VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00187
Package ID: USCOURTS-cofc-1_20-vv-00187
Petitioner: Gary Allen
Filed: 2020-02-24
Decided: 2021-07-06
Vaccine: influenza
Vaccination date: 2017-10-25
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 34000

AI-assisted case summary:
Gary Allen filed a petition for compensation on February 24, 2020, alleging he suffered a left shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on October 25, 2017. Mr. Allen stated the vaccine was administered in the United States, he experienced residual effects for more than six months, and had no prior award or settlement for this condition. The respondent denied that the petitioner sustained a SIRVA Table injury, denied that the vaccine caused the alleged shoulder injury or any other injury, and denied that his current condition was a sequela of a vaccine-related injury. Despite these positions, the parties filed a joint stipulation on June 1, 2021, agreeing to settle the case. Chief Special Master Brian H. Corcoran adopted the stipulation as his decision. Pursuant to the stipulation, Gary Allen was awarded $34,000.00 as compensation for all damages, to be paid as a lump sum in the form of a check payable to the petitioner. This amount represents a compromise of liability and damages, and the stipulation explicitly states it does not constitute an admission by the respondent that the vaccine caused the injury. Petitioner was represented by Bridget Candace McCullough of Muller Brazil, LLP, and respondent was represented by Naseem Kourosh of the U.S. Department of Justice.

Theory of causation field:
Petitioner Gary Allen received an influenza vaccine on October 25, 2017, and alleged a left shoulder injury related to vaccine administration (SIRVA), which is listed in the Vaccine Injury Table. Respondent denied that the injury was a SIRVA Table injury or caused by the vaccine. The parties filed a joint stipulation to settle the case, agreeing to an award of $34,000.00. The stipulation does not constitute an admission of causation by the respondent. The public decision does not describe the specific mechanism of injury, expert testimony, or detailed clinical findings. Petitioner was represented by Bridget Candace McCullough and respondent by Naseem Kourosh. Chief Special Master Brian H. Corcoran issued the decision on July 6, 2021, adopting the stipulation.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00187-0
Date issued/filed: 2021-03-19
Pages: 7
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/17/2021) regarding 28 Findings of Fact & Conclusions of Law,,, Scheduling Order,,, Order on Motion for Ruling on the Record,, Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0187V
UNPUBLISHED
GARY ALLEN, Chief Special Master Corcoran
Petitioner, Filed: February 17, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Findings of Fact; Site of Vaccination
HUMAN SERVICES, Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
Respondent. Administration (SIRVA)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for petitioner.
Naseem Kourosh, U.S. Department of Justice, Washington, DC, for respondent.
FINDINGS OF FACT1
On February 24, 2020, Gary Allen filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleges that he suffered left shoulder injuries related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine received on October
25, 2017. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters (the “SPU”).
1 Because this unpublished fact 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 fact 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 (2012).

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 2 of 7
For the reasons discussed below, I find that the flu vaccine Petitioner received in
October 2017 was more likely than not administered in his left arm.
I. Relevant Procedural History
On February 24, 2020, Mr. Allen filed the petition along with Exhibits 1-12
containing medical records and an affidavit (ECF No. 1). Petitioner filed a Statement of
Completion on March 4, 2020 (ECF No. 8). On March 4, 2020, the case was activated
and assigned to the SPU (ECF No. 9).
A telephonic status conference was held on April 16, 2020. Scheduling Order,
issued Apr. 17, 2020 (ECF No. 12). During the conference, there was discussion about
the details regarding the October 25, 2017 administration of the flu vaccine. The petition
asserted the vaccine was administered in Petitioner’s left shoulder, but the vaccine
administration record indicated it was administered in his right deltoid. Petition at 1, Ex. 1
at 2. Petitioner’s counsel stated that it was Mr. Allen’s position that the site of vaccine
administration had been incorrectly recorded in the record. The parties were encouraged
to discuss how to address this factual issue.
On June 8, 2020, Respondent filed a status report setting forth counsel’s informal
assessment of the case (ECF No. 13). Respondent suggested that Petitioner obtain and
file certified records concerning the vaccination from the pharmacy where the vaccine
was administered, as well as affidavit evidence from the pharmacist who administered
the vaccine. Id. To that end, Petitioner filed certified records from Albertson’s Pharmacy
on September 11, 2020, and later re-filed the same record as Exhibit 13 on February 12,
2021 (ECF Nos. 19, 27).3 On September 24, 2020, Petitioner was directed to file an
affidavit from the pharmacist who administered the vaccine (ECF No. 20).
On October 26, 2020, a telephonic status conference was held (ECF No. 23).
Petitioner’s counsel reported that an affidavit from the pharmacist could not be filed
because the pharmacist’s identity was not revealed in the vaccine administration records.
Id. The parties discussed how to proceed, and agreed that resolution of the administration
issue on the papers would be appropriate. Id.
On December 3, 2020, Petitioner filed a motion for ruling on the record (ECF No.
24). On December 17, 2020, respondent filed a response (ECF No. 25). On December
17, 2020, Petitioner’s counsel reported that Petitioner did not intend to file a reply. Informal
3 The September 11, 2020 filing was stricken because it was labeled with a duplicate exhibit number (ECF
No. 26).
2

