VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_20-vv-01670
Package ID: USCOURTS-cofc-1_20-vv-01670
Petitioner: Lisa Jackson
Filed: 2020-11-24
Decided: 2023-01-30
Vaccine: influenza
Vaccination date: 2019-09-12
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 12500

AI-assisted case summary:
Lisa Jackson filed a petition for compensation on November 24, 2020, alleging she suffered a Shoulder Injury Related to Vaccine Administration (SIRVA) after receiving the influenza vaccine on September 12, 2019. The influenza vaccine is listed on the Vaccine Injury Table, and Ms. Jackson contended that her injury occurred within the Table's timeframe and resulted in residual effects lasting more than six months. The respondent denied that the vaccine caused Ms. Jackson's alleged injury or any other injury, and denied that her condition was a sequela of a vaccine-related injury. The parties subsequently reached a settlement and filed a joint stipulation on December 23, 2022. Chief Special Master Brian H. Corcoran reviewed and adopted the stipulation, awarding Ms. Jackson $12,500.00 as compensation for all damages. This decision was issued on January 30, 2023. Petitioner was represented by Paul R. Brazil of Muller Brazil, LLP, and respondent was represented by Ronalda Elnetta Kosh of the U.S. Department of Justice. The public decision does not describe the specific onset of symptoms, medical tests, treatments, or expert witnesses involved in this case.

Theory of causation field:
Petitioner Lisa Jackson received an influenza vaccine on September 12, 2019, and alleged a Shoulder Injury Related to Vaccine Administration (SIRVA) within the Vaccine Injury Table timeframe, with residual effects lasting over six months. Respondent denied causation. The parties filed a joint stipulation agreeing to settle the case. Chief Special Master Brian H. Corcoran adopted the stipulation, awarding $12,500.00 for all damages. Petitioner was represented by Paul R. Brazil and respondent by Ronalda Elnetta Kosh. The stipulation does not admit that the vaccine caused the injury. The public text does not detail the specific mechanism of injury, expert testimony, or medical evidence presented.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_20-vv-01670-0
Date issued/filed: 2023-01-30
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 12/27/2022) regarding 34 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:20-vv-01670-UNJ Document 38 Filed 01/30/23 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 20-1670V
UNPUBLISHED
LISA JACKSON, Chief Special Master Corcoran
Petitioner,
v. Filed: December 27, 2022
SECRETARY OF HEALTH AND Special Processing Unit (SPU); Joint
HUMAN SERVICES, Stipulation on Damages; Influenza
(Flu) Vaccine; Shoulder Injury
Respondent. Related to Vaccine Administration
(SIRVA).
Paul R. Brazil, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Ronalda Elnetta Kosh, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On November 24, 2020, Lisa Jackson 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 received the influenza (“flu”) vaccine, which vaccine is
contained in the Vaccine Injury Table (the “Table”), 42 C.F.R. § 100.3(a), on September
12, 2019. Petitioner alleges that as a result of receiving the flu vaccine, she suffered a
shoulder injury related to vaccine administration (“SIRVA”) within the Table timeframe. Se
further alleges that she experienced the residual effects of this alleged injury for more
than six months.
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-01670-UNJ Document 38 Filed 01/30/23 Page 2 of 7
Respondent denies that Petitioner sustained a SIRVA Table injury; denies that the
vaccine caused Petitioner’s alleged shoulder injury, or any other injury; and denies that
Petitioner’s current condition is a sequela of a vaccine-related injury.
Nevertheless, on December 23, 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 the following
compensation: a lump sum of $12,500.00 in the form of a check payable to
Petitioner. This amount represents compensation for all items of damages that
would be available under Section 15(a). Stipulation at ¶ 8.
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-01670-UNJ Document 38 Filed 01/30/23 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
LISA JACKSON, )
)
)
Petitioner, )
) No. 20-1670V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEAL TH AND )
HUMAN SERVICES, )
)
Respondent. )
STIPULATION
The parties hereby stipulate to the following matters:
1. Lisa Jackson ("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 an injury allegedly related to petitioner's receipt
of the influenza ("flu") vaccine, which is contained in the Vaccine Injury Table (the "Table"), 42
C.F.R. § 100.3(a).
2. Petitioner received the flu vaccine on September 12, 2019.
3. The vaccine was administered in the United States.
4. Petitioner alleges that as a result of receiving the flu vaccine, she suffered a Shoulder
Injury Related to Vaccine Administration ("SIRVA") within the Table timeframe. She further
alleges that she suffered the residual effects of her alleged injury for more than six months.
I of5

