VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-00961
Package ID: USCOURTS-cofc-1_20-vv-00961
Petitioner: A.R.
Filed: 2020-08-03
Decided: 2023-07-05
Vaccine: Tdap
Vaccination date: 2017-08-18
Condition: Chronic Regional Pain Syndrome (CRPS), brachial plexus, and pain amplification syndrome
Outcome: compensated
Award amount USD: 14000

AI-assisted case summary:
On August 3, 2020, Pamela Flowers, as parent and natural guardian for her minor daughter A.R., filed a petition seeking compensation under the National Vaccine Injury Compensation Program. The petition alleged that the Tdap and inactivated polio vaccine (IPV) administered to A.R. on August 18, 2017, caused her to develop Chronic Regional Pain Syndrome (CRPS), brachial plexus injury, and pain amplification syndrome. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) Report on March 4, 2022, conceding entitlement to compensation. The respondent stated that medical personnel concluded A.R. developed CRPS of the left arm, which was more likely than not caused by the Tdap and/or IPV vaccines, and no other causes were identified. The respondent also confirmed that A.R.'s injury met the statutory requirement of lasting at least six months or resulting in inpatient hospitalization and surgical intervention. Based on this concession, Special Master Katherine E. Oler issued a Ruling on Entitlement on March 4, 2022, finding A.R. entitled to compensation. Subsequently, on May 19, 2023, the respondent filed a proffer of damages. On July 5, 2023, Special Master Oler issued a Decision Awarding Damages. The award included a lump sum of $14,719.70 to satisfy a State of California Medicaid lien. The remainder of the award was to be paid in the form of an annuity contract totaling $125,000.00. This annuity will provide monthly payments of $501.02 to A.R. starting December 11, 2024, for 27 years and 8 months, with annual increases of 3% compounded. The annuity contract will be purchased from a life insurance company meeting specific financial and rating criteria. Petitioner counsel was Robert Krakow of the Law Office of Robert J. Krakow, P.C. Respondent counsel included Terrence Mangan and Kyle Pozza from the U.S. Department of Justice.

Theory of causation field:
Petitioner Pamela Flowers filed on behalf of minor A.R., alleging that the Tdap and IPV vaccines administered on August 18, 2017, caused CRPS of the left arm, brachial plexus injury, and pain amplification syndrome. The respondent conceded entitlement, agreeing that A.R.'s CRPS of the left arm was more likely than not caused by the Tdap and/or IPV vaccines, with no other causes identified, and that the injury met the statutory duration requirement. The case proceeded as a Table injury claim. A Ruling on Entitlement was issued on March 4, 2022, finding entitlement based on the respondent's concession. A Decision Awarding Damages was issued on July 5, 2023, awarding $14,719.70 for a Medicaid lien and $125,000.00 for an annuity to cover pain and suffering. The annuity provides monthly payments starting December 11, 2024, for 27 years and 8 months, with annual 3% increases. Special Master Katherine E. Oler presided. Petitioner counsel was Robert Krakow; respondent counsel included Terrence Mangan and Kyle Pozza.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-00961-0
Date issued/filed: 2022-04-11
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 3/4/2022) regarding 38 Ruling on Entitlement. Signed by Special Master Katherine E. Oler. (sl) Service on parties made.
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Case 1:20-vv-00961-UNJ Document 41 Filed 04/11/22 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-961V
Filed: March 4, 2022
* * * * * * * * * * * * * * * * * * * * * * * * * *
*
*
PAMELA FLOWERS, parent and natural
*
guardian of A.R., a minor,
*
*
Petitioner, * Ruling on Entitlement; Table Injury; Tdap
*
* Vaccine; Injectable Polio Vaccine (IPV);
v. * Chronic Regional Pain Syndrome
* (CRPS).
SECRETARY OF HEALTH AND *
*
HUMAN SERVICES,
*
*
Respondent. *
*
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Robert Krakow, Law Office of Robert J. Krakow, P.C., New York, NY, for Petitioner
Terrence Mangan, U.S. Department of Justice, Washington, DC, for Respondent
RULING ON ENTITLEMENT1
Oler, Special Master:
On August 3, 2020, Pamela Flowers (“Ms. Flowers” or “Petitioner”) filed a petition for
compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10,
et seq.2 (the “Vaccine Act” or “Program”). Pet., ECF No. 1. Petitioner alleges that the Tdap vaccine
and injectable Polio vaccine (“IPV”) her daughter, A.R., received on August 18, 2017 caused her
1 Because this Ruling contains a reasoned explanation for the action in this case, I intend to post this Ruling
on the United States Court of Federal Claims’ website, in accordance with the E-Government Act of 2002,
Pub. L. No. 107-347, § 205, 116 Stat. 2899, 2913 (codified as amended at 44 U.S.C. § 3501 note (2012)).
In accordance with Vaccine Rule 18(b), a party has 14 days to identify and move to delete medical or other
information, that satisfies the criteria in 42 U.S.C. § 300aa-12(d)(4)(B). Further, consistent with the rule, a
motion for redaction must include a proposed redacted decision. If, upon review, I agree that the identified
material fits within the requirements of that provision, I will delete such material from public access.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L.
No. 99-660, 100 Stat. 3755 (codified as amended at 42 U.S.C. §§ 300aa-10–34 (2012)) (hereinafter
“Vaccine Act” or “the Act”). All subsequent references to sections of the Vaccine Act shall be to the
pertinent subparagraph of 42 U.S.C. § 300aa.

