VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00756
Package ID: USCOURTS-cofc-1_20-vv-00756
Petitioner: Camille Jefferson
Filed: 2020-06-23
Decided: 2023-03-20
Vaccine: influenza
Vaccination date: 2017-10-14
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 114299.39

AI-assisted case summary:
Camille Jefferson filed a petition on June 23, 2020, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on October 14, 2017. The case was assigned to the Special Processing Unit. Respondent filed a Rule 4(c) report conceding that Petitioner's injury was consistent with SIRVA as defined on the Vaccine Injury Table and that the injury lasted for at least six months. Based on this concession, a ruling on entitlement was issued on December 6, 2021, finding Petitioner entitled to compensation. Subsequently, on February 16, 2023, Respondent filed a proffer on award of compensation. The proffer indicated that Petitioner should be awarded a lump sum of $113,044.33 for pain and suffering and past unreimbursable expenses, and an additional $1,255.06 to satisfy a Medicaid lien. Petitioner agreed with the proffered award. The Chief Special Master issued a decision awarding these amounts, totaling $114,299.39.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00756-0
Date issued/filed: 2022-01-06
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 12/06/2021) regarding 39 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-00756-UNJ Document 42 Filed 01/06/22 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0756V
UNPUBLISHED
CAMILLE JEFFERSON, Chief Special Master Corcoran
Petitioner, Filed: December 6, 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)
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Kimberly Shubert Davey, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On June 23, 2020, Camille Jefferson 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”) as a result of an influenza (“flu”) vaccine that was administered
to her on October 14, 2017. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On December 3, 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 states that “petitioner’s alleged injury is consistent with
SIRVA, as define on the Vaccine Injury Table.” Id. at 8. Respondent further agrees that
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-00756-UNJ Document 42 Filed 01/06/22 Page 2 of 2
Petitioner has satisfied the statutory requirement that petitioner’s injury lasted for at least
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_20-vv-00756-1
Date issued/filed: 2023-03-20
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 02/17/2023) regarding 58 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:20-vv-00756-UNJ Document 62 Filed 03/20/23 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0756V
UNPUBLISHED
CAMILLE JEFFERSON, Chief Special Master Corcoran
Petitioner, Filed: February 17, 2023
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)
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Ronalda Elnetta Kosh, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On June 23, 2020, Camille Jefferson 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”) as a result of an influenza (“flu”) vaccine that was administered
to her on October 14, 2017. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On December 6, 2021, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. On February 16, 2023, Respondent filed a proffer on
award of compensation (“Proffer”) indicating Petitioner should be awarded (a) a lump sum
payment of $113,044.33 (comprised of $110,000.00 for pain and suffering and $3,044.33
for past unreimbursable expenses); and (b) a lump sum payment of $1,255.06,
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-00756-UNJ Document 62 Filed 03/20/23 Page 2 of 5
representing compensation for satisfaction of the Peach State Health Plan Lien. Proffer
at 1-2. In the 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 Proffer.
Pursuant to the terms stated in the attached Proffer, I award Petitioner:
A. a lump sum payment of $113,044.33 (comprised of $110,000.00 for pain and
suffering and $3,044.33 for past unreimbursable expenses) in the form of a
check payable to Petitioner; and
B. A lump sum payment of $1,255.06, representing compensation for
satisfaction of the Peach State Health Plan lien, in the form of a check
payable jointly to Petitioner and the “The Rawlings Company,” and mailed
to:
The Rawlings Company
ATTN: Ben Sweeney
Reference No: 102580635
P.O. Box 2000
La Grange, KY 40031-2000
Petitioner agrees to endorse this payment to The Rawlings Company.
These amounts represent compensation for all damages that would be available
under Section 15(a).
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-00756-UNJ Document 62 Filed 03/20/23 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
CAMILLE JEFFERSON, )
)
)
Petitioner, )
) No. 20-756V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On June 23, 2020, Camille Jefferson (“petitioner”) filed a petition for compensation
(“Petition”) under the National Childhood Vaccine Injury Act of 1986, as amended (“Vaccine
Act” or “Act”). See 42 U.S.C. §§ 300aa-1 et seq. Petitioner alleged that she suffered a Shoulder
Injury Related to Vaccine Administration (“SIRVA”) as a result of an influenza (“Flu”) vaccine
administered in her right shoulder on October 14, 2017. Petition at 1. On December 3, 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 December 6, 2021, the Chief Special Master issued a Ruling on Entitlement finding
petitioner entitled to compensation. ECF No. 38; ECF No. 39.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded a lump sum of $110,000.00 for
pain and suffering. Petitioner agrees.

Case 1:20-vv-00756-UNJ Document 62 Filed 03/20/23 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 $3,044.33. Petitioner agrees.
C. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy the Peach State
Health Plan lien in the amount of $1,255.06, which represents full satisfaction of any right of
subrogation, assignment, claim, lien, or cause of action the Peach State Health Plan may have
against any individual as a result of any Medicaid payment the Peach State Health Plan has made
to or on behalf of petitioner from the date of his eligibility for benefits through the date of
judgment in this case as a result of her alleged vaccine-related injury suffered on or about
October 14, 2017, under Title XIX of the Social Security Act.
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
two lump sum payments as described below and requests that the Chief Special Master’s
decision and the Court’s judgment award the following1:
A. A lump sum payment of $113,044.33, in the form of a check payable to
petitioner; and
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 pain and
suffering.

Case 1:20-vv-00756-UNJ Document 62 Filed 03/20/23 Page 5 of 5
B. A lump sum payment of $1,255.06, representing compensation for satisfaction of
the Peach State Health Plan lien, in the form of a check payable jointly to
petitioner and the “The Rawlings Company”, and mailed to:
The Rawlings Company
ATTN: Ben Sweeney
Reference No: 102580635
P.O. BOX 2000
La Grange, KY 40031-2000
Petitioner agrees to endorse this payment to The Rawlings Company.
III. Summary of Recommended Payments Following Judgment
A. Lump sum payable to petitioner, Camille Jefferson: $113,044.33
B. Medicaid lien: $1,255.06
Respectfully submitted,
BRIAN M. BOYNTON
Principal Deputy Assistant Attorney General
C. SALVATORE D’ALESSIO
Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
TRACI R. PATTON
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: February 16, 2023