VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01090
Package ID: USCOURTS-cofc-1_20-vv-01090
Petitioner: Amy Bandolik
Filed: 2020-08-28
Decided: 2022-01-06
Vaccine: influenza
Vaccination date: 2018-10-28
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 31144

AI-assisted case summary:
Amy Bandolik filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered a left shoulder injury related to vaccine administration (SIRVA) resulting from an influenza vaccination received on October 28, 2018. The respondent conceded that Ms. Bandolik is entitled to compensation, determining that her injury met the criteria set forth in the Vaccine Injury Table for SIRVA. Specifically, she had no prior history of shoulder issues, her pain and reduced range of motion occurred within 48 hours of the vaccination, her symptoms were limited to the vaccinated shoulder, and no other condition explained her symptoms. The statutory six-month sequela requirement was also satisfied. Following the ruling on entitlement, the respondent proffered an award of $31,144.08, which included $30,000.00 for pain and suffering and $1,144.08 for unreimbursed expenses. Ms. Bandolik agreed with this proffered award. The Chief Special Master issued a decision awarding the full proffered amount.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-01090-0
Date issued/filed: 2022-01-05
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/30/2021) regarding 23 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-01090-UNJ Document 28 Filed 01/05/22 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1090V
UNPUBLISHED
AMY BANDOLIK, Chief Special Master Corcoran
Petitioner, Filed: November 30, 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)
Jimmy A. Zgheib, Zgheib Sayad, P.C., White Plains, NY, for Petitioner.
Julia Marter Collison, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On August 28, 2020, Amy Bandolik 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 left shoulder injury related to vaccine
administration (SIRVA), resulting from the adverse effects of an influenza (flu) vaccination
received on October 28, 2018. Petition at 1. Petitioner further alleges that she received
the vaccination in the United States, her symptoms persisted for more than six months,
and neither Petitioner, nor any other party, has ever filed any action for Petitioner’s
vaccine-related injury. Petition at 1, 4. 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-01090-UNJ Document 28 Filed 01/05/22 Page 2 of 2
On November 30, 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 determined that Petitioner “has satisfied the criteria
set forth in the Vaccine Injury Table (“Table”) and the Qualifications and Aids to
Interpretation (“QAI”) for a Shoulder Injury Related to Vaccine Administration (“SIRVA”):
[P]etitioner had no history of pain, inflammation or dysfunction in her right shoulder; her
pain and reduced range of motion occurred within 48 hours of receipt of an intramuscular
vaccination; her symptoms were limited to the shoulder in which the vaccine was
administered; and no other condition or abnormality was identified to explain her
symptoms . . . . In addition, given the medical records outlined above, the statutory six-
month sequela requirement has been satisfied.” Id. at 4 (citations omitted).
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-01090-1
Date issued/filed: 2022-01-06
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 11/30/2021) regarding 24 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-01090-UNJ Document 29 Filed 01/06/22 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1090V
UNPUBLISHED
AMY BANDOLIK, Chief Special Master Corcoran
Petitioner, Filed: November 30, 2021
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Decision Awarding Damages; Pain
HUMAN SERVICES, and Suffering; Influenza (Flu)
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Administration (SIRVA)
Jimmy A. Zgheib, Zgheib Sayad, P.C., White Plains, NY, for Petitioner.
Julia Marter Collison, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On August 28, 2020, Amy Bandolik 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 left shoulder injury related to vaccine
administration (SIRVA), resulting from the adverse effects of an influenza (flu) vaccination
received on October 28, 2018. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On November 30, 2021, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. Also on November 30, 2021, Respondent filed a
combined Rule 4(c) report and proffer on award of compensation (“Proffer”) indicating
Petitioner should be awarded $31,144.08 ($30,000.00 for pain and suffering, and
$1,144.08 for unreimbursed expenses). Proffer at 5. In the Proffer, Respondent
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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:20-vv-01090-UNJ Document 29 Filed 01/06/22 Page 2 of 2
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 Proffer, I award Petitioner a lump sum
payment of $31,144.08 in the form of a check payable to Petitioner. This amount
represents compensation for all damages that would be available under § 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