VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00827
Package ID: USCOURTS-cofc-1_20-vv-00827
Petitioner: Michael Cervantes
Filed: 2024-12-19
Decided: 2025-01-22
Vaccine: Td and pneumococcal conjugate (Prevnar-13)
Vaccination date: 2018-09-13
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 68853

AI-assisted case summary:
Michael Cervantes filed a petition for vaccine compensation alleging he suffered a shoulder injury related to vaccine administration (SIRVA) in both shoulders as a result of receiving a tetanus and diphtheria (Td) vaccine and a pneumococcal conjugate (Prevnar-13) vaccine on September 13, 2018. He further alleged that he experienced residual effects of these injuries for more than six months. Respondent denied that the vaccines caused his alleged shoulder injuries or that he sustained a SIRVA Table injury. Nevertheless, the parties filed a joint stipulation agreeing that a decision should be entered awarding compensation. The court adopted the stipulation, awarding Michael Cervantes $7,353.19 to reimburse a State of Connecticut Medicaid lien and $61,500.00 to purchase an annuity contract for his benefit. This total award of $68,853.19 represents compensation for all items of damages available under the Vaccine Act. The parties agreed that this stipulation represents a full and complete negotiated settlement of liability and damages.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_20-vv-00827-0
Date issued/filed: 2025-01-22
Pages: 10
Docket text: PUBLIC DECISION (Originally filed: 12/19/2024) regarding 67 DECISION Stipulation/Proffer, Signed by Chief Special Master Brian H. Corcoran. (ppa) Service on parties made.
--------------------------------------------------------------------------------
Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0827V
MICHAEL CERVANTES, Chief Special Master Corcoran
Petitioner, Filed: December 19, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Bridget Candace McCullough, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Meghan Murphy, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On July 8, 2020, Michael Cervantes 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 shoulder injury related to vaccine
administration (“SIRVA”) as a result of receiving a tetanus and diphtheria (“Td”) vaccine
and a pneumococcal conjugate (“Prevnar-13”) vaccine on September 13, 2018. Petition
at 1; Stipulation, filed at December 19, 2024, ¶¶ 1-4. Petitioner further alleges that he
experienced the residual effects of these injuries for more than six months. Petition at 4;
Stipulation at ¶ 4. “Respondent denies that the Td and/or Prevnar-13 vaccines caused
petitioner to suffer his alleged shoulder injuries or any other injury or his current condition,
and denies that petitioner sustained a SIRVA Table injury in either shoulder.” Stipulation
at ¶ 6.
Nevertheless, on December 19, 2024, the parties filed the attached joint
stipulation, stating that a decision should be entered awarding compensation. I find the
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (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 (2018).

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 2 of 10
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. A lump sum of $7,353.19, representing reimbursement of a State of
Connecticut Department of Administrative Services Medicaid lien for
services rendered on behalf of Michael Cervantes, in the form of a check
payable jointly to Petitioner and
Connecticut Department of Administrative Services
450 Columbus Boulevard
Collections, Suite 1001 North
Hartford, CT 06103
Case Number: 3452081
Attn: Sarah Black
Petitioner agrees to endorse this check to the State of Connecticut
Department of Administrative Services.
b. An amount of $61,500.00 to purchase the annuity contract described in
paragraph 10 of the attached stipulation, as set forth in the stipulation.
Stipulation at 2-4. 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-00827-UNJ Document 71 Filed 01/22/25 Page 3 of 10
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
MICHAEL CERVANTES, )
)
Petitioner, )
V. ) No. 20-827V
) Chief Special Master Corcoran
SECRETARY OF HEALTH ) ECF
AND HUMAN SERVICES, )
)
Respondent. )
STIPULATION
The parties hereby stipulate to the following matters:
1. Michael Cervantes, 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 a tetanus and diphtheria (''Td") vaccine and a pneumococcal conjugate ("Prevnar-13")
vaccine, which are vaccines contained in the Vaccine Injury Table (the "Table"), 42 C.F.R.
§ 100.3 (a).
2. Petitioner received the Td and Prevnar-13 vaccinations on September 13, 2018.
3. The vaccinations were administered within the United States.
4. Petitioner alleges that he sustained a shoulder injury related to vaccine administration
("SIRVA") in his left shoulder as a result ofr eceiving the Td vaccine, and a SIRVA in his right
shoulder as a result of receiving the Prevnar-13 vaccine, and that he experienced the residual
effects oft hese injuries for more than six months.

