VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01683
Package ID: USCOURTS-cofc-1_19-vv-01683
Petitioner: Hanna Reynolds
Filed: 2019-10-30
Decided: 2024-08-12
Vaccine: influenza
Vaccination date: 2018-10-28
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 112647

AI-assisted case summary:
Hanna Reynolds, an adult, received an influenza vaccine on October 28, 2018. She alleged that she suffered a left shoulder injury related to vaccine administration (SIRVA) as a result of this vaccination. The medical records indicated that she experienced immediate pain upon receiving the shot, which continued and worsened over the following weeks. She sought medical attention approximately two months later, reporting pain and limited range of motion in her left shoulder. The injury was diagnosed as SIRVA, and she underwent extensive treatment including physical therapy, pain medication, and ultimately arthroscopic surgery on her left shoulder. The respondent initially contested the onset date, arguing that the two-month delay in seeking treatment and inconsistencies in reported dates meant the injury did not occur within the 48-hour window required for a Table SIRVA claim. However, the court found that the petitioner consistently linked her pain to the flu shot and that the evidence, including her own declarations and medical records, preponderantly supported an onset of pain immediately following vaccination. The court granted her motion for a ruling on entitlement, finding she met the criteria for a Table SIRVA. Subsequently, the court awarded Hanna Reynolds $110,000.00 for pain and suffering and $2,647.14 for unreimbursable expenses, for a total award of $112,647.14.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01683-0
Date issued/filed: 2023-05-30
Pages: 14
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/28/2023) regarding 39 Ruling on Entitlement, Order on Motion for Ruling on the Record. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 1 of 14
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1683V
UNPUBLISHED
HANNA REYNOLDS, Chief Special Master Corcoran
Petitioner, Filed: April 28, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on the Record; Ruling on
HUMAN SERVICES, Entitlement; Table Injury; Findings of
Fact; Onset; Influenza (Flu) Vaccine;
Respondent. Shoulder Injury Related to Vaccine
Administration (SIRVA)
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On October 30, 2019, Hanna Reynolds 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 left shoulder injury related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine received on October
28, 2018. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
1 Because this Ruling contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C.
§ 300aa (2018).

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 2 of 14
For the reasons discussed below, I find the onset of Petitioner’s SIRVA occurred
within the time set forth in the Table for a SIRVA, and that Petitioner is otherwise entitled
to compensation.
I. Relevant Procedural History
The case was activated on November 13, 2019 (ECF No. 7). On February 2, 2021,
Respondent indicated that he was willing to engage in settlement discussions (ECF No.
19), and the parties engaged in negotiations. However, on August 24, 2021, Petitioner
reported that they had reached an impasse (ECF No. 28). Respondent filed an amended
Rule 4(c) Report on October 18, 2021 (ECF No. 31), and the parties again attempted
negotiations, without success (ECF No. 33).
On January 5, 2022, Petitioner filed a motion for a ruling on the record (ECF No.
36). Respondent responded on February 3, 2022 (ECF No. 37), and Petitioner replied on
February 9, 2022 (ECF NO. 38). The issue of Petitioner’s entitlement to compensation is
now ripe for resolution.
II. Factual Findings and Ruling on Entitlement
A. Legal Standards
Before compensation can be awarded under the Vaccine Act, a petitioner must
demonstrate, by a preponderance of evidence, all matters required under Section
11(c)(1), including the factual circumstances surrounding the claim. Section 13(a)(1)(A).
In making this determination, the special master or court should consider the record as a
whole. Section 13(a)(1). Petitioner’s allegations must be supported by medical records or
by medical opinion. Id.
To resolve factual issues, the special master must weigh the evidence presented,
which may include contemporaneous medical records and testimony. See Burns v. Sec'y
of Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (explaining that a special
master must decide what weight to give evidence including oral testimony and
contemporaneous medical records). “Medical records, in general, warrant consideration
as trustworthy evidence. The records contain information supplied to or by health
professionals to facilitate diagnosis and treatment of medical conditions. With proper
treatment hanging in the balance, accuracy has an extra premium. These records are
also generally contemporaneous to the medical events.” Cucuras v. Sec’y of Health &
Human Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
2

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 3 of 14
To overcome the presumptive accuracy of medical records testimony, a petitioner
may present testimony which is “consistent, clear, cogent, and compelling.” Sanchez v.
Sec'y of Health & Human Servs., No. 11–685V, 2013 WL 1880825, at *3 (Fed. Cl. Spec.
Mstr. Apr. 10, 2013) (citing Blutstein v. Sec'y of Health & Human Servs., No. 90–2808V,
1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The Federal Circuit has
“reject[ed] as incorrect the presumption that medical records are accurate and complete
as to all the patient’s physical conditions.” Kirby v. Sec’y of Health & Human Servs., 997
F.3d 1378, 1383 (Fed. Cir. 2021) (explaining that a patient may not report every ailment,
or a physician may enter information incorrectly or not record everything he or she
observes).
In addition to requirements concerning the vaccination received, the duration and
severity of petitioner’s injury, and the lack of other award or settlement,3 a petitioner must
establish that he or she suffered an injury meeting the Table criteria, in which case
causation is presumed, or an injury shown to be caused-in-fact by the vaccination
received. Section 11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria
establishing a SIRVA under the accompanying Qualifications and Aids to Interpretation
(“QAI”) are as follows:
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
3 In summary, a petitioner must establish receipt of a vaccine covered by the Program, administered either
in the United States and its territories, or in another geographical area but qualifying for a limited exception;
that residual effects of the injury continued for more than six months (or meet the severity requirement in
other ways not applicable in this case); and no civil suit has been filed and no award or settlement has
been collected for the injury. See Section 11(c)(1)(A)(B)(D)(E).
3

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 4 of 14
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10) (2017).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
B. Relevant Factual History
The only factual issue disputed by the parties is whether Petitioner’s left shoulder
pain began within 48 hours of vaccine administration.
1. Medical Records
On October 28, 2018,4 Petitioner received a flu vaccine intramuscularly in her left
arm at a Publix Pharmacy. Ex. 2 at 1.
Two months later, on December 27, 2018, Petitioner reported to Dr. Marc
Hammerman of the Broward Institute of Orthopaedic Specialties, LLC. Ex. 3 at 8. This
record documented that Petitioner had reported left shoulder pain “since she had a flu
4 While the record indicates that the flu vaccine was given on October 28, 2018, Petitioner erroneously
dated the form 10/27/18. Ex. 2 at 1.
4