Case 1:20-vv-00961-UNJ Document 41 Filed 04/11/22 Page 2 of 2
to develop injuries including “Complex Regional Pain Syndrome, brachial plexus, and pain
amplification syndrome.” Id. at 1; Resp’t’s Rep. at 1.
On March 4, 2022, Respondent filed his Rule 4(c) Report in which he concedes that
Petitioner is entitled to compensation in this case. Resp’t’s Rep. at 1-2, ECF No. 37. Specifically,
Respondent states that
Medical personnel at the Division of Injury Compensation Programs, Department
of Health and Human Services (“DICP”), have reviewed the Petition and
supporting documentation filed in this case and concluded that A.R. developed
CRPS of the left arm, which was more likely than not caused by administration of
Tdap and/or IPV vaccines at the same location. No other causes for A.R.’s
condition have been identified. See 42 U.S.C. § 300aa-13(a)(1)(B). In addition,
given the medical records outlined above, petitioner has satisfied the statutory
requirement that A.R.’s injury lasted for at least six months, or resulted in “inpatient
hospitalization and surgical intervention” as required by 42 U.S.C. § 300aa-
11(c)(1)(D)(i), (iii). Therefore, based on the record as it now stands, petitioner has
satisfied all legal requisites for compensation under the Act.
Id. at 7-8.
In view of Respondent's position and the evidence of record, I find that Petitioner is
entitled to compensation. A separate order for the damages phase of this case will issue shortly.
IT IS SO ORDERED.
s/ Katherine E. Oler
Katherine E. Oler
Special Master
2

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DOCUMENT 2: USCOURTS-cofc-1_20-vv-00961-1
Date issued/filed: 2023-07-05
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 5/19/2023) regarding 56 DECISION of Special Master - Proffer. Signed by Special Master Katherine E. Oler. (sl) Service on parties made.
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Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-961V
(not to be published)
* * * * * * * * * * * * * * * * * * * * * * * * * *
*
*
PAMELA FLOWERS, parent and natural
*
guardian of A.R., a minor,
* Filed: May 19, 2023
*
*
Petitioner,
*
Entitlement; Decision by Proffer;
*
v. * Damages; Tetanus Diphtheria Acellular
*
Pertussis (“Tdap”) Vaccine; Inactivated
*
SECRETARY OF HEALTH AND Polio Vaccine (“IPV”); Chronic Regional
*
HUMAN SERVICES, * Pain Syndrome (“CRPS”); Brachial
* Plexus; Pain Amplification Syndrome.
Respondent. *
*
* * * * * * * * * * * * * * * * * * * * * * * * *
Robert Krakow, Law Office of Robert J. Krakow, P.C., New York, NY, for Petitioner
Kyle Pozza, U.S. Department of Justice, Washington, DC, for Respondent
DECISION AWARDING DAMAGES1
On August 3, 2020, Pamela Flowers (“Petitioner”) filed a petition on behalf of A.R. (her
minor daughter), seeking compensation under the National Vaccine Injury Compensation Program
(“the Vaccine Program”).2 Pet., ECF No. 1. Petitioner alleges that A.R. developed Chronic
Regional Pain Syndrome (“CRPS”), brachial plexus injury, and pain amplification syndrome as a
1 Because this Decision contains a reasoned explanation for my actions in this case, I will 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 (2012). This means the Decision will be available to anyone with access to the internet.
As provided by 42 U.S.C. § 300aa-12(d)(4)(B), however, the parties may object to the Decision’s inclusion
of certain kinds of confidential information. Specifically, under Vaccine Rule 18(b), each party has fourteen
days within which to request redaction “of any information furnished by that party: (1) that is a trade secret
or commercial or financial in substance and is privileged or confidential; or (2) that includes medical files
or similar files, the disclosure of which would constitute a clearly unwarranted invasion of privacy.”
Vaccine Rule 18(b). Otherwise, the whole Decision will be available to the public. Id.
2 The Vaccine Program comprises Part 2 of the National Childhood Vaccine Injury Act of 1986, Pub. L.
No. 99-660, 100 Stat. 3755 (codified as amended at 42 U.S.C. §§ 300aa-10–34 (2012)) (hereinafter
“Vaccine Act” or “the Act”). All subsequent references to sections of the Vaccine Act shall be to the
pertinent subparagraph of 42 U.S.C. § 300aa.

