VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00101
Package ID: USCOURTS-cofc-1_21-vv-00101
Petitioner: Samuel Beyer
Filed: 2021-01-05
Decided: 2024-02-27
Vaccine: influenza
Vaccination date: 2019-11-22
Condition: right shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 98500

AI-assisted case summary:
Samuel Beyer filed a petition for vaccine compensation on January 5, 2021, alleging a right shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 22, 2019. He claimed the injury was a Table injury or, in the alternative, a causation-in-fact injury. The respondent denied that Mr. Beyer sustained a SIRVA or that the vaccine caused his injury. Despite these denials, the parties filed a joint stipulation on January 26, 2024, agreeing to a settlement. Chief Special Master Brian H. Corcoran adopted the stipulation as the decision of the court. Mr. Beyer was awarded $98,500.00 as compensation for all items of damages. The stipulation also addressed future proceedings for attorneys' fees and costs. Petitioner was represented by Jeffrey S. Pop of Jeffrey S. Pop & Associates, and respondent was represented by Bridget Corridon of the U.S. Department of Justice.

Theory of causation field:
Petitioner Samuel Beyer alleged a right shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 22, 2019. He claimed the injury was a Table injury or, alternatively, a causation-in-fact injury. Respondent denied that petitioner sustained a SIRVA, that the vaccine caused the alleged shoulder injury, or that the current condition was a sequela of a vaccine-related injury. The parties filed a joint stipulation agreeing to a settlement, and Chief Special Master Brian H. Corcoran adopted the stipulation as the decision. The award was $98,500.00 as compensation for all items of damages. Petitioner was represented by Jeffrey S. Pop, and respondent was represented by Bridget Corridon. The public decision does not describe the specific mechanism of injury, expert testimony, or detailed clinical findings.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00101-0
Date issued/filed: 2023-03-28
Pages: 7
Docket text: PUBLIC ORDER/RULING (Originally filed: 02/21/2023) regarding 31 Findings of Fact & Conclusions of Law,, Scheduling Order, Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0101V
UNPUBLISHED
SAMUEL BEYER, Chief Special Master Corcoran
Petitioner, Filed: February 21, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Findings of Fact; Site of Vaccination
HUMAN SERVICES, Influenza (Flu) Vaccine; Shoulder
Injury Related to Vaccine
Respondent. Administration (SIRVA)
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Martin Conway Galvin, U.S. Department of Justice, Washington, DC, for Respondent.
FINDINGS OF FACT1
On January 5, 2021, Samuel Beyer 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 he suffered a right shoulder injury related to vaccine
administration (“SIRVA”), as defined in the Vaccine Table, after receiving an influenza
(“flu”) vaccine on November 20, 2019. Petition at 1, ¶ 4. In the alternative, he maintains
that his right shoulder injury was vaccine caused. Id. at 1.
1 Because this unpublished Fact 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 Fact 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 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 2 of 7
For the reasons discussed below, I find the flu vaccine Petitioner received was
most likely administered in his right deltoid, as alleged (although other fact issues remain
to be resolved).
I. Relevant Procedural History
Based upon the prior concern that SIRVA was to be removed from the Vaccine
Injury Table,3 Mr. Beyer filed his petition without medical records in January 2021. Petition
at 1. A few weeks later he filed his signed declaration4 and vaccine record. Exhibits 1-2,
filed Jan. 20, 2021, ECF No. 6. Because the vaccine record did not indicate the site of
vaccination (Exhibit 2), Petitioner was granted subpoena authority to obtain additional
documentation such as his consent form. ECF No. 9. In May 2021, he filed the remainder
of his medical records, a supplemental signed declaration, and amended petition – all
containing the same assertions but supplemented by additional detailed information and
medical records citations. Exhibits 3-17, ECF Nos. 10-11; Amended Petition, ECF No. 12.
A few months later, Petitioner filed the additional documentation obtained from the
vaccine administrator. Exhibits 18-19, filed Aug. 31, 2021, ECF No. 15. Like the initial
vaccine record (which indicated only that the flu vaccine was administered intramuscularly
(Exhibit 2)), this documentation failed to show the site of vaccination. Id.
Following the activation of the case to the “Special Processing Unit” (OSM’s
adjudicatory system for resolution of cases deemed likely to settle) (ECF No. 17),
Petitioner was instructed to file medical records from a previous primary care provider
(“PCP”), additional situs evidence, and a more detailed affidavit and evidence regarding
the Vaccine Act’s severity requirement. ECF No. 20. In response, Petitioner filed a better
copy of his vaccine consent form, additional medical records, briefing on both factual
issues, signed declarations from family and friends, and medical literature. Exhibits 20-
38, Petitioner’s Brief Regarding Situs and Severity Requirement (“Brief”) ECF Nos. 21,
26-27, 29-30.
3 On July 20, 2020, the Secretary of Health and Human Services proposed the removal of SIRVA from the
Vaccine Injury Table. National Vaccine Injury Compensation Program: Revisions to the Vaccine Injury
Table, Proposed Rule, 85 Fed. Reg. 43794 (July 20, 2020). The proposed rule was finalized six months
later. National Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table, Final Rule,
86 Fed. Reg. 6249 (Jan. 21, 2021). Approximately one month later, the effective date for the final rule was
delayed. National Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table, Delay of
Effective Date, 86 Fed. Reg. 10835 (Feb. 23, 2021) (delaying the effective date of the final rule until April
23, 2021). On April 22, 2021, the final rule removing SIRVA from the Vaccine Table was rescinded. National
Vaccine Injury Compensation Program: Revisions to the Vaccine Injury Table, Withdrawal of Final Rule, 86
Fed. Reg. 21209 (Apr. 22, 2021).
4 Petitioner’s declaration is signed under penalty of perjury as required by 28 U.S.C.A. § 1746. Exhibit 1.
2

Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 3 of 7
Because the record as it currently stands contains sufficient evidence regarding
the site of vaccination, I am addressing this issue prior to the HHS review. Before
determining the length of Petitioner’s sequela, however, I will allow Respondent to present
argument on the issue, if desired.
II. Issue
At issue is whether Petitioner received the vaccination alleged as causal in his
injured right deltoid, as alleged.
III. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy
evidence. The records contain information supplied to or by health professionals to
facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in
the balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. “Written records which are, themselves, inconsistent, should be
accorded less deference than those which are internally consistent.” Murphy v. Sec’y of
Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25,
1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd
per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as
incorrect the presumption that medical records are accurate and complete as to all the
patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021).
The United States Court of Federal Claims has outlined four possible explanations
for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
3

Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 4 of 7
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y
of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health
& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998).
The credibility of the individual offering such fact testimony must also be determined.
Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley
v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v.
Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within
the special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
IV. Finding of Fact
I make these findings after a complete review of the record, which includes all
medical records, affidavits or signed declarations, and additional evidence filed.
Specifically, I highlight the following:
• Petitioner (21 years old at the time of vaccination) experienced previous
cervical and neck pain in 2017. Exhibit 9 at 9-10.
4

Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 5 of 7
• In early 2019, his PCP noted diagnoses of asthma, anxiety, and depression.
Exhibit 3 at 35. It also appears he had suffered a concussion previously (id.)
and from a migraine in February 2019 (id. at 10).
• In May 2019, Petitioner was seen by his orthopedist for chronic left upper
chest/shoulder pain which worsened “when reaching up or across [his]
body." Exhibit 4 at 6. The onset of Petitioner’s pain was identified as May 1,
2018. Id. at 8. The results of x-rays - taken that day, were unremarkable,
and Petitioner was instructed to apply ice and take over the counter pain
medication. Id. at 9-10.
• On November 22, 2019, Petitioner received the flu vaccine alleged as
causal at a Rite Aid Pharmacy. Exhibits 2, 19-20. The initial vaccine record
indicates only that the vaccine was administered intramuscularly. Exhibit 2.
Under site of administration, the record indicates “unknown.” Exhibit 2. In
the later provided consent form - containing the usual notation: “Site RA or
LA – Circle One,” neither option was circled. Exhibit 20 at 2 (most legible
copy).
• Ten days post-vaccination (December 2, 2019), Petitioner visited his PCP
complaining of “extreme soreness in his right deltoid” after receiving a flu
shot on November 22nd. Exhibit 3 at 121. Stating that his pain worsened
with abduction and the flexing of his forearm, he indicated he was taking
200mg of Ibuprofen for the pain. Id.
• On January 7, 2020, Petitioner returned to his PCP, now reporting a