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 5 of 14
shot on 5/30/18.”5 Id. Dr. Hammerman assessed Petitioner with pain of the left shoulder
joint on movement, adding, “[r]otator cuff tendinitis but with the patient having the pain
correlating to the time when she had her flu injection in the area of the proximal deltoid.”
Id. at 9. A form completed the same day indicated that Petitioner sought care for “pain
after flu shot.” Id. at 12. A questionnaire completed on the same date has a "Date of
Injury,” of either 5/30/2018 or 9/30/2018.6 Id. at 14. Underneath that date in what appears
to be a different person’s handwriting are the words “since flu shot.” Id.
On January 28, 2019, Petitioner returned to Dr. Hammerman to follow up
concerning “LEFT shoulder complaints and upper extremity complaints after having the
flu injection.” Ex. 3 at 6. Dr. Hammerman again assessed Petitioner with left shoulder pain
“correlating to the time when she had her flu injection in the area of the proximal deltoid.”
Id.
On February 18, 2019, Petitioner underwent a left shoulder MRI. The clinical
indication for the MRI states, “[e]valuate left shoulder pain. Evaluate rotator cuff tendinitis.
Pain and decreased range of motion for five months” (which would place onset in
September 2018). Ex. 4 at 1. On the intake form, Petitioner stated she sought care for
her shoulder injury due to “left shoulder and upper arm pain after a flu shot.” Id. at 7. In
response to a question about what caused her problem, she answered “flu shot.” Id.
Finally, the form inquired when her symptoms began, and Petitioner responded, “when I
received a flu shot in Sep 2018.”7 Id.
Petitioner underwent a physical therapy evaluation on March 5, 2019. Ex. 5 at 5.
The record includes an injury date of 11/14/2018 and indicates that the injury occurred
four months earlier when Petitioner “had a flu shot and it aggravated her shoulder. pain
never went away.” Id. Petitioner saw Dr. Hammerman for additional follow up visits on
February 25, April 18, and June 24, 2019. Ex. 3 at 1-4; Ex. 6 at 1-2.
After another treatment gap, Petitioner established care with Dr. Nancy Pyram-
Bernard in August 2019, and underwent an annual physical examination. Ex. 14 at 9.
She now reported a history of left shoulder pain for 11 months (which would put onset in
September 2018). Id. Petitioner also reported that “last year she received a flu shot from
publix where they hit a ligament in her left shoulder, that caused pain. she continued to
5 There is no record of a flu shot on May 30, 2018, and neither party has asserted that she received a flu
shot on that date.
6 Dr. Hammerman’s office appears to have interpreted this as 5/30/2018. Ex. 3 at 8.
7 There is no record indicating that Petitioner received a flu shot in September 2018, and neither party has
asserted that she did.
5

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 6 of 14
have pain for 2 months after the injection and went to an orthopedic surgeon who noted
that she had a 50% tear in her ligament.” Id. Petitioner was scheduled for surgery in
October 2019. Id.
On September 25, 2019, Petitioner was seen by Dr. Pyram-Bernard for a pre-
operative appointment. Ex. 14 at 14. She was cleared for surgery. Id. at 15.
On October 16, 2019, Petitioner underwent left shoulder surgery. Ex. 9 at 14. She
was seen for post operative orthopedic appointments on October 17, October 21,
November 11, and November 25, 2019. Ex. 9 at 5-10; Ex. 10 at 34-37.
Petitioner reported for a physical therapy evaluation on November 26, 2019. Ex.
11 at 2. The record now notes (for the first time in the records overall) an injury date of
October 30, 2018 and states, “[p]atient reports that she got a flu shot in 10/18 which
resulted in pain in the left shoulder. Patient went to doctor following the flu shot and tried
anti-inflammatory medication with no results.” Id. This treatment visit occurred after the
case’s initiation.
Petitioner was seen by Dr. Hammerman on December 26, 2019 and January 27
and February 17, 2020. Ex. 10 at 26-33. She returned to Dr. Hammerman nearly a year
later, on February 4, 2021. Ex. 18 at 17-18. At the February 4, 2021 appointment, she
reported some pain. Id. Dr. Hammerman noted that she had been swimming and that it
“may be an overuse syndrome.” Id. She was also experiencing some problems with her
right arm. Id. On examination, her left shoulder range of motion was described as “quite
satisfactory,” with 170 degrees of abduction and forward flexion. Id. She was assessed
with tendinitis of the left rotator cuff and advised to modify activities. Id.
2. Declarations
Petitioner submitted four declarations in support of her claim, two on her own
behalf, one from her daughter, and one from a colleague.
Petitioner averred that when she received the flu shot on October 28, 2018, she
felt immediate pain that “was so intense that I remember screaming out loud.” Ex. 1 at
¶ 6. Petitioner explained that she took ibuprofen to help with the pain. Id. She did not
immediately seek medical care because she “kept thinking that my pain would go away
on its own.” Id. at ¶ 7. With respect to the December 27, 2018 record of her appointment
with Dr. Hammerman, she explained that she “filled out a questionnaire explaining that
the onset of my pain was after I got the flu shot. I accidentally mixed up the date that I got
the flu shot on the questionnaire but am certain that my pain started from the shot.” Id. at
¶ 9.
6

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 7 of 14
In her supplemental declaration, Petitioner explained that she “yelled out loud from
the pain” as the shot was administered. Ex. 19 at ¶ 3. When she got home, she told her
daughter about the pain. Id. at ¶ 4. She explained that she does not like to take pain
medication, but took ibuprofen for pain that night. Id. Before this injury, she was “healthy
and rarely saw doctors,” and put off going to a doctor because she expected the pain to
resolve on its own. Id. at ¶ 6. However, rather than improving, her shoulder pain
worsened. Id. at ¶ 7. The pain interfered with daily chores like lifting things or driving. Id.
She asked her daughter and husband for help when cooking for Thanksgiving. Id.
Petitioner states that her insurance company’s nurse line advised her to see an
orthopedist. Ex. 19 at ¶ 9. She called four orthopedist offices before scheduling an
appointment with Dr. Hammerman. Id. at ¶ 10.
Petitioner’s daughter, Alicia Reynolds, averred that one afternoon in October 2018
Petitioner came home complaining about a flu shot she had just received at a Publix
pharmacy. Ex. 16. Petitioner’s daughter explained that Petitioner told her that “she
screamed while she was getting the shot because it felt like it was jabbed into her shoulder
with a lot of force. Her left shoulder was still hurting her.” Id. at ¶ 7. Petitioner’s daughter
explained that Petitioner’s shoulder pain worsened over the following weeks and months,
and that Petitioner had difficulty with activities such as driving, getting dressed, and
carrying things. Id. at ¶¶ 10-14.
Jennifer Aleman, a co-worker of Petitioner’s, stated that in October 2018, Petitioner
told her that she was planning to get a flu shot at Publix due to a gift card promotion. Ex.
17 at ¶¶ 7-8. Ms. Aleman stated that she saw Petitioner the following workday after she
received the flu shot, and Petitioner told her that her shoulder “really hurt” and she was
worried that it was caused by the flu shot. Id. at ¶ 9.
C. The Parties’ Arguments
Petitioner asserts that the record supports a finding that her pain began
immediately after receiving the flu vaccine. Petitioner’s Motion for Ruling on Entitlement
(“Mot.”) at 8. She relies on the December 27, 2018 appointment with Dr. Hammerman
reporting left shoulder pain since her flu shot and noting pain correlating to the time of the
flu injection, in addition to other records noting shoulder pain after her flu shot and that
her symptoms began after her flu shot. Id. at 9-10. Petitioner asserts:
Whenever Petitioner complained about her left shoulder pain she
consistently linked it to stemming from her flu vaccination. Petitioner told all
of her medical providers that the pain had been ongoing since the flu
7