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 2 of 8
result of the tetanus diphtheria acellular pertussis (“Tdap”) vaccine and inactivated polio vaccine
(“IPV”) she received on August 18, 2017. See Pet. at 1; Proffer at 1.
On March 4, 2022, Respondent filed a Rule 4(c) Report conceding entitlement to
compensation. Resp’t’s Rep. at 1, ECF No. 37. Specifically, Respondent states that
Medical personnel at the Division of Injury Compensation Programs, Department
of Health and Human Services (“DICP”), have reviewed the Petition and
supporting documentation filed in this case and concluded that A.R. developed
CRPS of the left arm, which was more likely than not caused by administration of
Tdap and/or IPV vaccines at the same location. No other causes for A.R.’s
condition have been identified. See 42 U.S.C. § 300aa-13(a)(1)(B). In addition,
given the medical records outlined above, petitioner has satisfied the statutory
requirement that A.R.’s injury lasted for at least six months, or resulted in “inpatient
hospitalization and surgical intervention” as required by 42 U.S.C. § 300aa-
11(c)(1)(D)(i), (iii). Therefore, based on the record as it now stands, petitioner has
satisfied all legal requisites for compensation under the Act.
Id. at 7-8.
On March 4, 2022, I issued a Ruling on Entitlement finding that Petitioner was entitled to
compensation due to Respondent’s concession in his Rule 4(c) Report. ECF No. 38.
Respondent filed a proffer on May 19, 2023 (ECF No. 55), agreeing to issue the following
payment:
1. A Lump Sum
A lump sum of $14,719.70, which amount represents reimbursement of a State of
California Medicaid lien for services rendered on behalf of A.R., in the form of a check payable
jointly to petitioners and Department of Health Care Services, mailed to
Department of Health Care Services
Recovery Branch - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
DHCS Account No.: C95939244F-VAC03
Petitioner agrees to endorse the check to the California Department of Health Care Services
in satisfaction of the Medicaid lien.
2. An Annuity
The remainder of damages shall be paid in the form of an annuity contract, which shall be
purchased as soon as practicable after entry of judgment. Accordingly, pursuant to 42 U.S.C. §
300aa-15(f)(4), I order Respondent to purchase, and take ownership of, an annuity contract in the

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 3 of 8
amount of $125,000.00,3 as described below:
Each Life Insurance Company must meet the following criteria:
1. Have a minimum of $250,000,000 of capital and surplus, exclusive of any mandatory
security valuation reserve; and
2. 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, Aa1, 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.
The Secretary of Health and Human Services shall purchase an annuity contract from the
Life Insurance Company for the benefit of A.R., pursuant to which the Life Insurance Company
will agree to make payments periodically to A.R. as described in Section II(B) of the attached
Proffer.
I adopt Respondent’s proffer attached hereto, and award compensation in the amount and
on the terms set forth therein. I approve a Vaccine Program award in the requested amount set
forth above to be made to Petitioner. The Clerk of Court is directed to enter judgment in accordance
with this decision.4
IT IS SO ORDERED.
s/ Katherine E. Oler
Katherine E. Oler
Special Master
3 To satisfy the conditions set forth herein, in Respondent’s discretion, Respondent may purchase one or
more annuity contracts from one or more life insurance companies.
4 Pursuant to Vaccine Rule 11(a), entry of judgment can be expedited by each party filing a notice
renouncing the right to seek review.