worsening of his right arm pain over the last ten days and inability to raise
his arm to a parallel position (abduction) due to pain. Exhibit 3 at 139.
Petitioner again related his pain to the flu vaccine he received on November
22nd at Rite Aid. Id. Concerned that Petitioner may have a rotator cuff or
synovial issue in the glenohumeral joint, the PCP ordered an MRI. Id. This
same history of right shoulder pain after receiving a flu vaccine two months
earlier is found in the record from x-rays taken that day.
• The MRI – performed on January 16, 2020, revealed evidence of fluid within
the bursal and insertional fibers of the infraspinatus tendon near the
humeral attachment and moderate thickening and fluid in the subdeltoid
bursa. Exhibit 3 at 5. The likely cause was noted to be a low-grade
insertional tendon tear, with reactive edema and bursitis. Id. at 6. Localized
acute calcific tendinitis/bursitis was considered, but the MRI report showed
no evidence of calcium on the MRI or x-rays. Id.
5

Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 6 of 7
• When seen by an orthopedist on January 30th, Petitioner reported that he
“had a flu shot around the beginning of Dec. 2019, and his shoulder has
hurt ever since.” Exhibit 4 at 11. In this record, the onset of his right shoulder
pain is described as “[t]he very next day.” Id. at 12. The orthopedist
diagnosed Petitioner with bursitis and administered a Depo-Medrol
injection. Id. at 13.
The above medical entries show that, when seeking treatment for his right shoulder
pain, Petitioner consistently attributed his pain to a vaccination he reported receiving in
his right arm. While originating from Petitioner, these statements are memorialized in
contemporaneous records, and should therefore be afforded greater weight than any
subsequent assertion or witness statement. The Federal Circuit has stated that “[m]edical
records, in general, warrant consideration as trustworthy evidence . . . [as they] contain
information supplied to or by health professionals to facilitate diagnosis and treatment of
medical conditions.” Cucuras, 993 F.2d at 1528 (emphasis added). Thus, and even
though the record in question simply memorializes what the petitioner said at the time, its
contemporaneous nature makes it somewhat more trustworthy than after-the-fact witness
statements prepared in connection with this matter.
The vaccine record clearly establishes that Petitioner received a flu vaccine on
November 22, 2019, but is silent as to the site of administration. Not long thereafter,
however, when seeking medical care for his right shoulder pain, Petitioner consistently
attributed the source of his pain to the flu vaccine. There is a dearth of evidence that the
vaccine was administered in any other location. I thus determine, based on the record
as a whole, that preponderant evidence establishes that the flu vaccine to which
Petitioner attributes his SIRVA was most likely administered in his right deltoid on
November 22, 2019.
V. Sequela of Alleged Injury
To satisfy the Vaccine Act’s severity, Petitioner must establish that he suffered the
residual effects of his injury for more than six months – beyond May 22, 2020, or that he
required inpatient hospitalization and surgical intervention. Section 11(c)(1)(D). Citing the
information contained in his medical records – including the statements of his treating
physicians, signed statements from himself and others, and submitted medical literature,
Petitioner maintains he has provided sufficient evidence of both six-month sequela and
the required surgical intervention. Brief at 14-22.
Petitioner sets forth persuasive arguments to support his assertion that the right
shoulder pain he suffered in the second half of 2020 – following a seven-month gap in
6