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 8 of 14
vaccination. Petitioner explained that she had immediate pain from the
vaccination that continued to worsen. Even though Petitioner occasionally
misstated the actual date of vaccination, she was consistent in placing onset
on the day she received her flu vaccination.
Mot. at 10.
Petitioner argues that in addition to her own declarations, declarations from two
other witnesses support a finding that the onset of her shoulder pain was immediate. She
asserts that declarations submitted by her daughter and colleague indicate that they recall
her complaining of her left shoulder “within days if not hours after receiving her flu
vaccination.” Mot. at 11.
Petitioner argues that she meets the remaining SIRVA Table requirements as well.
Mot. at 14-15. She asserts that she did not have a history of pain, inflammation, or
dysfunction of her left shoulder prior to receiving the October 28, 2018 flu vaccine. Id. at
14. She argues that there is no evidence that her symptoms expanded beyond her left
shoulder where the vaccine was administered, and she never exhibited any symptoms
that would cause her providers to believe she was suffering from another condition or
abnormality that would explain her symptoms. Id. at 15. Thus, Petitioner believes she is
entitled to compensation.
Respondent argues that the record does not establish that Petitioner suffered the
first symptom or manifestation of onset of her injury within 48 hours of vaccine
administration, and thus she is not entitled to compensation. Respondent’s Response in
Opposition (“Opp.”) at 1. Respondent asserts that Petitioner did not seek treatment for
her left shoulder until two months after vaccination, which Respondent infers “suggests
that petitioner did not experience immediate, severe post-vaccination shoulder pain.” Id.
at 2. Respondent further emphasizes that when Petitioner did seek care, she
inconsistently reported the date of onset. Id.
Respondent further argues that although Petitioner’s medical records relate onset
to her flu vaccination, the records place onset at variable times: five months before
vaccination, one month prior to vaccination, as well as two weeks after vaccination. Opp.
at 3. And Respondent disputes Petitioner’s claim that she was consistent in placing onset
on the day of vaccination. Id. Instead, Respondent asserts that the records “merely
document petitioner’s own recollection that her pain began sometime after vaccination,”
thus not preponderantly showing a 48-hour onset. Id. Respondent further suggests that
a notation stating that the vaccine had “aggravated” her shoulder could suggest a
preexisting injury. Id. at n. 4 (citing Ex. 5 at 5).
8

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 9 of 14
Respondent asserts that Petitioner’s witness declarations asserting that she
suffered immediate pain are “difficult to square with her decisions to forego care” until two
months after vaccination. Opp. at 4. Respondent discounts the declarations submitted
from Petitioner’s daughter and coworker because they were executed nearly two and a
half years after vaccination and, in Respondent’s view, are not corroborated by records.
Id.
Petitioner replies that Respondent fails to look at the record as a whole. Petitioner’s
Reply (“Reply”) at 1. Petitioner asserts that the inconsistencies in the records occurred
because Petitioner provided an incorrect approximate date of vaccination. Id. Petitioner
maintains that despite this error, she “always made it clear that her symptoms were
caused by the vaccination.” Id.
Petitioner asserts that the introductory questionnaire she filled out at her first
appointment after vaccination was incorrectly transcribed, and that Petitioner reported the
date of injury as 9/30/2018, but the transcriber misread the “9” as a “5.” Reply at 3.
Petitioner cites other handwritten “5s” in the record. Id. Petitioner adds that she “made a
point to write ‘since flu shot’ after the date” on the record, but provided an approximate
date of vaccination that incorrectly placed the date one month before vaccination. Id.
Petitioner asserts that “it is clear she did not write that the onset of her injury was in May
2018.” Id.
Petitioner relies on the Federal Circuit’s recognition in Kirby, 997 F.3d at 1383, that
medical records are not always accurate and complete. Reply at 1-2. Petitioner argues:
By focusing on these inaccuracies in the medical record (that all most likely
stemmed from Petitioner incorrectly approximating the date of her flu
vaccination), Respondent ignores the totality of the medical records that
clearly places onset within 48 hours of vaccination. Petitioner always linked
her left shoulder injury from the flu vaccination to all of her medical
providers.
Reply at 4.
D. Factual Finding Regarding QAI Criteria for Table SIRVA
Respondent objects only to the second SIRVA QAI requirement, arguing that there
is not preponderant evidence that the onset of Petitioner’s alleged SIRVA occurred within
48 hours, the time set forth in the Table. The other SIRVA QAI criteria are uncontested.
9

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 10 of 14
1. Onset
As a threshold consideration, I note that Respondent’s suggestion that a two month
delay in seeking treatment undercuts a favorable onset determination is unpersuasive.
Given the nature of SIRVA injuries, some delays in treatment are common in Program
cases. Winkle v. Sec’y of Health & Human Servs., No. 20-485V, 2021 WL 2808993, at *4
(Fed. Cl. Spec. Mstr. June 3, 2021) (“[i]t is common for a SIRVA petitioner to delay
treatment, thinking his/her injury will resolve on its own” and finding that the onset of the
petitioner’s pain occurred within 48 hours of vaccination in spite of a five month delay in
seeking treatment). And treatment gaps otherwise more commonly go to the severity of
the injury, and thus impact damages. See Miller v. Sec’y of Health & Human Servs., No.
20-604V, 2022 WL 3641716 (Fed. Cl. Spec. Mstr. July 22, 2022) (rejecting Respondent’s
argument that a petitioner could not establish onset due to a 71 day delay in seeking
treatment, coupled with a record suggesting that her pain began slightly before the date
of vaccination, in light of other evidence placing onset after vaccination). Whether Table
onset is met requires consideration of what records support that issue – not (in most
cases) when they were created.8
There are also issues about mistakes in the record regarding fundamental issues
like the date of vaccination, which in turn impact the onset issue. A petitioner’s errors or
inconsistencies in reporting the onset of his or her symptoms are relevant evidence, but
do not by themselves defeat a finding of onset within 48 hours. See Miller, 2022 WL
3641716, at *3 (finding onset despite record suggesting onset occurred prior to
vaccination, where other records clarified that the onset of pain occurred after
vaccination). At bottom, the fact that medical records do not reflect a precise date of onset
does not undercut a finding of onset within 48 hours, based upon the totality of the
evidence. Welch v. Sec’y of Health & Human Servs., No. 18-660V, 2020 WL 7483129, at
*6 (Fed Cl. Spec. Mstr. Nov. 18, 2020).
Respondent asserts that this case is distinguishable from Welch because in that
case I indicated that there was “no counterevidence undercutting Petitioner’s contention
that her pain began close-in-time to vaccination,” while in this case Respondent asserts
there is such evidence undercutting Petitioner’s claim, e.g., the medical records
suggesting varying dates of onset. However, the Vaccine Act contemplates this precise
situation, and allows me to find onset within the Table period despite having to weigh
contrary evidence. Section 13(b)(2).
8 Of course, the longer a claimant avoids treatment, the more attenuated the argument that SIRVA pain
was immediate; a six month or one-year gap is facially more difficult to overcome. But a short gap does not
operate as a per se rebuttal of onset.
10