Case 1:20-vv-01670-UNJ Document 38 Filed 01/30/23 Page 4 of 7
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages as a result of her alleged condition.
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the flu
vaccine caused petitioner's alleged shoulder injury, or any other injury; and denies that her
current condition is a sequelae of a vaccine-related injury.
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-2l(a)(l), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of $12,500.00, in the form of a check payable to petitioner, which
represents compensation for all damages that would be available under 42 U.S.C. §
300aa-l 5(a).
9. As soon as practicable after the entry of judgment 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-2l(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.
10. Petitioner and her 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-l 5(g), including State compensation programs, insurance policies, Federal or State
2 ofS

Case 1:20-vv-01670-UNJ Document 38 Filed 01/30/23 Page 5 of 7
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.
I I. Payment made pursuant to paragraph 8 of this Stipulation, and any amount awarded
pursuant to paragraph 9, will be made in accordance with 42 U.S.C. § 300aa-15(i), subject to the
availability of sufficient statutory funds.
12. 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 will be used solely for the benefit of petitioner as contemplated by a
strict construction of 42 U.S.C. § 300aa-15(a) and (d), and subject to the conditions of 42 U.S.C.
§ 300aa-15(g) and (h).
13. 1n return for the payments described in paragraph 8, and any amount awarded
pursuant to paragraph 9, petitioner, in her individual capacity, and on behalf of her heirs,
executors, administrators, successors, or assigns, does forever irrevocably and unconditionally
release, acquit and discharge the United States and the Secretary 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 Injury 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 alleged to have resulted from the flu vaccine
administered on September 12, 2019, as alleged in a Petition filed on November 24, 2020, in the
United States Court of Federal Claims as petition No. 20-J670V.
3 ofS

Case 1:20-vv-01670-UNJ Document 38 Filed 01/30/23 Page 6 of 7
14. If petitioner should die prior to entry ofj udgment, this agreement shall be voidable
upon proper notice of the Court on behalf of either or both of the parties.
15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the United States Court of Federal Claims fails to enter judgment in
conformity with a decision that is in complete conformity with the terms of this Stipulation, then
the parties' settlement and this Stipulation shall be voidable at the sole discretion of either party.
16. 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 9 above. There is absolutely no agreement on the part of the
parties hereto to make any payment or 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.
17. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the flu vaccine caused petitioner's alleged shoulder
injury, or any other injury.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
4 ofS

Case 1:20-vv-01670-UNJ Document 38 Filed 01/30/23 Page 7 of 7
Respectfully submitted,
PETITIONER:
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LISA JACKSON
ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
PETITIONER: OF THE A'ITORNEY GENERAL:
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'1iEAfHER L. PEARLMAN
MULLER BRAZIL Deputy Director
715 Twining Road, Suite 208 Torts Branch
Dresher, PA 19025 Civil Division
Telephone: (215) 885-1655 U.S. Department of Justice
Fax: (215) 885-1644 P.O. Box 146
Email: paul@myvaccinelawyer.com Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OFTHESECRETARYOFHEALTH RESPONDENT:
AND HUMAN SERVICES:
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George R. Grimes - ~~JQ ~'>
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Date:2022.11.2917:34:48-0S'OO'
CDR GEORGE REED GRIMES, M.D., MPH RONALDA E. KOSH
Director, Division of Injury Trial Attorney
Compensation Programs Torts Branch
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, 08N 146B ronalda.kosh@usdoj.gov
Rockville, MD 208S7 (202) 616-4476
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Dated:
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