” Id.
(citations omitted).
In view of Respondent’s position and the evidence of record, I find that
Petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Daniel T. Horner
Daniel T. Horner
Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-01581-1
Date issued/filed: 2021-09-15
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 8/2/2021) regarding 38 DECISION Stipulation/Proffer. Signed by Special Master Daniel T. Horner. (tkp) Service on parties made.
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Case 1:19-vv-01581-UNJ Document 42 Filed 09/15/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1581V
Filed: August 2, 2021
UNPUBLISHED
HECTOR DAVILA-MAYORGA a/k/a Special Master Horner
ERNESTO CERVANTES,
Petitioner, Damages Decision Based on Proffer;
v. Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
SECRETARY OF HEALTH AND Administration (SIRVA)
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, S.C., Milwaukee, WI, for petitioner.
Mollie Danielle Gorney, U.S. Department of Justice, Washington, DC, for respondent.
DECISION AWARDING DAMAGES1
On October 10, 2019, Hector Davila-Mayorga, also known as Ernesto, 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”). (ECF No. 1.)
On April 1, 2021, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for his SIRVA. On July 29, 2021, Respondent filed a proffer on award of
compensation (“Proffer”) indicating petitioner should be awarded $90,000.00 for pain
and suffering related to his SIRVA. (ECF No. 37.) In the 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 Proffer.
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.

Case 1:19-vv-01581-UNJ Document 42 Filed 09/15/21 Page 2 of 2
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $90,000.00 for pain and suffering related to his SIRVA 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/Daniel T. Horner
Daniel T. Horner
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