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I also reject Respondent’s suggestion that a record indicating that the flu shot
aggravated Petitioner’s shoulder means that the vaccination aggravated a pre-existing
injury. The mere use of the term “aggravated,” with no other evidence of a pre-existing
shoulder injury, is not convincing. Indeed, while one definition of aggravate is “to make
worse, more serious, or more severe,” another is “to produce inflammation in.” Merriam-
Webster Online Dictionary, https://www.merriam-webster.com/dictionary/aggravate (last
visited Apr. 28, 2023).
The medical records in this case admittedly include a variety of different potential
dates for the onset of Petitioner’s shoulder pain: May 30, 2018,9 September 2018,10
October 30, 2018,11 early November 2018,12 and November 14, 2018.13 This makes
determining the onset of Petitioner’s pain challenging. The onset question is further
complicated by the fact that the medical records closest in time to Petitioner’s vaccination
and initial treatment support an onset date prior to vaccination. The first medical record
in which Petitioner reported that she received the flu shot and her pain began in October
2018 was over a year after vaccination, in November 2019 (and because it was generated
after the case’s initiation, it is reasonably given less weight).
However, despite these contradictions, Petitioner was consistent in relating the
pain to the receipt of her flu shot, and she repeatedly reported that her pain had continued
since her flu shot. The medical records thus record that she had pain “since a flu shot,”14
“pain correlating to the time when she had her flu injection in the area of her proximal
deltoid,”15 “pain after flu shot,”16 pain “since flu shot,”17 “LEFT shoulder complaints and
9 Ex. 3 at 8 (December 27, 2018 appointment with orthopedist Dr. Hammerman indicating that Petitioner
presented with “pain involving her LEFT shoulder since she had a flu shot on 5/30/18”).
10 Ex. 4 at 1, 7 (February 18, 2019 record indicating that pain and decreased range of motion had been
present for five months); Ex. 14 at 9 (August 23, 2019 record of Dr. Pyram-Bernard documenting shoulder
pain for 11 months).
11 Ex. 11 at 2 .(November 26, 2019 physical therapy evaluation listing an injury date of October 30, 2018).
12 Ex. 5 at 5 (March 5, 2019 physical therapy evaluation indicating that the injury occurred four months
earlier).
13 Ex. 5 at 5 (listing an injury date of 11/14/2018 at top of form).
14 Ex. 3 at 8 (December 27, 2018 appointment with Dr. Hammerman documenting pain “since she had a flu
shot”).
15 Ex. 3 at 9 (December 27, 2018 Dr. Hammerman record).
16 Ex. 3 at 12 (December 27, 2018 Dr. Hammerman record).
17 Ex. 3 at 14 (December 27, 2018 Dr. Hammerman record).
11

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upper extremity complaints after having the flu injection,”18 “left shoulder and upper arm
pain after a flu shot . . . . [symptoms began] when I received a flu shot in Sep 2018,”19 she
“had a flu shot and it aggravated her shoulder,”20 “last year she received a flu shot from
publix where they hit a ligament in her left shoulder, that caused pain,”21 “[p]atient reports
that she got a flu shot in 10/18 which resulted in pain in the left shoulder.”22 Several of
these records were the product, moreover, of treatment events from the fall of 2018.
Some records support an onset in May or September of 2018, which would predate
vaccination entirely. But they too relate the onset of Petitioner’s pain to a flu shot that she
unquestionably had not received at those times. Thus, the overall record establishes that
Petitioner consistently related her pain to her flu shot, but displayed a poor memory for
dates, resulting in several inaccurate onset dates being reflected in her medical records.
I thus find that the medical records establish at least two fundamental points:
Petitioner (1) received a flu vaccine on October 28, 2018, and (2) subsequently and
repeatedly sought medical treatment for shoulder pain since her flu vaccination. “Since”
is defined as “from a definite past time until now.” Merriam-Webster Online Dictionary,
https://www.merriam-webster.com/dictionary/since (last visited Apr. 28, 2023). Therefore,
the medical records support a finding that Petitioner experienced shoulder pain from the
date of her flu vaccine – October 28, 2018 – and continued at least until her December
27, 2018 appointment with Dr. Hammerman (Ex. 3 at 8-9).
Admittedly, the same records containing varying potential onset dates are
troubling. Nonetheless, the Vaccine Act contemplates that records may not be accurate
as to onset, and allow me to find, by a preponderance of the evidence, that the onset of
an injury occurred within the time set forth in the Table even if it was incorrectly recorded
as having occurred outside that timeframe. Section 13(b)(2). “The preponderance of
evidence standard is often described as 50 percent plus a feather.” K.A. v. Sec’y of Health
& Human Servs., 164 Fed. Cl. 98, 127 (2022) (citing Torday v. Sec’y of Health & Human
Servs., No. 07-372V, 2009 WL 5196163 (Fed. Cl. Spec. Mstr. Dec. 10, 2009)). This is a
quintessential “close case,” and it should be decided for Petitioner given the weight of
evidence even if Respondent reasonably observed that (due to repeated mistakes about
18 Ex. 3 at 6 (January 28, 2019 appointment with Dr Hammerman).
19 Ex. 4 at 7 (February 2019 MRI patient questionnaire form).
20 Ex. 5 at 5 (March 5, 2019 physical therapy evaluation).
21 Ex. 14 at 9 (August 23, 2019 Dr. Pyram-Bernard record).
22 Ex. 11 at 2 (November 26, 2019 physical therapy evaluation).
12

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 13 of 14
the date of vaccination) onset was misreported on several occasions (although always
with respect to the flu shot occurring first).
My determination is strengthened by the declarations Petitioner submits. They are
consistent with the conclusion that her shoulder pain began immediately following the
administration of her flu vaccine on October 28, 2018. I do not rely solely on these
declarations, but they are not rebutted by the medical evidence, and bulwark overall
Petitioner’s onset claim.
The fact that the delay in seeking treatment was only two months – which is not
immediate, but not atypical in a SIRVA case23 – and that Petitioner was consistent in
relating her symptoms to her flu vaccine is, in my view, the tiniest feather, sufficient to tip
the balance. I find that a preponderance of the evidence supports a finding that
Petitioner’s left shoulder pain began immediately following the administration of the flu
vaccine on October 28, 2018.
2. Other SIRVA QAI Criteria
With respect to the remaining SIRVA QAI criteria, which are uncontested, the
record contains sufficient evidence showing they are satisfied in this case. See 42 C.F.R.
§ 100.3(c)(10)(i) & (iii)-(iv). A thorough review of the record in this case does not reveal
either a prior or other condition or abnormality that would explain Petitioner’s symptoms,
or pain or limited ROM other than in her left shoulder. Exs. 3, 7, 8, 14. Thus, all elements
of a Table SIRVA claim have been preponderantly established.
E. Other Requirements for Entitlement
Because Petitioner has satisfied the requirements of a Table SIRVA, she need not
prove causation. Section 11(c)(1)(C). However, she must satisfy the other requirements
of Section 11(c) regarding the vaccination received, the duration and severity of the injury,
and the lack of other award or settlement. Section 11(c)(A), (B), and (D). Respondent
does not dispute that Petitioner has satisfied these requirements in this case, and the
overall record contains preponderant evidence which fulfills these additional
requirements. Exs. 1, 2, 6, 9.
23 See, e.g., Miller, 2022 WL 3641716, and Winkle, 2021 WL 2808993, discussed infra.
13

Case 1:19-vv-01683-UNJ Document 41 Filed 05/30/23 Page 14 of 14
Conclusion
Based on my review of the record as a whole, I find that it is more likely than not
that the onset of Petitioner’s shoulder pain occurred immediately upon vaccination. I find
that all other SIRVA Table requirements are met, as are other requirements for
entitlement. Therefore, Petitioner’s motion for a ruling on the record that she is entitled to
compensation is GRANTED.
In view of the face ruling herein 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
14

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_19-vv-01683-1
Date issued/filed: 2024-08-12
Pages: 13
Docket text: PUBLIC DECISION (Originally filed: 07/11/2024) regarding 49 DECISION of Special Master. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
--------------------------------------------------------------------------------
Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1683V
HANNA REYNOLDS, Chief Special Master Corcoran
Petitioner, Filed: July 11, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On October 30, 2019, Hanna Reynolds 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 alleged that that she suffered a left shoulder injury related to
vaccine administration (“SIRVA”) as a result of an influenza (“flu”) vaccine received on
October 28, 2018. The case was assigned to the Special Processing Unit of the Office of
Special Masters (the “SPU”).
For the reasons set forth below, I find that Petitioner is entitled to a damages award
of $110,000.00 for actual pain and suffering, plus $2,647.14 in actual
unreimbursable expenses.
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website , and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C.
§ 300aa (2018).

Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 2 of 13
I. Relevant Procedural History
The case was activated on November 13, 2019 (ECF No. 7). On February 2, 2021,
Respondent indicated that he was willing to engage in settlement discussions (ECF No.
19). The parties negotiated for six months, but reached an impasse (ECF No. 28). After
Respondent filed his Rule 4(c) Report, which he later amended, the parties again
attempted negotiations, without success (ECF Nos. 29-33).
After briefing, I ruled that Petitioner was entitled to compensation on April 28, 2023
(ECF No. 39). The parties then attempted to negotiate damages, but again reached an
impasse (ECF Nos. 42-44). The parties have now briefed damages (ECF Nos. 45, 46,
48). The matter is ripe for resolution.
II. Relevant Medical History
On October 28, 2018,3 Petitioner received a flu vaccine intramuscularly in her left
arm at a Publix Pharmacy. Ex. 2 at 1.
Two months later, on December 27, 2018, Petitioner reported to Dr. Marc
Hammerman of the Broward Institute of Orthopaedic Specialties, LLC for left shoulder
pain after her flu vaccination. Ex. 3 at 8. She reported pain levels ranging from five to
seven out of ten depending on activities. Id. Her pain limited her motion and interfered
with her work activities as an accountant. Id. It also severely restricted her sports
activities. Id. On examination, she had full passive range of motion (“ROM”) but painful
active ROM. Dr. Hammerman assessed Petitioner with pain of the left shoulder joint on
movement and tendonitis of the left rotator cuff. Id. at 9.
On January 28, 2019, Petitioner returned to Dr. Hammerman. Ex. 3 at 6. Her left
shoulder pain was slightly better, but she still experienced discomfort, especially at
nighttime. Id. Her active ROM continued to be painful. Id. Dr. Hammerman prescribed a
Medrol dosepak, instructing Petitioner to take Zantac as well for gastrointestinal side
effects from Medrol. Id. If her pain continued, he planned to order an MRI. Id.
Three weeks later (February 18, 2019), Petitioner underwent a left shoulder MRI.
Ex. 4 at 1. The MRI showed a moderate degree of rotator cuff tendinosis with low grade
partial thickness tearing involving the supraspinatus tendon, mild infraspinatus and
subscapularis tendinosis, moderate biceps tendinosis, mild subdeltoid bursitis,
3 While the record indicates that the flu vaccine was given on October 28, 2018, Petitioner erroneously
dated the form October 27th (instead of the 28th). Ex. 2 at 1.
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Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 3 of 13
degenerative changes with edema, mild labral blunting and fraying, and small joint
effusion. Id. at 1-2.
Petitioner saw Dr. Hammerman to review the MRI on February 25, 2019. Ex. 3 at
3. She stated that in the morning her pain ranged from one to four out of ten, but as the
day progressed her pain increased to six to eight out of ten. Id. Her pain was not affecting
her work activities any longer. Id. On examination, she displayed “satisfactory” shoulder
ROM, but “obvious pain” with abduction and internal rotation. Id. During the examination,
her pain ranged from one to three out of ten. Id. Dr. Hammerman assessed her with a
partial rotator cuff tear, and prescribed Mobic and physical therapy (“PT”). Id. at 4.
Petitioner underwent a PT evaluation on March 5, 2019. Ex. 5 at 5. She reported
a current pain level of two out of ten, ranging to eight out of ten at worst. Id. On
examination, her left shoulder active ROM was reduced compared to her right shoulder.
Id. at 6. A treatment plan of three visits a week for four weeks was established. Id. at 7.
Petitioner returned to Dr. Hammerman on April 18, 2019. Ex. 3 at 1. She had seen
improvement in strength after six weeks of PT, but was still in pain, especially with activity
during the daytime. Id. Her left shoulder ROM was 170 degrees in abduction and forward
flexion, with a pain level of five out of ten. Id. Dr. Hammerman recommended that she
continue working on her home exercise program and return as needed. Id.
Petitioner attended a total of 12 PT sessions between March 5 and May 10, 2019.
Ex. 5 at 5-45. By March 17th, her pain had decreased to three to six out of ten, and she
had slight improvements in her left shoulder active ROM. Id. at 19-20. However, by April
5th, her pain had worsened, now ranging from five to eight out of ten, with no further
improvements in ROM. Id. at 36. At her discharge on May 10th, her pain level remained
between five and eight out of ten. Id. at 45.
Petitioner told Dr. Hammerman on June 24, 2019 that PT had helped with her
strength and motion, but pain was impacting her quality of life and she was considering
surgery. Ex. 6 at 1. She described her pain as three out of ten. Id. On examination, she
had satisfactory ROM, but pain with abduction and internal rotation, and tenderness in
the subacromial area. Id. Dr. Hammerman and Petitioner reviewed the risks and benefits
of surgery, with Petitioner deciding to take time to contemplate her choices. Id. at 1-2.
Petitioner established care with Dr. Nancy Pyram-Bernard in August 2019, and
underwent an annual physical examination. Ex. 14 at 9. Petitioner complained of left
shoulder pain, explaining that she had been in constant pain for 11 months and that it
was “very disruptive and bothersome.” Id. The pain was aggravated by movement and
relieved by rest. Id. She was scheduled for surgery in October 2019 and wanted to make
3

Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 4 of 13
sure she was healthy. Id. Petitioner had pre-operative appointments with Dr. Pyram-
Bernard and Dr. Hammerman in September and October 2019. Ex. 14 at 14; Ex. 9 at 11.
On October 16, 2019, Petitioner underwent left shoulder surgery. Ex. 9 at 14. Dr.
Hammerman repaired superficial tearing of her supraspinatus tendon and performed a
left shoulder arthroscopy with debridement of the labrum, acromioplasty, resection of the
distal clavicle, and release of residual biceps tendon and biceps tenodesis. Id.
Petitioner saw Dr. Hammerman for a post operative evaluation the day after her
surgery. Ex. 9 at 9. She had postoperative pain as expected, and was advised to continue
working on passive ROM. Id. Four days later (October 21, 2019), Petitioner saw Dr.
Hammerman’s physician assistant Katherine Wintle, reporting difficulty tolerating
exercises over the weekend, with significant pain. Id. at 7. Petitioner’s incisions were
healing well, and passive ROM was “performed relatively easily.” Id. Petitioner saw Dr.
Hammerman again on October 25, 2019. Id. at 5.
On November 11, 2019, Petitioner saw Dr. Hammerman for a follow up. Ex. 10 at
36. Petitioner had continued working on passive ROM and was doing well, but noted
some increased pain over the past weekend. Id. Two weeks later (November 25, 2019),
Dr. Hammerman noted that Petitioner was doing well and working on passive ROM. Id.
at 34. He instructed her to start PT. Id. at 35.
Petitioner was seen for a PT evaluation on November 26, 2019, just over a month
after her shoulder surgery. Ex. 11 at 2. Her pain levels ranged from two to six out of ten.
Id. Her left shoulder passive ROM was 140 degrees in flexion, 95 degrees in abduction,
and 50 degrees in external rotation. Id. at 3.
After a month of post-operative PT (December 26, 2019), Petitioner’s pain had
worsened somewhat, now ranging from four to seven out of ten. Ex. 11 at 38. She had
slight improvements in her left shoulder passive ROM. Id. at 39. Her treater noted that
she continued to lack functional mobility in her left upper extremity and continued to
require formal PT. Id. at 52.
Petitioner saw Dr. Hammerman on December 26, 2019, reporting that she was
doing well but had some increased discomfort as she increased her strengthening
program. Ex. 10 at 32. Dr. Hammerman recommended that she continue PT, but
decrease the strengthening component which he thought may be aggravating her. Id. By
mid-January 2020, she again reported increased pain to her physical therapist, ranging
from six to eight out of ten, and her passive ROM had worsened. Ex. 11 at 53, 58.
On January 27, 2020, Petitioner returned to Dr. Hammerman for persistent left
elbow and forearm pain. Ex. 10 at 29. She was continuing PT for her shoulder, which was
4

Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 5 of 13
gradually improving, although she still had pain at night. Id. However, she had returned
to desk work approximately two weeks after her shoulder surgery with her arm in a sling,
and typing with her elbow flexed. Id. She believed this is when she started experiencing
left forearm pain, and it had since progressed to include paresthesias along the ulnar
nerve distribution to her fourth and fifth digits. Id. On examination, she had full left elbow
ROM, with a positive Tinel sign. Id. She had mild discomfort with pronation of the forearm
against resistance. Id. Her left shoulder was still somewhat weak. Id. She was assessed
with left cubital tunnel syndrome and given Mobic and Gabapentin. Id. at 30.
A few weeks later (February 17, 2020), Petitioner returned to Dr. Hammerman. Ex.
10 at 26. Her elbow and forearm were 60-70% better, and her shoulder had improved as
well. Id. Dr. Hammerman determined that no further treatment was needed for her elbow,
and advised her to continue working on strengthening and ROM exercises for her
shoulder. Id.
Petitioner attended 26 PT sessions between November 26, 2019 and March 12,
2020, before stopping treatment due to the COVID-19 Pandemic. Ex. 11 at 2-80; Ex. 24
at 8-30. By March 2020, her pain levels had improved, ranging between zero to four out
of ten. Ex. 24 at 16. Her ROM had improved, but she continued to have intermittent pain
and decreased ROM and strength. Id. Her left shoulder active ROM was 140 degrees in
flexion, 120 degrees in abduction, 50 degrees in external rotation, and 70 degrees in
internal rotation. Id.
Petitioner returned to Dr. Hammerman nearly a year later, on February 4, 2021,
reporting left shoulder pain and right cubital tunnel syndrome. Ex. 18 at 17. Dr.
Hammerman noted that she had been swimming and that it “may be an overuse
syndrome.” Id. On examination, her left shoulder range of motion was “quite satisfactory,”
with 170 degrees of abduction and forward flexion, but she continued to have tenderness
in the subacromial area. Id. She was assessed with tendinitis of the left rotator cuff and
right cubital tunnel syndrome, and advised to avoid putting pressure directly over the ulnar
aspect of the elbow and try Gabapentin. Id. For her left shoulder, Dr. Hammerman advised
activity modification, such as cycling instead of swimming. Id. No further medical records
have been filed.
III. Declarations
Petitioner submitted four declarations in support of her claim: two on her own
behalf, one from her daughter, and one from a colleague. Exs. 1, 16, 17, 19.
Petitioner states that when she received the flu vaccine, she “felt instant pain that
was more intense than pain from any other shot [she] had ever received,” and she recalls
screaming out loud from the pain. Ex. 1 at ¶ 6. She did not seek care right away because
5

Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 6 of 13
she assumed that it was normal to have pain after vaccination, but the pain lingered. Id.
at ¶ 7. Her shoulder pain made daily chores such as lifting things or driving painful. Ex.
19 at ¶ 7.
Prior to her shoulder injury, Petitioner was very active, doing cardio workouts with
exercise videos at least three times a week to manage her diabetes. Ex. 19 at ¶ 13. For
over ten years since being diagnosed with diabetes, she did not have any symptoms
because she was so active. Id. However, following her shoulder injury she has not been
able to exercise in the same manner, and started having diabetes symptoms that she
needs to closely monitor. Id. She is afraid to do strength training such as planks out of
fear it will aggravate her shoulder. Id.
Petitioner began working from home eight days after her shoulder surgery (before
the COVID-19 Pandemic) because it is painful to drive long distances, and continues to
work from home. Ex. 19 at ¶ 15. Before her surgery, she developed right elbow pain from
the way she typed in order to protect her left arm. Id. at ¶ 16. She continues to have
stiffness and occasional pain in her left shoulder. Id. at ¶ 17. She stopped going to PT
and orthopedic appointments in March 2020 because of the COVID-19 Pandemic, opting
to do at home exercises. Id. at ¶ 12.
Petitioner’s daughter, Alicia Reynolds, submitted a declaration in support of
Petitioner. Ex. 16. She lives at home and sees her mother daily. Id. at ¶ 6. She recalls her
mother coming home the day she received the flu vaccine in October 2018 and stating
that she “screamed while she was getting the shot because it felt like it was jabbed into
her shoulder with a lot of force.” Id. at ¶ 7. Petitioner’s shoulder pain worsened and limited
her driving. Id. at ¶¶ 10-12. She also noticed her mother having pain while getting
dressed, and had to help her mother carry groceries due to pain. Id. at ¶¶13-14. Her
mother complained daily of her shoulder pain. Id. at ¶ 15. During Christmas 2018, her
mother could not lift the box of ornaments or help decorate the tree as she usually
does. Id. at ¶ 16.
Petitioner’s co-worker, Jennifer Aleman, submitted a declaration in support of
Petitioner. Ex. 17. Petitioner told Ms. Aleman about her shoulder pain from the flu shot,
and was in “constant pain” because of her shoulder. Id. at ¶¶ 9, 12-13. Petitioner was
usually in pain when she arrived at work because it hurt to drive and she had a long
commute. Id. at ¶ 13. Petitioner had difficulty getting things down from high cabinets due
to shoulder pain. Id. at ¶ 14.
IV. The Parties’ Arguments
Petitioner first sought treatment for her shoulder pain 60 days after vaccination,
but had no intervening appointments during that time. Petitioner’s Brief in Support of
Damages, filed Sept. 25, 2023, at *8 (ECF No. 45) (“Br.”). She did not seek care sooner
6

Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 7 of 13
because she hoped the pain would subside on its own; when it did not, she began the
process of finding an orthopedist for an evaluation. Br. at *8-9.
Petitioner treated for 15 months before stopping treatment in March 2020, at the
start of the COVID-19 Pandemic. Br. at *9. Her treatment consisted of arthroscopic
shoulder surgery, an MRI, two rounds of PT with a total of 38 sessions, pain medications
and steroids, and adherence to a home exercise program. Id. She describes her condition
in the first four months as moderate to severe, with pain levels ranging from six to eight.
Id. at *11. Her MRI showed a partial thickness tear, fraying, tendinosis, and bursitis. Id. at
*12.
Petitioner started PT four months after vaccination, but obtained no relief. Br. at
*14. She therefore opted for surgery to improve her quality of life. Id. at *15. After surgery,
however, her pain continued and at times worsened. Id. at *17. But by March 2020, her
pain had abated to between zero and four out of ten. Id. At that point, she abruptly stopped
treatment due to the COVID-19 Pandemic, but continued to do her home exercise
program. Id.
Prior to her SIRVA, Petitioner was fully independent and lived an active lifestyle.
Br. at *19. Since her injury, she cannot exercise the same way, no longer doing strength
training or shoulder-intensive exercises like planks to avoid aggravating her shoulder.4 Id.
Although she was diabetic before her SIRVA, she was asymptomatic. Id. However, after
her SIRVA, she became less active and began developing diabetes symptoms.5 Id. She
continues to experience residual stiffness in her shoulder. Id. Swimming helps with the
stiffness, but Dr. Hammerman told her in February 2021 that swimming may be causing
rotator cuff tendinitis from overuse and advised her to reduce her swimming. Id. at *19-
20. Petitioner also developed right elbow pain due to adjusting the way she typed to
compensate for her left shoulder pain. Id. at *20.
Petitioner seeks $123,000.00 in pain and suffering. Br. at *28. She relies on Adams
and Nute, in which petitioners were awarded $123,000.00 and $125,000.00,
respectively.6 Id. Petitioner argues that her SIRVA is comparable, in that she and the
Adams and Nute petitioners all underwent surgery, although those petitioners also
4 Petitioner was advised to try cycling instead of swimming due to shoulder pain (Ex.18 at 17), but her
medical records do not indicate that she has been advised not to do strength training or shoulder exercises
in general.
5 Petitioner did not provide medical records relating to diabetes diagnosis or treatment, or elaborate on what
symptoms she experienced after her shoulder injury.
6 Adams v. Sec’y of Health & Human Servs., No. 20-703V, 2022 WL 963790 (Fed. Cl. Spec. Mstr. Feb. 24,
2022); Nute v. Sec’y of Health & Human Servs., No. 18-140V, 2019 WL 6125008 (Fed. Cl. Spec. Mstr.
Sept. 6, 2019).
7

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received cortisone injections. Id. at *24-26. Petitioner also compares her case to Stokes,7
in which a petitioner was awarded $125,000.00. Br. at *26. Petitioner asserts that both
she and the Stokes petitioner attended PT before and after surgery, underwent surgery,
and did not have any cortisone injections. Id. at *26-27. Petitioner acknowledges that the
Stokes petitioner’s injury was slightly worse, but argues that Petitioner underwent a more
severe surgery and endured pain for a longer duration, justifying a similar award. Id. at
*27. Petitioner also cites four cases with pain and suffering awards of $110,000.00 – Gray,
Vaccaro, Guymon, and Wilt8 – arguing that her injury was more severe and of longer
duration than these cases, justifying a higher award. Id. at *21.
Respondent proposes a lower pain and suffering award of $85,000.00.
Respondent’s Response to Petitioner’s Brief in Support of Damages, filed Nov. 8, 2023,
at *2 (ECF No. 46) (“Resp.”). Respondent argues that Petitioner’s SIRVA course was
relatively mild compared to other surgical cases. Resp. at *8. Respondent emphasizes
Petitioner’s two-month delay in seeking care for her shoulder pain, noting that in ruling in
Petitioner’s favor on entitlement I stated that treatment gaps impact damages. Id. at *8-9
(citing my April 28, 2023 Entitlement Decision, ECF No. 39, at *10). When Petitioner did
seek care, she initially had full ROM and only mild tenderness in the subacromial area.
Id. at *9. With conservative treatment, including PT, Petitioner made improvements,
although she continued to report pain. Id. After a brief treatment gap, Petitioner elected
to pursue surgery. Id.
After surgery and post-operative PT, Petitioner exhibited a good recovery. Resp.
at *9.9 Although she had some cubital tunnel symptoms after wearing a post-operative
sling while typing, these symptoms largely resolved within a month. Id. She continued PT
7 Stokes v. Sec’y of Health & Human Servs., No. 19-752V, 2021 WL 6550888 (Fed. Cl. Spec. Mstr. Dec.
17, 2021).
8 Gray v. Sec’y of Health & Human Servs., No. 20-1708V, 2022 WL 6957013 (Fed. Cl. Spec. Mstr. Sept.
12, 2022), Vaccaro v. Sec’y of Health & Human Servs., No. 19-1883, 2022 WL 662550 (Fed. Cl. Spec.
Mstr. Feb. 2, 2022), Guymon v. Sec’y of Health & Human Servs., No. 19-1411V, 2022 WL 1447006 (Fed.
Cl. Spec. Mstr. Mar. 25, 2022), and Wilt v. Sec’y of Health & Human Servs., No. 18-446V, 2020 WL 1490747
(Fed. Cl. Spec. Mstr. Feb. 24, 2020).
9 Respondent asserts that much of Petitioner’s post-operative discomfort occurred after performing too
many household chores against medical advice and increasing her strengthening program during PT. Resp.
at *10 (citing Ex. 10 at 32, 36). There is only a single notation of Petitioner doing household chores against
medical advice, when she reported sweeping using her nonoperative arm somewhat assisting with her left
arm a month after her surgery. Ex. 10 at 36. The record does not support that this single instance caused
much of her post-operative pain, and the strengthening she did during PT was part of her recovery program.
8