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 3 of 7
Communication, dated Dec. 18, 2020. The issue of the site of vaccine administration is
now ripe for resolution.
II. Issue
At issue is whether Petitioner received the vaccination alleged as causal in his left
arm. 42 C.F.R. § 100.3(a) XIV.B. (2017) (influenza vaccination).
III. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “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).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Human Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. In Lowrie, the special master wrote that “written records which
are, themselves, inconsistent, should be accorded less deference than those which are
internally consistent.” Lowrie, at *19.
The United States Court of Federal Claims has recognized that “medical records
may be incomplete or inaccurate.” Camery v. Sec’y of Health & Human Servs., 42 Fed.
Cl. 381, 391 (1998). The Court later outlined four possible explanations for
inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Human Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
3

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 4 of 7
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery, 42 Fed.
Cl. at 391 (citing Blutstein v. Sec’y of Health & Human Servs., No. 90-2808, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998). The credibility of the individual offering
such testimony must also be determined. Andreu v. Sec’y of Health & Human Servs., 569
F.3d 1367, 1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Human Servs., 991 F.2d
1570, 1575 (Fed. Cir. 1993).
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.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing § 12(d)(3); Vaccine Rule 8); see also Burns v. Sec’y of
Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within the
special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
IV. Finding of Fact
I make these findings after a complete review of the record, including all medical
records, affidavits, the motion and response, and other evidence filed. Specifically, I rely
upon the following evidence:
• Ex. 1 at 2, establishing that a flu vaccine was administered to Petitioner on
October 25, 2017. This record states the vaccine was administered
intramuscularly, and “R” is circled, suggesting Petitioner’s right deltoid as
the administration situs.
• Ex. 13 at 4-5, a certified record from the pharmacy documenting that a flu
vaccine was dispensed for Petitioner on October 25, 2017, but not indicating
the vaccination site or other details pertaining to administration.
• Ex. 4 at 36, a record of a December 27, 2017 visit to a licensed massage
therapist at Lutheran Medical Center where Petitioner reported that his “left
4

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 5 of 7
upper arm has been sore and has difficulty raising arm ever since he got a
flu shot in October 2017.”
• Ex. 2 at 32, a record of a January 17, 2018 office visit with Dr. Todd Wisser,
documenting that Petitioner reported left arm tenderness and that he “had
pain in this area since an influenza vaccine 10/2017.” Dr. Wisser assessed
Petitioner with deltoid tendinitis and added “[p]ain noted after influenza
vaccine October 2017, it has been roughly 3 months the patient has not had
any improvement.” Id. On examination, Petitioner was found to have
tenderness to palpation at the insertion of the deltoid tendon to the humerus,
pain with abduction of his left arm, but full passive range of motion. Id. at
33.
• Ex. 2 at 30, a record of a January 24, 2018 ultrasound of Petitioner’s left
shoulder, noting that the ultrasound was indicated due to “[p]ain in the
region of the deltoid muscle attachment following a flu shot in October.” Id.
The ultrasound found no abnormality at the deltoid muscle attachment on
the humerus and a suspected small intrasubstance tear of the rotator cuff
tendon measuring 2 mm thick. Id.
• Ex. 3 at 33, pertaining to a March 27, 2018 physical therapy initial
examination and noting that the evaluation was due to “left shoulder pain
that onset after getting a flu shot in October of 2017. The patient states he
had no pain prior to the injection, although after developed discomfort that
has remained consistent since.” Id. His primary concern was noted as “L
shoulder discomfort that onset following a flu shot in October 2017.” Id.
• Ex. 8 at 50, a record of a May 31, 2018 visit with Dr. Charles Gottlob,
assessing Petitioner with bursitis and noting that “Gary had probably a
proximal flu vaccine in October and has developed some subacromial
bursitis related to that. He had an ultrasound that showed a ‘2 mm interstitial
partial tear of his rotator cuff’, that is really clinically relevant. I think the issue
really is that he just developed a bursitis from the flu vaccine.” Id. This
record, confusingly, refers to problems with both Petitioner’s left and right
shoulders. Id. Dr. Gottlob assessed Petitioner with “bursitis of left shoulder”
and “Pain in left shoulder,” and directly below that states “Right shoulder
bursitis.” Id. (emphases added). Based on the context, including the
significance placed on the ultrasound findings, which resulted from an
ultrasound of Petitioner’s left shoulder, I find that Dr. Gottlob’s assessment
related to Petitioner’s left shoulder and that the reference to right shoulder
bursitis appears to be a typographical error.
5

