VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00938
Package ID: USCOURTS-cofc-1_20-vv-00938
Petitioner: Mary Ward
Filed: 2020-10-14
Decided: 2022-11-15
Vaccine: Tdap
Vaccination date: 2019-05-16
Condition: right shoulder injury related to vaccination (SIRVA)
Outcome: compensated
Award amount USD: 32137

AI-assisted case summary:
Mary Ward filed a petition for compensation under the National Vaccine Injury Compensation Program on October 14, 2020, alleging a right shoulder injury related to vaccine administration (SIRVA) after receiving a tetanus vaccine on May 16, 2019. She stated that her injury met the Table SIRVA definition and that she continued to suffer residual effects more than six months later. Respondent denied that Petitioner sustained a SIRVA Table injury or that the vaccine caused her injury. Despite the denial, the parties filed a joint stipulation on October 13, 2022, agreeing to an award of compensation. Chief Special Master Corcoran found the stipulation reasonable and awarded Mary Ward $32,137.84. This amount included a lump sum of $32,000.00 payable to Petitioner and $137.84 to reimburse a Medicaid lien for services rendered by the State of California. The decision directed the Clerk of Court to enter judgment in accordance with the stipulation, absent a motion for review.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_20-vv-00938-0
Date issued/filed: 2022-11-15
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 10/14/2022) regarding 36 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
--------------------------------------------------------------------------------
Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-0938V
UNPUBLISHED
MARY WARD, Chief Special Master Corcoran
Petitioner, Filed: October 14, 2022
v.
Special Processing Unit (SPU); Joint
SECRETARY OF HEALTH AND Stipulation on Damages; Tetanus
HUMAN SERVICES, Diphtheria acellular Pertussis (Tdap)
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Administration (SIRVA)
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On July 31, 2020, Mary Ward 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
vaccination (“SIRVA”), which meets the Table SIRVA definition, after receiving a tetanus
vaccine on May 16, 2019. Id. at 1, ¶¶ 5, 23; Stipulation, file Oct. 13, 2022, at ¶¶ 1-2, 4. In
the alternative, Petitioner alleges that her right shoulder injury was caused-in-fact by the
flu vaccine she received. Id. Petitioner further alleges that she received the vaccine in the
United States, that she continues to suffer the residual effects of her SIRVA more than
six months later, and that neither she nor any other party has filed a civil action or received
compensation for her SIRVA injury. Petition at ¶¶ 5, 21-22; Stipulation at ¶¶ 3-5.
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-00938-UNJ Document 40 Filed 11/15/22 Page 2 of 8
“Respondent denies that [P]etitioner sustained a SIRVA Table injury; denies that the
vaccine caused [P]etitioner’s alleged shoulder injury, or any other injury; and denies that
her current condition is a sequela of a vaccine-related injury.” Stipulation at ¶ 6.
Nevertheless, on October 13, 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 $32,137.84 as
follows:
1. A lump sum payment of $32,000.00 in the form of a check payable to
Petitioner; and
2. A lump sum payment of $137.84, representing reimbursement of a Medicaid
lien for services rendered to Petitioner by the State of California, in the form
of a check payable jointly to Petitioner and the Medi-Cal Program, and
mailed to:
Department of Health Care Services
Recovery Branch – MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
DHCS Account Number: C93013007A-VAC03.
Stipulation at ¶ 8. Petitioner agrees to endorse the check to the Department of Health
Care Services for satisfaction of the Medicaid lien. These amounts represent
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-00938-UNJ Document 40 Filed 11/15/22 Page 3 of 8

Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 4 of 8

Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 5 of 8

Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 6 of 8

Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 7 of 8

Case 1:20-vv-00938-UNJ Document 40 Filed 11/15/22 Page 8 of 8