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until March 2020, 15 months after vaccination. Id. At her final evaluation, Respondent
asserts that she was “no longer wearing her sling and had no pain (0/10).”10 Id.
Although Petitioner returned to her orthopedist in February 2021 reporting left
shoulder pain, she has not shown that this was related to her SIRVA, and these symptoms
were likely due to overuse from swimming. Resp. at *10. On examination, she exhibited
good stability and ROM in her left shoulder, and any cubital tunnel syndrome complaints
were confined to the right side. Id.
Respondent argues that Adams and Stokes are not good comparable decisions.
Resp. at *10-12. The Adams petitioner sought care just eight days after vaccination and
was already displaying ROM deficits – compared to Ms. Reynolds, who did not seek care
for two months and at her first evaluation had full ROM. Id. at *11. Furthermore, that
petitioner had a near full-thickness tear and large shoulder effusion, recovered only 75%
of her previous functioning, treated for 23 months, and was unable to work for several
months due to recovery – compared to Ms. Reynolds, who achieved a good recovery with
surgery and PT, treated for 15 months with modest pain, and returned to work eight days
after surgery. Id.
Respondent asserts that the Stokes petitioner had a far more severe SIRVA,
prompting her to seek care only two weeks after vaccination. Resp. at *11-12. Thereafter,
her pain was persistent and severe enough that she underwent surgery only a few months
after vaccination. Id. at *12. In addition, the Stokes petitioner was undergoing cancer
treatment during her SIRVA treatment and ultimately succumbed to cancer while her
SIRVA claim was pending. Id. Respondent argues that the cases Petitioner cites with
awards of $110,000.00 are closer comparisons than Adams and Stokes, but still involve
more severe courses of SIRVA. Id. at *12-14.
Respondent instead cites favorably to Hunt and Felland, featuring pain and
suffering awards of $95,000.00 and $100,000.00, respectively.11 Resp. at *15. Although
Petitioner attended more PT sessions than the Hunt petitioner, in Respondent’s view this
is balanced by the Hunt petitioner’s three cortisone injections, contrasted with none for
Petitioner. And the Felland petitioner attended less PT and treated for a shorter time, but
underwent two steroid injections, making Petitioner’s case less severe than Felland in
Respondent’s view. Id.
10 At her final PT evaluation, Petitioner reported no current pain, but reported that at worst her pain was
four out of ten. Ex. 24 at 16.
11 Hunt v. Sec’y of Health & Human Servs., No. 19-1003V, 2022 WL 2826662 (Fed. Cl. Spec. Mstr. June
16, 2022), and Felland v. Sec’y of Health & Human Servs., No. 20-406V, 2022 WL 10724100 (Fed. Cl.
Spec. Mstr. Sept. 6, 2022).
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Petitioner disagrees with Respondent’s contention that she had limited treatment
and a prompt recovery after surgery. Petitioner’s Reply Brief in Support of Damages, filed
Nov. 29, 2023, at *1 (ECF No. 48) (“Reply”). Instead, Petitioner notes that she attended
26 post-operative PT sessions before the COVID-19 Pandemic brought her treatment to
a halt – before she had fully recovered from her SIRVA. Reply at *1. But for the Pandemic,
Petitioner asserts she would have attended PT twice weekly for at least another month,
as recommended. Id.
Although Petitioner rated her then-current pain as zero at her final PT evaluation
on March 2, 2020, she continued to have intermittent pain, decreased ROM and strength,
and functional deficits. Reply at *1-2. Petitioner argues that her recovery was likely slowed
because she could no longer attend in person PT and receive treatments like cupping
from her therapist. Id. at *2.
Petitioner asserts that Respondent unfairly suggests that her returning to work
eight days after shoulder surgery implies a greater degree of recovery than was the case.
Reply at *3. Petitioner explains that she is an accountant who worked from home at the
time of her surgery, which facilitated a prompt return to work – but did not mean she was
cured. Id. If she had been a caregiver like the petitioner in Adams, or a substitute teacher
like the petitioner in Guymon – jobs requiring physical presence and the use of one’s
shoulders – it is unlikely she would have been able to return to work eight days after
surgery. Id.
Petitioner asserts that the Hunt petitioner had a mild to moderate SIRVA, and was
largely pain free by four months after vaccination due to pain relief from cortisone
injections – unlike Ms. Reynolds, who continued to report moderate (six out of ten) pain
levels even two months after surgery. Reply at *3-4. And Petitioner disagrees that Felland
is comparable, noting that the Felland petitioner reported no pain at discharge from PT
and trained for Tough Mudder, an intense sporting event, three months thereafter,
suggesting a full recovery – compared to Ms. Reynolds, who was still experiencing pain
and reduced ROM when her PT abruptly stopped due to the COVID-19 Pandemic, and
can no longer do strength training or shoulder exercises. Id. at *5-6.
Petitioner asserts that her case is most like Adams, with both undergoing similar
surgeries and nearly identical amounts of post-operative PT. Reply at *6. Although the
Adams petitioner treated for longer, Petitioner argues her treatment was cut short
because of the Pandemic. Id. at *7.
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V. Legal Standard
In another recent decision, I discussed at length the legal standard to be
considered in determining damages and prior SIRVA compensation within SPU. I fully
adopt and hereby incorporate my prior discussion in Section IV of Amor v. Sec’y of Health
& Human Servs., No. 20-978V, 2024 WL 1071877, at *7-10 (Fed. Cl. Spec. Mstr. Feb. 8,
2024).
In sum, compensation awarded pursuant to the Vaccine Act shall include “[f]or
actual and projected pain and suffering and emotional distress from the vaccine-related
injury, an award not to exceed $250,000.” Section 15(a)(4). The petitioner bears the
burden of proof with respect to each element of compensation requested. Brewer v. Sec’y
of Health & Human Servs., No. 93-0092V, 1996 WL 147722, at *22-23 (Fed. Cl. Spec.
Mstr. Mar. 18, 1996). Factors to be considered when determining an award for pain and
suffering include: 1) awareness of the injury; 2) severity of the injury; and 3) duration of
the suffering.12
VI. Appropriate Compensation for Petitioner’s Pain and Suffering
In this case, awareness of the injury is not disputed. The record reflects that at all
times Petitioner was a competent adult with no impairments that would impact her
awareness of her injury. Therefore, I analyze principally the severity and duration of
Petitioner’s injury.
Petitioner suffered a moderate SIRVA that continued for at least 15 months (and
likely for a bit longer), although she stopped treatment due to the COVID-19 Pandemic.
Her pain levels fluctuated, and her injury ultimately resulted in surgery just under a year
after vaccination. She treated with two rounds of PT totaling 38 sessions, as well as
medications and a home exercise program.
I find the most comparable damage decision cases cited by the parties are Wilt
and Gray. The petitioners in those cases also underwent surgery, did not have cortisone
injections, and underwent PT, with the Gray petitioner attending a similar amount of PT
as Petitioner, and the Wilt petitioner doing substantially less. Gray, 2022 WL 6957013, at
*6; Wilt, 2020 WL 1490757, at *3-8 The Wilt and Gray petitioners also reported similar
pain levels as Petitioner, and the Wilt petitioner had similar ROM restrictions. Gray, 2022
WL 6957013, at *6; Wilt, 2020 WL 1490757, at *3-8 The Gray petitioner, like Ms.
12 I.D. v. Sec’y of Health & Human Servs., No. 04-1593V, 2013 WL 2448125, at *9 (Fed. Cl. Spec. Mstr.
May 14, 2013) (quoting McAllister v. Sec’y of Health & Human Servs., No 91-1037V, 1993 WL 777030, at
*3 (Fed. Cl. Spec. Mstr. Mar. 26, 1993), vacated and remanded on other grounds, 70 F.3d 1240 (Fed. Cir.
1995)).
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Case 1:19-vv-01683-UNJ Document 50 Filed 08/12/24 Page 12 of 13
Reynolds, did not seek care until nearly two months after vaccination, while the Wilt
petitioner sought care only five days after vaccination. Gray, 2022 WL 6957013, at *6;
Wilt, 2020 WL 1490757, at *2. And the Wilt petitioner underwent surgery only four months
after vaccination, suggesting a more severe injury. Wilt, 2020 WL 1490757, at *5.
Significantly, however, Ms. Reynolds’ injury persisted for 15 months, longer than Wilt (ten
months) or Gray (eleven months).
Respondent’s cases are not on point. Felland involves a milder injury of shorter
duration. Felland, 2022 WL 10724100, at *6. And while the duration of the Hunt
petitioner’s injury was similar, the Hunt petitioner had lower pain levels and attended half
the number of PT sessions. Hunt, 2022 WL 2826662, at *9. Significantly, after a cortisone
injection two months after vaccination, the Hunt petitioner had minimal pain. Id. And
Petitioner’s other cases with higher awards (Adams, Nute, and Stokes) involve injuries
that were more severe, of longer duration, and/or other extenuating circumstances not
applicable in this case. Accordingly, taking all of the above into consideration (plus the
fact that I commonly award a six-figure sum for surgery SIRVA cases), I find a pain and
suffering amount somewhat lower than what Petitioner requests to be appropriate, and I
shall award $110,000.00.
Conclusion
For all of the reasons discussed above and based on consideration of the record
as a whole, I find that $110,000.00 represents a fair and appropriate amount of
compensation for Petitioner’s actual pain and suffering. 13 I also find that Petitioner
is entitled to $2,647.14 in actual unreimbursable expenses (as agreed by the
parties).14
Based on consideration of the record as a whole and arguments of the parties, I
award Petitioner a lump sum payment of $112,647.14, in the form of a check payable
to Petitioner. This amount represents compensation for all damages that would be
available under Section 15(a).
13 Since this amount is being awarded for actual, rather than projected, pain and suffering, no reduction to
net present value is required. See Section 15(f)(4)(A); Childers v. Sec’y of Health & Human Servs., No. 96-
0194V, 1999 WL 159844, at *1 (Fed. Cl. Spec. Mstr. Mar. 5, 1999) (citing Youngblood v. Sec’y of Health &
Human Servs., 32 F.3d 552 (Fed. Cir. 1994)).
14 Br. at 28; Resp. at 2 n.1.
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The Clerk of Court is directed to enter judgment in accordance with this Decision.15
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
15 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.
13