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 6 of 7
• Ex. 10, Petitioner’s affidavit, at ¶¶ 4-6, explaining that Petitioner arrived at
the flu vaccine clinic 15 minutes before it closed, and that when he arrived
there were two or three other people waiting and only one person, who
seemed flustered by the number of people, administering vaccines.
Petitioner stated that he requested that the vaccine be administered in his
left arm because he is right handed, and noted that the person administering
vaccines “seemed rushed and was not talkative.” Id. at ¶ 8. Petitioner
added:
Before I knew it, he put the needle in my left shoulder. I instantly felt
a pain that was different than other flu vaccinations I received. When
I looked up, the gentleman was already working with the next person
in line. I no longer saw the piece of paper that I filled out and he did
not complete his portion of the form while he was sitting with me.
Ex. 10 at ¶ 9.
The above medical entries preponderantly support the conclusion that the October
25, 2017 flu vaccine Mr. Allen received was likely administered in his left arm. Although
Ex. 1 records the site of vaccination as Petitioner’s right deltoid, the preponderance of the
evidence indicates that the vaccine was more likely administered in Petitioner’s left arm.
Indeed – virtually all evidence in the record temporally thereafter supports that allegation.
In seeking treatment, Petitioner consistently related his left shoulder pain to his October
2017 flu vaccination. Petitioner’s assertion that the person who administered the vaccine
did not complete the form, including the portion indicating in which arm the vaccine was
administered, in Petitioner’s presence also provides a rational explanation for the
purported error.
Accordingly, I find there is preponderant evidence to establish that the vaccination
alleged as causal in this case was, more likely than not, administered in Petitioner’s left
arm on October 25, 2017. Thus, Petitioner’s motion for a fact ruling is granted.
V. Scheduling Order
Petitioner should proceed with preparing a demand, with supporting
documentation, for Respondent’s consideration. I understand that Respondent cannot
provide a response to this demand until he has obtained formally his client’s position.
However, the parties should strive to be in a position to immediately discuss damages
once Respondent indicates he is amenable to consideration of Petitioner’s demand after
Respondent’s review is complete. In addition, it is sensible for Petitioner to calculate likely
damages as quickly as possible in any case pending in SPU.
6

Case 1:20-vv-00187-UNJ Document 29 Filed 03/19/21 Page 7 of 7
Accordingly:
• Petitioner shall file, by no later than Wednesday, March 31, 2021, a status
report providing the following information:
o Whether and when Petitioner provided a demand for damages with
supporting documentation to Respondent’s counsel;
o Whether there is a Medicaid lien in this case and, if so, when Petitioner
anticipates providing documentation of the lien to Respondent;
o Petitioner’s current treatment status and condition;
o Whether all updated medical records have been filed; and
o A list of each component of damages allegedly suffered by Petitioner.
• Respondent shall file a status report indicating how he intends to proceed in
this case by Wednesday, May 05, 2021. At a minimum, the status report shall
indicate whether he is willing to engage in tentative discussions regarding
settlement or proffer, is opposed to negotiating at this time, or that the Secretary
has not yet determined his position. In the event Respondent wishes to file a Rule
4(c) report, he may propose a date for filing it, but shall indicate his position on
entering into negotiations regardless of whether he wishes to file a Rule 4(c) report.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
7

