VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01473
Package ID: USCOURTS-cofc-1_20-vv-01473
Petitioner: Thomas Roubik
Filed: 2021-04-16
Decided: 2021-06-21
Vaccine: influenza
Vaccination date: 2019-11-08
Condition: Guillain-Barré Syndrome (GBS)
Outcome: compensated
Award amount USD: 328212

AI-assisted case summary:
Julie Roubik, as personal representative of the estate of Thomas Roubik, filed a petition for compensation under the National Vaccine Injury Compensation Program on October 27, 2020. The petition alleged that Thomas Roubik received an influenza vaccine on November 8, 2019, and subsequently suffered from Guillain-Barré Syndrome (GBS), which ultimately led to his death on January 11, 2020. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on April 16, 2021, conceding that the petitioner was entitled to compensation. The respondent agreed that Mr. Roubik's GBS met the criteria set forth in the Vaccine Injury Table and its Qualifications and Aids to Interpretation. Furthermore, the respondent conceded that the evidence established, by a preponderance, that Mr. Roubik's death was related to his GBS, satisfying the statutory severity requirement. Based on the respondent's concession and the evidence of record, Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement on April 16, 2021, finding the petitioner entitled to compensation. Subsequently, on May 21, 2021, the respondent filed a proffer on the award of compensation. The proffer indicated that the petitioner should be awarded $328,212.87, comprising $250,000.00 for the death benefit, $77,500.00 for pain and suffering, and $712.87 for unreimbursed expenses. The petitioner agreed with this proffered award. Chief Special Master Corcoran issued a Decision Awarding Damages on June 21, 2021, awarding the petitioner a lump sum of $328,212.87, payable by check to Julie Roubik as the legal representative of Thomas Roubik's estate. This award represented compensation for all damages available under Section 15(a) of the Vaccine Act. Petitioner's counsel was Nancy Routh Meyers, and respondent's counsel was Lauren Kells. The public decision does not describe the specific onset of symptoms, diagnostic tests, treatments, or the medical mechanism of causation beyond the general concession of a Table injury.