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 4 of 10
5. Petitioner represents that there has 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 the Td and/or Prevnar-13 vaccines caused petitioner to suffer
his alleged shoulder injuries or any other injury or his current condition, and denies that
petitioner sustained a SIRVA Table injury in either shoulder.
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(aX1), the Secretary of Health and Human Services will issue
the following vaccine compensation payments:
a. A lump sum of $7,353.19, 1 representing reimbursement of a State of Connecticut
Department of Administrative Services Medicaid lien for services rendered on behalf of
Michael Cervantes, in the form of a check payable jointly to petitioner and
Connecticut Department of Administrative Services
450 Columbus Boulevard
Co11ections, Suite 1001 North
Hartford, CT 06103
Case Number: 3452081
Attn: Sarah Black
Petitioner agrees to endorse this check to the State of Connecticut Department of
Administrative Services.
1 This amount represents full satisfaction of any right of subrogation, assignment. claim, lien, or
cause of action that the State of Connecticut Deparbnent of Administrative Services may have
against any individual as a result of any Medicaid payments made to or on behalf of Michael
Cervantes as a result of his alleged vaccine-related injury suffered on or about September 13,
2018, under Title XIX of the Social Security Act. See 42 U.S.C. § 300aa-1S(g),(h).
2

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 5 of 10
b. An amount of $61,500.00 to purchase the annuity contract described in paragraph l 0
below, paid to the life insurance company from which the annuity will be purchased (the
"Life Insurance Company").
These amounts represent compensation for aU damages that would be available under 42
U.S.C. §300aa-15(a).
9. The Life Insurance Company must have a minimum of$ 250,000,000.00 capital and
surplus, exclusive of any mandatory security valuation reserve. The Life Insurance Company
must have one of the following ratings from two of the following rating organizations:
a. A.M. Best Company: A++, A+, A+g, A+p, A+r, or A+s;
b. Moody's Investor Service Claims Paying Rating: Aa3, Aa2, Aal, or Aaa;
c. Standard and Poor's Corporation Insurer Claims-Paying Ability Rating: AA-,
AA, AA+, or AAA;
d. Fitch Credit Rating Company, Insurance Company Claims Paying Ability Rating:
AA-, AA, AA+, or AAA.
10. The Secretary of Health and Hwnan Services agrees to purchase an annuity contract
from the Life Insurance Company for 1he benefit of Michael Cervantes, pursuant to which the
Life Insurance Company wiU agree to make payments to Michael Cervantes, as foHows:
a. Beginning one month from the date of purchase, $1,180.08 per month for 5
years life contingent.
The purchase price of the annuity described in this paragraph shall neither be greater nor less
than $61,500.00. In the event that the cost oft he annuity set forth above varies from $61,500.00,
the life contingent monthly payments beginning one month from the date of purchase shall be
adjusted to ensure that the total cost of the annuity is neither less nor greater than $61,500.00.
The monthly payments shall end with the last scheduled payment set forth above, or on the
payment date immediately preceding Michael Cervantes's death, whichever is earlier. However,
written notice to the Secretary of Health and Human Services and the Life Insurance Company
shall be provided within twenty (20) days of Michael Cervantes's death.
3