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DOCUMENT 2: USCOURTS-cofc-1_20-vv-00187-1
Date issued/filed: 2021-07-06
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 06/02/2021) regarding 37 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0187V
UNPUBLISHED
GARY ALLEN, Chief Special Master Corcoran
Petitioner, Filed: June 2, 2021
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)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for petitioner.
Naseem Kourosh, U.S. Department of Justice, Washington, DC, for respondent.
DECISION ON JOINT STIPULATION1
On February 24, 2020, Gary Allen filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). Petitioner alleges that he suffered a left shoulder injury related to vaccine
administration (“SIRVA”) as a result of an influenza vaccine received on October 25,
2017. Petition at 1; Stipulation, filed June 1, 2021, at ¶¶ 2-4. Petitioner further alleges the
vaccine was administered in the United States, he experienced the residual effects of his
condition for more than six months, and there has been no prior award or settlement of a
civil action for damages on his behalf as a result of his condition. Petition at 1, 3;
Stipulation at ¶¶ 3-5. “Respondent denies that petitioner sustained a SIRVA Table injury;
denies that the vaccine caused petitioner’s alleged shoulder injury, or any other injury;
and denies that his current condition is a sequela of a vaccine-related 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 2 of 7
Nevertheless, on June 1, 2021, 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:
A lump sum of $34,000.00 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 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 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
GARY ALLEN, )
)
Petitioner, )
) No. 20-187V (ECF)
v. ) Chief Special Master Corcoran
)
SECRETARY OF HEALTH )
AND HUMAN SERVICES, )
)
_______________
Respondent. )
)
STIPULATION
The parties hereby stipulate to the following matters:
1. Gary Allen, petitioner, filed a petition for vaccine compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-10 et seq. (the "Vaccine Program").
The petition seeks compensation for injuries allegedly related to petitioner's receipt of the
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 October 25, 2017.
3. The vaccination was administered within the United States.
4. Petitioner alleges that he sustained a shoulder injury related to vaccine administration
("SIRVA") as set forth in the Table. He further alleges that he experienced the residual effects
of this condition for more than six months.
5. Petitioner represents that there bas been no prior award or settlement of a civil action
for damages on his behalf as a result of his condition.
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the

Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 4 of 7
vaccine caused petitioner's alleged shoulder injury, or any other injury; and denies that his
current condition is a sequela of a vaccine-related 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)( 1) , the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of $34,000.00 in the form of a check payable to petitioner. This
amount represents compensation for all damages that would be available under 42
U.S.C. §300aa-15(a).
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
U.S.C. § 300aa-2l(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 his attorney represent that compensation to be provided pursuant to
this Stipulation is not for any items or services for which the Program is not primarily liable
under 42 U. S.C. § 300aa-15(g), to the extent that payment bas been made or can reasonably be
expected to be made under any 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 by entities that provide health services on a pre-paid basis.
2

Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 5 of 7
11. Payment made pursuant to paragraph 8 of this Stipulation and any amounts awarded
pursuant to paragraph 9 oft his 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 petitioner's benefit as contemplated by a strict
construction of 42 U. S.C. §§ 300aa-l 5(a ) and (d ), and subject to the conditions of 42 U. S.C. §§
300aa-l 5(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in his
individual capacity, and on behalf of his heirs, executors, administrators, successors 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
ofw hatever 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 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 ofp etitioner resulting
from, or alleged to have resulted from, the flu vaccination administered on October 25, 2017, as
alleged by petitioner in a petition for vaccine compensation filed on or about February 24, 2020,
in the United States Court of Federal Claims as petition No. 20-187V.
14. If petitioner should die prior to entry ofj udgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
3

Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 6 of 7
15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete conformity 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 Service that the flu vaccine caused petitioner's alleged injury or
any other injury or his current disabilities, or that petitioner suffered an injury contained in the
Vaccine Injury Table.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
4

Case 1:20-vv-00187-UNJ Document 41 Filed 07/06/21 Page 7 of 7
Respectfully submitted,
PETITIONER:
~~
ATTORNEY OF RECORD AUTHORIZED REPRESENTATIVE
FO PETITIONER: OF THE ATTORNEY GENERAL:
~\:bP(J
--.AY, 6/\fk-
8 A
HEATHER L. PEARLMAN
r---1Vmtler r I, Acting Deputy Director
71 S Twining Road Torts Branch
Suite 208 Civil Division
Dresher, PA 19025 U.S. Department of Justice
Tel: (215) 885-1655 P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEALTH RESPONDENT:
AND HUMAN SERVICES:
va& ~ , vf½5£?;_,#~
TAMARA OVERBY NASEEM KOUROSH
Acting Director, Division of Injwy Trial Attorney
Compensation Programs Torts Branch
Healthcare System Bureau Civil Division
Health Resources and Services U.S. Department of Justice
Administration· P.O. Box 146
U.S. Department of Health Benjamin Franklin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08N 146B Tel: (202) 305-1159
Rockville, MD 20857 Email: Naseem.kourosh@usdoj.gov
I
Dated: do I()\ 1.01 I
5