Theory of causation field:
Thomas Roubik received an influenza vaccine on November 8, 2019. He subsequently developed Guillain-Barré Syndrome (GBS), which is listed on the Vaccine Injury Table. The respondent conceded that Mr. Roubik's GBS was a Table injury and that his death on January 11, 2020, was related to the GBS. The public text does not detail the specific medical mechanism, expert testimony, or diagnostic findings. The case was resolved via concession and a proffer on damages. Julie Roubik, as personal representative of the estate, was awarded $328,212.87, consisting of $250,000.00 for the death benefit, $77,500.00 for pain and suffering, and $712.87 for unreimbursed expenses. The ruling on entitlement was issued by Chief Special Master Brian H. Corcoran on April 16, 2021, and the final decision awarding damages was issued by Chief Special Master Corcoran on June 21, 2021. Petitioner's counsel was Nancy Routh Meyers, and respondent's counsel was Lauren Kells.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-01473-0
Date issued/filed: 2021-05-19
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 04/16/2021) regarding 16 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-01473-UNJ Document 19 Filed 05/19/21 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1473V
UNPUBLISHED
JULIE ROUBIK, personal Chief Special Master Corcoran
representative of ESTATE OF
THOMAS ROUBIK, Filed: April 16, 2021
Petitioner, Special Processing Unit (SPU);
v. Ruling on Entitlement; Concession;
Table Injury; Influenza (Flu) Vaccine;
SECRETARY OF HEALTH AND Guillain-Barre Syndrome (GBS)
HUMAN SERVICES,
Respondent.
Nancy Routh Meyers, Turning Point Litigation, Greensboro, NC, for petitioner.
Lauren Kells, U.S. Department of Justice, Washington, DC, for respondent.
RULING ON ENTITLEMENT1
On October 27, 2020, Julie Roubik filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), as personal representative of the estate of Thomas Roubik. Petitioner
alleges that “[a]s a direct and proximate result of the reaction to the influenza vaccination
administered to Thomas Roubik on November 8, 2019, he suffered from the effects of
Guillain-Barré Syndrome (GBS) which ultimately lead to his untimely death.” Petition at ¶
16. 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:20-vv-01473-UNJ Document 19 Filed 05/19/21 Page 2 of 2
On April 16, 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 agrees “that [P]etitioner has satisfied the criteria set forth in the
Vaccine Injury Table (“Table”) and the Qualifications and Aids to Interpretation (“QAI”).”
Id. at 4. Respondent further agrees that “based on the medical records outlined above, a
preponderance of evidence establishes that [P]etitioner has met the statutory severity
requirement in that Mr. Roubik’s death was related to his GBS.” 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-01473-1
Date issued/filed: 2021-06-21
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 05/21/2021) regarding 21 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:20-vv-01473-UNJ Document 25 Filed 06/21/21 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1473V
UNPUBLISHED
JULIE ROUBIK, personal Chief Special Master Corcoran
representative of ESTATE OF
THOMAS ROUBIK, Filed: May 21, 2021
Petitioner,
v. Special Processing Unit (SPU);
Damages Decision Based on Proffer;
SECRETARY OF HEALTH AND Influenza (Flu) Vaccine; Guillain-
HUMAN SERVICES, Barre Syndrome (GBS)
Respondent.
Nancy Routh Meyers, Turning Point Litigation, Greensboro, NC, for Petitioner.
Lauren Kells, U.S. Department of Justice, Washington, DC, for Respondent.
.
DECISION AWARDING DAMAGES1
On October 27, 2020, Julie Roubik filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), as personal representative of the estate of Thomas Roubik. Petitioner
alleged that “[a]s a direct and proximate result of the reaction to the influenza vaccination
administered to Thomas Roubik on November 8, 2019, he suffered from the effects of
Guillain-Barré Syndrome (GBS) which ultimately lead to his untimely death.” Petition at ¶
16. The case was assigned to the Special Processing Unit of the Office of Special
Masters.
On April 16, 2021, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for Thomas Roubik’s injury. On May 21, 2021, Respondent filed a proffer
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-01473-UNJ Document 25 Filed 06/21/21 Page 2 of 5
on award of compensation (“Proffer”) indicating Petitioner should be awarded
$328,212.87, representing compensation in the amounts of $250,000.00 for the death
benefit, $77,500.00 for pain and suffering, and $712.87 for unreimbursed expenses.
Proffer at 1-2. In the Proffer, Respondent represented that Petitioner agrees with the
proffered award. Id. at 2. 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 lump
sum payment of $328,212.87, representing compensation in the amounts of
$250,000.00 for the death benefit, $77,500.00 for pain and suffering, and $712.87 for
unreimbursed expenses in the form of a check payable to Petitioner, as the legal
representative of Thomas Roubik’s estate.3 This amount represents compensation for
all damages that would be available under Section 15(a).
The clerk of the court is directed to enter judgment in accordance with this
decision.4
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 The Proffer indicates that Petitioner will provide documentation showing her appointment as the legal
representative of Thomas Roubik’s estate before any payment is made. Proffer at 2 n.1. Additionally, if
another individual is appointed as the legal representative, payment will be made to that individual. Id.
4 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-01473-UNJ Document 25 Filed 06/21/21 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
JULIE ROUBIK, PERSONAL )
REPRESENTATIVE OF THE )
ESTATE OF THOMAS ROUBIK, )
)
Petitioner, )
) No. 20-1473V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On October 27, 2020, Julie Roubik (“petitioner”), personal representative of the estate of
Thomas Roubik (“decedent”), filed a petition for compensation under the National Childhood
Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act” or “Act”), alleging that
the decedent suffered Guillain-Barré syndrome (“GBS”), as defined in the Vaccine Injury Table,
following administration of an influenza vaccine he received on November 8, 2019; petitioner
further alleged that the decedent passed away due to complications of GBS on January 11, 2020.
See generally Petition. On April 16, 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 GBS Table injury, and the same day, the Chief Special Master
issued a Ruling on Entitlement finding petitioner entitled to compensation. ECF Nos. 15, 16.
I. Items of Compensation
Based upon the evidence, respondent proffers that petitioner should be awarded a lump
sum of $328,212.87 ($250,000.00 for the death benefit; $77,500.00 for pain and suffering; and

Case 1:20-vv-01473-UNJ Document 25 Filed 06/21/21 Page 4 of 5
$712.87 for unreimbursed expenses). This amount represents all elements of compensation to
which petitioner would be entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
Respondent recommends that compensation be awarded to petitioner in the amount of
$328,212.87, in the form of a check payable to petitioner, as the legal representative of the
decedent’s estate.1 Petitioner agrees.
Respectfully submitted,
BRIAN M. BOYNTON
Acting Assistant Attorney General
C. SALVATORE D’ALESSIO
Acting Director
Torts Branch, Civil Division
HEATHER L. PEARLMAN
Acting Deputy Director
Torts Branch, Civil Division
ALEXIS B. BABCOCK
Assistant Director
Torts Branch, Civil Division
/s/ Lauren Kells
LAUREN KELLS
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) 616-4187
Email: Lauren.Kells@usdoj.gov
1 Before payment on a judgment can be made in this case, respondent will require petitioner to
provide documentation establishing her appointment as legal representatives of the decedent’s
estate. If petitioner is not authorized by a court of competent jurisdiction to serve as the legal
representative of the decedent’s estate, then such payment on any judgment shall be made to the
party or parties appointed by a court of competent jurisdiction to serve as legal representative of
the decedent’s estate.
2

Case 1:20-vv-01473-UNJ Document 25 Filed 06/21/21 Page 5 of 5
DATED: May 21, 2021
3