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 6 of 10
11. The annuity contract will be owned solely and exclusively by the Secretary of Health
and Human Services and will be purchased as soon as practicable following the entry of a
judgment in conformity with this Stipulation. The parties stipulate and agree that the Secretary
of Health and Human Services and the United States ofA merica are not responsible for the
payment of any sums other than the amounts set forth in paragraph 8 herein and the amounts
awarded pursuant to paragraph 13 herein and that they do not guarantee or insure any oft he
t
future annuity payments. Upon the purchase of the annuity contract, the Secretary of Health and
Human Services and the United States of America are released from any and an obligations with
respect to future annuity payments.
12. The parties stipulate and agree that the annuity payments cannot be assi ed,
gn
accelerated, deferred. increased, or decreased by the parties and that no part of any annuity
payments called for herein, nor any assets oft he United States or the annuity company, are
subject to execution or any legal process for any obligation in any manner. Petitioner and
petitioner's heirs, executors, administrators, successors, and assigns do hereby agree that they
have no power or right to seJI, assign, mortgage t encumber, or anticipate said annuity payments,
or any part thereof, by assignment or otherwise, and further agree that they will not sell, assi gn ,
mortgage, encumber, or anticipate said annuity payments, or any part thereof, by assignment or
otherwise.
13. 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-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.
4

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 7 of 10
14. Petitioner and his attorney represent that they have identified to respondent all
known sources of payment for items or services 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.
15. Payments made pursuant to paragraph 8 and any amounts awarded pursuant to
paragraph 13 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-15(i),
subject to the availability of sufficient statutoiy funds.
16. 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 either immediately or as part of the annuity contract, will be used
solely for petitioner's benefit as contemplated by a strict construction of 42 U.S.C. §§ 300aa-
t S(a) and (d), and subject to the conditions of 42 U.S.C. §§ 300aa-1 S(g) and (h).
17. In return for the payments described in paragraphs 8 and 13, 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 Secretaiy 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 Injwy 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 al1eged to have resulted from, the Td and/or Prevnar-13 vaccinations administered on
5

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 8 of 10
September 13, 2018, as alleged by petitioner in a petition for vaccine compensation filed on or
about July 8, 2020, in the United States Court ofF ederal Claims as petition No. 20-827V.
18. 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.
19. If the special master fails to issue a decision in complete confonnity with the terms
of this Stipulation or ift he Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete conformity with the tenns of this Stipulation, then the parties'
settlement and this Stipulation shaJI be voidable at the sole discretion of either party.
20. 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 13 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.
21. Petitioner hereby authorizes respondent to disclose docwnents filed by petitioner in
this case consistent with the Privacy Act and the routine uses described in the National Vaccine
Injury Compensation Program System of Records, No. 09 15-0056.
22. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the Td or Prevnar-13 vaccines caused or
significantly aggravated petitioner's alleged shoulder injuries, or any other injury or his current
condition, or that petitioner suffered an injury or injuries contained in the Vaccine Injury Table.
6

Case 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 9 of 10
23. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
7

C ase 1:20-vv-00827-UNJ Document 71 Filed 01/22/25 Page 10 of 10
Respectfu1ly submitted,
PETITIONER:
MICHAEL CERVANTES
FRECORDFOR AUTHORIZED REPRESENTATIVE
OF THE ATTORNEY GENERAL:
WUG
LP Deputy Director
....• '-r,.L..,J..,,.,
7 I 5 Twining Road, Suite 208 Torts Branch
Dresher, PA 19025 Civil Division
Tel: (215) 885-1655 U.S. Department of Justice
bridget@mullerbrazil.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
m
OF THE SECRETARY OF HEAL RESPONDENT:
AND HUMAN SERVICES:
Jeffrey S. :t::: 1
Beach -S 0ate:2024.11.os
09:49:43 -osw for
CAPT GEORGE REED GRIMES, MD, MPH
Director, Division of Injury
Compensation Programs
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 Franklin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08W-25A Tel: (202) 616-4264
Rockville, MD 20857 meghan.r.murphy@usdoj.gov
i 1 /
Dated:
8