VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_19-vv-01779
Package ID: USCOURTS-cofc-1_19-vv-01779
Petitioner: Katherine Beltz
Filed: 2019-11-11
Decided: 2021-05-13
Vaccine: Tdap
Vaccination date: 2016-12-21
Condition: left shoulder injury related to the vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 47500

AI-assisted case summary:
Katherine Beltz filed a petition on November 11, 2019, alleging that she received a tetanus/diphtheria/acellular pertussis (Tdap) vaccine on December 21, 2016. She claimed to have subsequently suffered a left shoulder injury related to vaccine administration (SIRVA), which is a Table injury. The respondent conceded that Ms. Beltz is entitled to compensation, stating that she had no recent history of left shoulder pain, the onset of pain occurred within 48 hours after vaccination, the pain was limited to the injection site, and no other condition explained the symptoms. The respondent also agreed that no other causes were identified and that she met the statutory requirement of suffering the condition for more than six months. A ruling on entitlement was issued on April 8, 2021, finding her eligible for compensation. Subsequently, on May 13, 2021, a decision awarding damages was issued. The respondent proffered an award of $47,500.00, which Ms. Beltz accepted. The court awarded her a lump sum payment of $47,500.00 for all damages.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_19-vv-01779-0
Date issued/filed: 2021-05-11
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/08/2021) regarding 25 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:19-vv-01779-UNJ Document 36 Filed 05/11/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1779V
UNPUBLISHED
KATHERINE BELTZ, Chief Special Master Corcoran
Petitioner, Filed: April 8, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Tetanus Diphtheria
acellular Pertussis (Tdap) Vaccine;
Respondent. Shoulder Injury Related to Vaccine
Administration (SIRVA)
John Robert Howie, Howie Law, PC, Dallas, TX, for Petitioner.
Amanda Pasciuto, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On November 11, 2019, Katherine Beltz 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 received a tetanus/diphtheria/acellular
pertussis (“Tdap”) vaccine on December 21, 2016, and that she subsequently suffered a
left shoulder injury related to the vaccine administration (“SIRVA”), a Table injury. Petition
at 1. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On April 5, 2021, Respondent filed his Rule 4(c) report and Proffer (“Rule
4/Proffer”) in which he concedes that Petitioner is entitled to compensation in this case.
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-01779-UNJ Document 36 Filed 05/11/21 Page 2 of 2
Rule 4/Proffer at 1. Specifically, Respondent states that Petitioner “suffered a SIRVA of
the left shoulder as defined by the Vaccine Injury Table. Specifically, petitioner had no
recent history of pain, inflammation, or dysfunction of her left shoulder; the onset of pain
occurred within 48 hours after receipt of an intramuscular vaccination; the pain was limited
to the shoulder where the vaccine was administered; and, no other condition or
abnormality, such as brachial neuritis, has been identified to explain petitioner’s left
shoulder symptoms.” Id. at 6. Respondent further agrees that no other causes were
identified that could cause Petitioner’s SIRVA and that she has met the statutory
requirements by suffering the condition for more than six months. Id.
In view of Respondent’s position and the evidence of record, I find that
Petitioner is entitled to compensation.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_19-vv-01779-1
Date issued/filed: 2021-05-13
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 04/08/2021) regarding 26 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:19-vv-01779-UNJ Document 37 Filed 05/13/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 19-1779V
UNPUBLISHED
KATHERINE BELTZ, Chief Special Master Corcoran
Petitioner, Filed: April 8, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Damages Decision Based on Proffer;
HUMAN SERVICES, Tetanus Diphtheria acellular
Pertussis (Tdap) Vaccine; Shoulder
Respondent. Injury Related to Vaccine
Administration (SIRVA)
John Robert Howie, Howie Law, PC, Dallas, TX, for Petitioner.
Amanda Pasciuto, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On November 11, 2019, Katherine Beltz 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 received a tetanus/diphtheria/acellular
pertussis (“Tdap”) vaccine on December 21, 2016, and that she subsequently suffered a
left shoulder injury related to the vaccine administration (“SIRVA”), a Table injury. Petition
at 1. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On April 8, 2021, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for SIRVA. On April 5, 2021, Respondent filed a combined Rule 4(c) report
and proffer on award of compensation (“Rule 4/Proffer”) stating that Petitioner is entitled
to compensation and should be awarded $47,500.00. Rule 4/Proffer at 7. In the Rule
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-01779-UNJ Document 37 Filed 05/13/21 Page 2 of 2
4/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 Rule 4/Proffer.
Pursuant to the terms stated in the Rule 4/Proffer, I award Petitioner a lump sum
payment of $47,500.00, 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