VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00705
Package ID: USCOURTS-cofc-1_20-vv-00705
Petitioner: Donna Jackson
Filed: 2020-06-11
Decided: 2022-01-06
Vaccine: influenza
Vaccination date: 2018-11-12
Condition: right shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 65000

AI-assisted case summary:
Donna Jackson filed a petition for compensation under the National Vaccine Injury Compensation Program on June 11, 2020, alleging she suffered a right shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 12, 2018. The petition stated that the vaccine was administered in the United States, that the residual effects of the SIRVA lasted for more than six months, and that no civil action had been filed or compensation received for the injury. The case was assigned to the Special Processing Unit. On October 25, 2021, the respondent filed a Rule 4(c) report conceding that Ms. Jackson was entitled to compensation, agreeing that her injury met the criteria for a Table SIRVA. Chief Special Master Brian H. Corcoran issued a ruling on entitlement on October 25, 2021, finding Ms. Jackson entitled to compensation. Subsequently, on December 6, 2021, the parties submitted a proffer on the award of compensation. The respondent proffered that Ms. Jackson should be awarded $65,000.00 for pain and suffering, representing all elements of compensation available under Section 15(a) of the Vaccine Act. The proffer stated that Ms. Jackson agreed with this proposed award. Chief Special Master Corcoran issued a decision on January 6, 2022, awarding Ms. Jackson a lump sum payment of $65,000.00, payable by check to Ms. Jackson, for pain and suffering. Petitioner counsel was Bridget Candace McCullough of Muller Brazil, LLP, and respondent counsel was Althea Walker Davis of the U.S. Department of Justice. The case was processed as a Table injury claim, and entitlement was conceded by the respondent.

Theory of causation field:
Petitioner Donna Jackson alleged a right shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 12, 2018. The respondent conceded entitlement, agreeing that the injury met the criteria for a Table SIRVA. The public decision does not describe the specific mechanism of injury, expert testimony, or detailed clinical facts. The case was processed as a presumed Table injury. Chief Special Master Brian H. Corcoran issued a ruling on entitlement on October 25, 2021, and a decision awarding damages on January 6, 2022. The award was a lump sum of $65,000.00 for pain and suffering, based on a proffer agreed to by both parties. Petitioner counsel was Bridget Candace McCullough, and respondent counsel was Althea Walker Davis.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00705-0
Date issued/filed: 2021-11-30
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/25/2021) regarding 21 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00705-UNJ Document 24 Filed 11/30/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0705V
UNPUBLISHED
DONNA JACKSON, Chief Special Master Corcoran
Petitioner, Filed: October 25, 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)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Althea Walker Davis, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On June 11, 2020, Donna Jackson 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 right shoulder injury related to
vaccine administration (“SIRVA”), which meets the definition of a Table SIRVA, after
receiving the influenza vaccine on November 12, 2018. Petition at 1, ¶ 2. Petitioner further
alleges that she received the vaccine in the United States, that she suffered the residual
effects of his SIRVA for more than six months, and that neither she nor any other party
has filed a civil action or received compensation for her injury. Id. at ¶¶ 13-15. The case
was assigned to the Special Processing Unit of the Office of Special Masters.
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 section references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. §
300aa (2012).

Case 1:20-vv-00705-UNJ Document 24 Filed 11/30/21 Page 2 of 2
On October 25, 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. Specifically, Respondent believes “[P]etitioner has satisfied the criteria set forth in the
Vaccine Injury Table (“Table”) and the Qualifications and Aids to Interpretation (“QAI”) for
a presumed AIRVA.” Id. at 5.
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_20-vv-00705-1
Date issued/filed: 2022-01-06
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 12/06/2021) regarding 26 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00705-UNJ Document 30 Filed 01/06/22 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0705V
UNPUBLISHED
DONNA JACKSON, Chief Special Master Corcoran
Petitioner, Filed: December 6, 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)
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Althea Walker Davis, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On June 11, 2020, Donna Jackson 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 right shoulder injury related to
vaccine administration (“SIRVA”), which meets the definition of a Table SIRVA, after
receiving the influenza vaccine on November 12, 2018. Petition at 1, ¶ 2. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On October 25, 2021, a ruling on entitlement was issued, finding Petitioner entitled
to compensation for her SIRVA. On December 6, 2021, Respondent filed a proffer on
award of compensation (“Proffer”) indicating Petitioner should be awarded $65,000.00,
representing compensation for her pain and suffering. Proffer at 1. In the Proffer,
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-00705-UNJ Document 30 Filed 01/06/22 Page 2 of 4
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 Proffer.
Pursuant to the terms stated in the attached Proffer, I award Petitioner a lump
sum payment of $65,000.00, representing compensation for pain and suffering 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 1:20-vv-00705-UNJ Document 30 Filed 01/06/22 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DONNA JACKSON, )
)
Petitioner, ) No. 20-705V
) Chief Special Master
v. ) Brian Corcoran
) SPU
SECRETARY OF HEALTH )
AND HUMAN SERVICES, )
)
Respondent. )
)
RESPONDENT'S PROFFER ON AWARD OF COMPENSATION
On June 11, 2020, Donna Jackson (“petitioner”) filed a petition for compensation
(“Petition”) under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -
34 (“Vaccine Act” or “Act”), as amended. Respondent conceded petitioner’s entitlement to
compensation in his Rule 4(c) Report filed on October 25, 2021. ECF No. 20. Based on
Respondent’s Rule 4(c) Report, that same day Chief Special Master Corcoran found petitioner
entitled to compensation for her right shoulder SIRVA injury. ECF No. 21.
I. Items of Compensation
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$65,000.00 for petitioner’s pain and suffering. This represents all elements of compensation to
which petitioner would be entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made

Case 1:20-vv-00705-UNJ Document 30 Filed 01/06/22 Page 4 of 4
through a lump sum payment of $65,000.00, in the form of a check made payable to petitioner. 1
Petitioner agrees.
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
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
ALEXIS B. BABCOCK
Assistant Director
Torts Branch, Civil Division
s/Althea Walker Davis
ALTHEA WALKER DAVIS
Senior Trial Counsel
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, D.C. 20044-0146
Tel: (202) 616-0515
Althea.Davis@usdoj.gov
DATED: December 6, 2021
1 Should petitioner die prior to the entry of judgment, the parties reserve the right to move the
Court for appropriate relief. In particular, respondent would oppose any award for future
medical expenses, future lost earnings, and future pain and suffering.
2