VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01773
Package ID: USCOURTS-cofc-1_19-vv-01773
Petitioner: Olga Capkeviciene
Filed: 2019-11-19
Decided: 2021-11-17
Vaccine: influenza
Vaccination date: 2018-12-23
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 65687

AI-assisted case summary:
Olga Capkeviciene filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a Table injury, specifically shoulder injury related to vaccine administration (SIRVA), as a result of her influenza vaccination on December 23, 2018. The respondent conceded that Ms. Capkeviciene was entitled to compensation, finding that she met the criteria for a SIRVA Table injury. Specifically, she had no prior history of shoulder pain, her pain occurred within 48 hours of the vaccination, and the pain and reduced range of motion were limited to the shoulder that received the vaccine. A ruling on entitlement was issued on July 23, 2021, finding her entitled to compensation. Subsequently, on October 6, 2021, the respondent filed a proffer recommending an award of $65,687.90, which included $65,000.00 for pain and suffering and $687.90 for past unreimbursable expenses. Ms. Capkeviciene agreed with this proffered award. On November 17, 2021, the Chief Special Master issued a decision awarding Ms. Capkeviciene the sum of $65,687.90.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01773-0
Date issued/filed: 2021-08-24
Pages: 2
Docket text: rrect Petitioner's counsel's firm affiliation.) (fm).PUBLIC ORDER/RULING (Originally filed: 07/23/2021) regarding 36 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made. (Main Document 39 replaced on 8/24/2021 to co
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Case 1:19-vv-01773-UNJ Document 39 Filed 08/24/21 Page 1 of 2
CORRECTED
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1773V
UNPUBLISHED
OLGA CAPKEVICIENE, Chief Special Master Corcoran
Petitioner, Filed: July 23, 2021
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)
Richard H. Moeller, Moore, Hefferman, et. al, Sioux City, IA, for petitioner.
Ronalda Elnetta Kosh, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On November 19, 2019, Olga Capkeviciene 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 that she suffered a Table injury – shoulder injury
related to vaccine administration (“SIRVA”) – as a result of her December 23, 2018
influneza (“flu) vaccination. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On July 16, 2021, 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-01773-UNJ Document 39 Filed 08/24/21 Page 2 of 2
Specifically, Respondent indicates that
[m]edical personnel at the Division of Injury Compensation Programs,
Department of Health and Human Services, have reviewed the petition and
medical records filed in the case. It is respondent’s position that petitioner
has satisfied the criteria set forth in the Vaccine Injury Table (Table) and the
Qualifications and Aids to Interpretation, which affords petitioner the
presumption of causation because petitioner had no history of pain,
inflammation or dysfunction in her left shoulder; her pain occurred within 48
hours of receipt of an intramuscular vaccination; her pain and reduced
range of motion were limited to the shoulder in which the vaccine was
administered; and no other condition or abnormality was identified to explain
her symptoms. 42 C.F.R. § 100.3(a)(XIV)(B), (c)(10).
Id. at 4.
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

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-01773-1
Date issued/filed: 2021-11-17
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 10/12/2021) regarding 42 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:19-vv-01773-UNJ Document 49 Filed 11/17/21 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1773V
UNPUBLISHED
OLGA CAPKEVICIENE, Chief Special Master Corcoran
Petitioner, Filed: October 12, 2021
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)
Richard H. Moeller, Moore, Hefferman, et. al, Sioux City, IA, for Petitioner.
Ronalda Elnetta Kosh, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On November 19, 2019, Olga Capkeviciene 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 Table injury – shoulder injury related
to vaccine administration (“SIRVA”) – as a result of her December 23, 2018 influneza
(“flu) vaccination. Petition at 1. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On July 23, 2021, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for SIRVA. On October 6, 2021, Respondent filed a proffer on award of
compensation (“Proffer”) indicating Petitioner should be awarded $65,687.90
(representing an award of $65,000.00 for pain and suffering, and $687.90 for past
unreimbursed expenses). Proffer at 1-2. In the Proffer, Respondent represented that
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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:19-vv-01773-UNJ Document 49 Filed 11/17/21 Page 2 of 5
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.
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $65,687.90 (representing an award of $65,000.00 for pain and
suffering, and $687.90 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 Section 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-01773-UNJ Document 49 Filed 11/17/21 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
OLGA CAPKEVICIENE, )
)
)
Petitioner, )
) No. 19-1773V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On November 19, 2019, Olga Capkeviciene (“petitioner”) filed a petition for
compensation (“Petition”) under the National Childhood Vaccine Injury Act of 1986 (“Vaccine
Act” or “Act”). See 42 U.S.C. §§ 300aa-1 et seq. Petitioner alleges that she suffered a shoulder
injury related to vaccine administration (“SIRVA”) as a result of an influenza (“flu”) vaccine
intramuscularly administered in her left shoulder on December 23, 2018. See Petition at 1. On
May 26, 2021, the Secretary of Health and Human Services (“respondent”) filed a Rule 4(c)
Report indicating that this case is appropriate for compensation under the terms of the Act for a
SIRVA Table injury, and on May 27, 2021, the Chief Special Master issued a Ruling on
Entitlement finding petitioner entitled to compensation. ECF No. 36; ECF No. 38.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $65,000.00 in pain and suffering.
See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.

Case 1:19-vv-01773-UNJ Document 49 Filed 11/17/21 Page 4 of 5
B. Past Unreimbursable Expenses
Evidence supplied by petitioner documents that she incurred past unreimbursable
expenses related to her vaccine-related injury. Respondent proffers that petitioner should be
awarded past unreimbursable expenses in the amount of $687.90. See 42 U.S.C. § 300aa-
15(a)(1)(B). Petitioner agrees.
These amounts represent all elements of compensation to which petitioner is entitled
under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner should be made through a
lump sum payment as described below and requests that the Chief Special Master’s decision and
the Court’s judgment award the following1: a lump sum payment of $65,687.90, in the form of a
check payable to petitioner.
III. Summary of Recommended Payments Following Judgment
Lump sum payable to petitioner, Olga Capkeviciene: $65,687.90
Respectfully submitted,
BRIAN M. BOYNTON
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
1 Should petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future lost earnings
and future pain and suffering.

Case 1:19-vv-01773-UNJ Document 49 Filed 11/17/21 Page 5 of 5
DARRYL R. WISHARD
Assistant Director
Torts Branch, Civil Division
s/ Ronalda E. Kosh
RONALDA E. KOSH
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel.: (202) 616-4476
Email: ronalda.kosh@usdoj.gov
DATED: October 6, 2021