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 4 of 8
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
__________________________________________
)
PAMELA FLOWERS, parent and natural )
guardian of A.R., a minor, )
)
Petitioner, ) No. 20-961V
v. ) Special Master Oler
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
__________________________________________)
RESPONDENT’S PROFFER OF DAMAGES
I. Procedural History
On August 3, 2020, Pamela Flowers (“petitioner”) filed this claim under the National
Childhood Vaccine Injury Act of 1986 (“Vaccine Act” or “Act”), as amended, 42 U.S.C. §§
300aa-1 to -34, on behalf of her minor daughter, A.R., alleging that tetanus-diphtheria-acellular
pertussis vaccine (“Tdap”) and inactivated polio vaccine (“IPV”) administered on August 18,
2017, caused injuries including Complex Regional Pain Syndrome (“CRPS”), brachial plexus
injury, and pain amplification syndrome. Petition at 1-2. On March 4, 2022, respondent filed his
Rule 4(c) Report in which he concedes that petitioner is entitled to compensation in this case for
CRPS. ECF No. 37. Accordingly, on March 4, 2022, the Special Master issued a Ruling on
Entitlement finding petitioner entitled to compensation. ECF No. 38.
1

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 5 of 8
II. Items of Compensation and Form of the Award
Based upon the evidence of record, respondent proffers, and the parties recommend, that
compensation be made through a lump sum and future annuity payments as described below, and
request that the Special Master's decision and the Court's judgment award the following:1
A. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy a State of
California Medicaid lien in the amount of $14,719.70, which represents full satisfaction of any
right of subrogation, assignment, claim, lien, or cause of action the State of California may have
against any individual as a result of any Medicaid payments the State of California has made to
or on behalf of A.R. from the date of her eligibility for benefits through the date of judgment in
this case as a result of A.R.’s alleged vaccine-related injury suffered on or about August 18,
2017, under Title XIX of the Social Security Act. Reimbursement of the State of California
Medicaid lien shall be made through a lump sum payment of $14,719.70, representing
compensation for satisfaction of the State of California Medicaid lien, in the form of a check
payable jointly to petitioner and:
Department of Health Care Services
Recovery Branch - MS 4720
P.O. Box 997421
Sacramento, CA 95899-7421
DHCS Account No.: C95939244F-VAC03
Petitioner agrees to endorse the check to the California Department of Health Care Services in
satisfaction of the Medicaid lien.
1 Should A.R. 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 medical
expenses, future lost earnings, and future pain and suffering.
2

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 6 of 8
B. Pain and Suffering
For pain and suffering, an amount not to exceed $125,000.00 to purchase an annuity
contract,2 paid to the life insurance company3 from which the annuity will be purchased,4 subject
to the conditions described below. The annuity contract will be owned solely and exclusively by
the Secretary of Health and Human Services and will provide payments to A.R. as set forth
below:
Beginning December 11, 2024, $501.02 per month for 27 years and 8 months certain,
increasing at 3% compounded annually from the date payments begin.
The purchase price of the annuity described in this section II.B. shall neither be greater
nor less than $125,000.00. In the event that the cost of the certain annuity payments set forth
above varies from $125,000.00, the certain monthly payment of $501.02 due on December 11,
2024, shall be adjusted to ensure that the total cost of the annuity is neither less than nor greater
than $125,000.00. Should A.R. predecease any of the certain annuity payments set forth above,
2 In respondent’s discretion, respondent may purchase one or more annuity contracts from
one or more life insurance companies.
3 The Life Insurance Company must have a minimum of $250,000,000 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, Aa1, 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.
4 Petitioner authorizes the disclosure of certain documents filed by the 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.
3

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 7 of 8
said payments shall be made to her estate. Written notice to the Secretary of Health and Human
Services and to the Life Insurance Company shall be provided within twenty (20) days of A.R.’s
death.
These amounts represent all elements of compensation to which A.R. would be entitled
under 42 U.S.C. § 300aa-15(a). Petitioner agrees.5
III. Summary of Recommended Payments Following Judgment
A. Medicaid lien: $14,719.70
B. An amount of $125,000.00 to purchase the annuity contract
described above in section II. B.
5 At the time payment is received, A.R. will be an adult, and thus guardianship is not
required.
4

Case 1:20-vv-00961-UNJ Document 61 Filed 07/05/23 Page 8 of 8
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
DARRYL R. WISHARD
Assistant Director
Torts Branch, Civil Division
/s/Kyle E. Pozza
KYLE E. POZZA
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) 616-3661
Email: Kyle.Pozza@usdoj.gov
DATED: May 19, 2023
5