VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00007
Package ID: USCOURTS-cofc-1_20-vv-00007
Petitioner: Nancy Clark
Filed: 2020-01-03
Decided: 2022-03-03
Vaccine: influenza
Vaccination date: 2017-11-21
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 108808

AI-assisted case summary:
Nancy Clark filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered a shoulder injury related to vaccine administration (SIRVA) resulting from an influenza vaccination she received on November 21, 2017. She stated that the vaccine was administered in the United States, her pain lasted longer than six months, and she had not received prior compensation for this injury. Respondent denied that Ms. Clark sustained a Table SIRVA within the Table's timeframe and denied that the flu immunization caused or aggravated her alleged shoulder injury. Despite these positions, the parties filed a joint stipulation agreeing that a decision should be entered awarding compensation. The court adopted the stipulation as its decision, awarding a lump sum payment of $8,808.04 to satisfy a State of Oklahoma Medicaid lien and a lump sum of $100,000.00 payable to Ms. Clark. This total award of $108,808.00 represents compensation for all damages available under the Vaccine Act. The case was settled based on a joint stipulation, and the court directed entry of judgment in accordance with the decision.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00007-0
Date issued/filed: 2022-03-03
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 01/27/2022) regarding 24 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-7V
UNPUBLISHED
NANCY CLARK, Chief Special Master Corcoran
Petitioner, Filed: January 27, 2022
v.
Special Processing Unit (SPU); Joint
SECRETARY OF HEALTH AND Stipulation on Damages; Influenza
HUMAN SERVICES, (Flu) Vaccine; Shoulder Injury
Related to Vaccine Administration
Respondent. (SIRVA)
Leah V. Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for Petitioner.
Ryan Daniel Pyles, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 3, 2020, Nancy Clark 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 shoulder injury related to vaccine
administration (SIRVA) resulting from the adverse effects of an influenza (flu) vaccination
she received on November 21, 2017. Petition at 1; Stipulation, filed at January 25, 2022,
¶¶ 1-2. Petitioner further alleges that she received the vaccination within the United
States, that her pain lasted longer than six months, and neither she, nor any other party,
has ever received compensation in form of an award or settlement for Petitioner’s
vaccine-related injury. Petition at ¶¶ 1, 3; Stipulation at ¶¶ 3-5. “Respondent denies that
[P]etitioner sustained a Table SIRVA within the timeframe set forth in the Table; and
denies that the flu immunization caused or significantly aggravated [P]etitioner’s alleged
shoulder injury and/or any other injury.” Stipulation at ¶ 6.
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 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 2 of 8
Nevertheless, on January 25, 2022, the parties filed the attached joint stipulation,
stating that a decision should be entered awarding compensation. I find the stipulation
reasonable and adopt it as my decision awarding damages, on the terms set forth therein.
Pursuant to the terms stated in the attached Stipulation, I award the following
compensation:
1. A lump sum payment of $8,808.04, representing compensation for
satisfaction of a State of Oklahoma Medicaid lien, payable jointly to
Petitioner and:
Oklahoma Health Care Authority
Third Party Liability Unit
4345 N. Lincoln Blvd.
Oklahoma City, Oklahoma 73105
2. A lump sum of $100,000.00 in the form of a check payable to Petitioner.
Stipulation at ¶ 8. This amount represents compensation for all items of damages that
would be available under Section 15(a). Id.
I approve the requested amount for Petitioner’s compensation. In the absence of
a motion for review filed pursuant to RCFC Appendix B, the Clerk of 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 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 3 of 8
THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
NANCY CLARK,
Petitioner,
v. No. 20-7V
Chief Special Master Brian H. Corcoran
SECRETARY OF HEALTH AND ECF
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
1. Nancy Clark ("petitioner") filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 to -34 (the "Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of an influenza ("flu") vaccine, which vaccine is contained in the Vaccine Injury Table (the
"Table"), 42 C.F.R. § 100.3(a).
2. Petitioner received a flu vaccine on or about November 21, 2017. in her left deltoid.
3. The vaccine was administered within the United States.
4. Petitioner alleges that the flu vaccine caused her to develop a left-sided shoulder
injury related to vaccine administration ("SIRVA") and that she experienced residual effects of
this injury for more than six months.
S. Petitioner represents that there has been no prior award or settlement of a civil action
for damages as a result of her condition.

Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 4 of 8
6. Respondent denies that petitioner sustained a Table SIRVA within the timeframe set
forth in the Table; and denies that the flu immunization caused or significantly aggravated
petitioner's alleged shoulder injury and/or any other injury.
7. Maintaining their above-stated positions, the parties nevertheless now agree that the
issues between them shall be settled and that a decision should be entered awarding the
compensation described in paragraph 8 of this Stipulation.
8. As soon as practicable after an entry ofj udgment reflecting a decision consistent with
the terms of this Stipulation, and after petitioner has filed an election to receive compensation
pursuant to 42 U.S.C. § 300aa-21(a)(l), the Secretary of Health and Human Services will issue
the following vaccine compensation payments:
a, A lump sum payment of $8,808.04, 1 representing compensation for satisfaction of a
State of Oklahoma Medicaid lien, payable jointly to petitioner and
Oklahoma Health Care Authority
Third Party Liability Unit
4345 N. Lincoln Blvd.
Oklahoma City, Oklahoma 731 OS.
Petitioner agrees to endorse this payment to the Oklahoma Health Care Authority; and
b. A lump sum of $100,000.00 in the form of a check payable to petitioner. This amount
represents all remaining compensation for all damages that would be available under 42
U.S.C. § 300aa-15(a) for injuries allegedly related to petitioner's receipt of the flu
vaccine,
9. As soon as practicable after the entry ofj udgment on entitlement in this case) and after
petitioner has filed both a proper and timely election to receive compensation pursuant to 42
1 This amount represents full satisfaction of any right of subrogation, assignment, claim, Hen, or
cause of action the State of Oklahoma may have against any individual as a result of any
Medicaid payments made by, or on behalf of, the State of Oklahoma to, or on behalf of, Nancy
Clark as a result of her alleged vaccine-related injury suffered as a result of her Nove1nbcr 21,
2017 flu vaccination, under Title XIX of the Social Security Act, see 42 U.S.C. § 300aa.-15(g),
(h).
2

Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 5 of 8
U.S.C. § 300aa-21(a)(l), and an application, the parties will submit to further proceedings before
the special master to award reasonable attorneys' fees and costs incurred in proceeding upon this
petition.
10. Petitioner and her attorney represent that they have identified to respondent all
known sources of payment for items or seivices for which the Program is not primarily liable
under 42 U.S.C. § 300aa-15(g), including State compensation programs, insurance policies,
Federal or State health benefits programs (other than Title XIX of the Social Security Act (42
U.S.C. § 1396 et seq.)), or entities that provide health services on a pre-paid basis.
11. Payment made pursuant to paragraph 8 and any amounts awarded pursuant to
paragraph 9 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-15(i), subject
to the availability of sufficient statutory funds.
12. The parties and their attorneys further agree and stipulate that, except for any award
for attorneys' fees and litigation costs, and past unreimbursable expenses, the money provided
pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a
stric~ construction of 42 U.S.C. § 300aa-15(a) and (d), and subject to the conditions of 42 U.S.C.
§ 300aa-15(g) and (h).
13. In retum for the payments described in paragraphs 8 and 9, petitioner, in her
individual capacity and on behalf of her heirs, executors, administrators, successors and/or
assigns, does forever irrevocably and unconditionally release, acquit and discharge the United
States and the Secretary of Health and Human Services from any and all actions or causes of
action (including agreements, judgments, claims, damages, loss of services, expenses and all
demands of whatever kind or nature) that have been brought, could have been brought, or could
be timely brought in the Court of Federal Claims, under the National Vaccine Injury
3

Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 6 of 8
Compensation Program, 42 U.S.C. § 300aa-10 et seq., on account of, or in any way growing out
of, any and all known or unknown, suspected or unsuspected personal injuries to or death of
petitioner resulting from, or alleged to have resulted from, the flu vaccination administered on or
about November 21, 2017, as alleged by petitioner in a petition for vaccine compensation filed
on or about January 3, 2020, in the United States Court of Federal Claims as petition No. 20-7V.
14. If petitioner should die prior to entry of judgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
15. If the special master fails to issue a decision in complete conformity with the tenns
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete confonnity with the terms of this Stipulation, then the parties'
settlement and this Stipulation shall be voidable at the sole discretion of either party.
16. This Stipulation expresses a full and complete negotiated settlement of liability and
damages claimed under the National Childhood Vaccine Injury Act of 1986, as amended, except
as otherwise noted in paragraph 9 above. There is absolutely no agreement on the part of the
parties hereto to make any payment or to do any act or thing other than is herein expressly stated
and clearly agreed to. The parties further agree and understand that the award described in this
Stipulation may reflect a compromise of the parties' respective positions as to liability and/or
amount of damages, and further, that a change in the nature of the injury or condition or in the
items of compensation sought, is not grounds to modify or revise this agreement.
17. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the flu vaccine caused petitioner's alleged shoulder
injury and/or any other injury.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
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Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 7 of 8
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
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Case 1:20-vv-00007-UNJ Document 28 Filed 03/03/22 Page 8 of 8
Respectfully submitted,
PETITIONER:
~ =
ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
OF THE ATTORNEY GENERAL:
P~ R:
~cb+v\~?~
LEAH V. D' µ
HEATHER L. PEARLMAN
LAW OFFICES OF LEAH V. DURANT, PLLC Deputy Director
1717 K Street NW, Suite 900 Torts Branch
Washington, DC 20006 Civil Division
(202) 775-9200 U.S. Department of Justice
ldurant@durantllc.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044·0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEAL TH RESPONDENT:
AND HUMAN SERVICES:
~~LP~
z:>aA /1/JM, #1,
~ I ~C,I
CDR GEORGE REED GRIMES, MD, "1PH RYAN D. PYLES
Director, Division of Injury Senior Trial Attorney
Compensation Programs Torts Branch
Health Systems Bureau Civil Division
Health Resources and Services U.S. Department of Justice
Administration P.O. Box 146
U.S. Department of Health Benjamin FrankJin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08N 146B (202) 616-9847
Rockville, MD 20857 ryan.pyles@usdoj.gov
lzs/zaz:L
Dated: O I
6