Case 1:21-vv-00101-UNJ Document 35 Filed 03/28/23 Page 7 of 7
treatment he attributes to temporary relief obtained from the first steroid injection he
received - was linked to his earlier vaccine-related pain. See, e.g. Brief at 16 (citing Exhibit
4 at 26 containing the orthopedist’s opinion that earlier and later MRIs showed findings in
the same area). And the medical records show that both Petitioner and his treating
physicians viewed this later 2020 pain as a continuation of his earlier condition, despite
the seven-month gap in treatment. See Exhibit 3 at 185-99 (September PCP visit); Exhibit
4 at 23-26 (November orthopedic visit). Moreover, it is common for petitioners to
experience several months of temporary pain relief after receiving a steroid injection.
However, Petitioner also appears to have suffered from some conditions not
necessarily related to the vaccine he received – such as a shoulder labral tear. See, e.g.
Exhibit 24 at 6-8 (results of July 2021 MRI); Exhibit 27 at 78-80 (December 2021 surgery).
And the record clearly indicates he suffered left shoulder, neck, and cervical pain as
recent as early 2019. Exhibit 4 at 6-10. At a minimum, these other potential co-morbidities
will affect the amount of any compensation awarded in this case – and arguably could be
a complete bar to compensation, depending on their resolution.
VI. Scheduling Order
Because the HHS review has not yet been completed in this case, but is likely
occurring now, I will allow Respondent the opportunity to provide his tentative position
and briefing regarding the severity issue - if he believes this requirement has not been
met. However, I encourage the parties to attempt an informal resolution of this case.
Therefore, Petitioner should finalize a reasonable demand - which he may convey, along
with any supporting documentation, to Respondent at any time.
Respondent shall file a status report providing his tentative position
regarding the merits of Petitioner’s case by no later than Wednesday, March 22,
2023. In the status report, he should state whether he believes Petitioner has
satisfied the Vaccine Act’s severity requirement.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
7

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DOCUMENT 2: USCOURTS-cofc-1_21-vv-00101-1
Date issued/filed: 2024-02-27
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 01/26/2024) regarding 50 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0101V
SAMUEL BEYER, Chief Special Master Corcoran
Petitioner, Filed: January 26, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Bridget Corridon, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 5, 2021, Samuel Beyer (“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”). On May 14, 2021, he filed an amended petition. ECF No. 12.
Petitioner alleged that he suffered a right shoulder injury related to vaccine administration
(“SIRVA”), a defined Table injury or, in the alternative, a causation-in-fact injury, after
receiving an influenza (“flu”) vaccine on November 22, 2019. Amended Petition at 1, ¶¶
5, 34; Stipulation, filed Jan. 26, 2024, ¶¶ 1-2, 4. Petitioner further alleged that he received
the vaccine within the United States, that he suffered the residual effects of his injury for
more than six months, and that neither he nor any other person has filed a civil action or
received compensation for his injury. Amended Petition at ¶¶ 5, 35-37; Stipulation at ¶¶
3-5. “Respondent denies that [P]etitioner sustained a SIRVA, as defined in the Table;
denies that the vaccine caused [P]etitioner’s alleged shoulder injury, or any other injury;
1 Because this Decision contains a reasoned explanation for the action taken in this case, it must be made
publicly accessible and will be posted on the United States Court of Federal Claims' website, and/or
at https://www.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Government
Act of 2002. 44 U.S.C. § 3501 note (2018) (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 (2018).

Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 2 of 7
and denies that his current condition is a sequela of a vaccine-related injury.” Stipulation
at ¶ 6.
Nevertheless, on January 26, 2024, 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 $98,500.00 in the form of a check payable to Petitioner.
Stipulation at ¶ 8. This amount represents 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 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 3 of 7
IN THE UNITED ST ATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
SAMUEL BEYER ,
)
)
Petitioner,
) No. 21-I0IV
v.
) Chief Special Master Corcoran
ECF
SECRETARY OF HEAL TH AND HUMAN )
SERVICES, ~
Respondent. )
______________
)
STIPULATION
The parties hereby stipulate to the following matters:
I. Samuel Beyer, 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 injuries allegedly related to petitioner's receipt of the
influenza ("flu") vaccine, which vaccine is contained in the Vaccine Injury Table (the "Table"),
42 C.F.R. § I0 0.3(a).
2. Petitioner received the flu vaccination in his right arm on November 22, 2019.
3. The vaccine was administered within the United States.
4. Petitioner alleges that he suffered a right Shoulder Injury Related to Vaccine
Administration ("SIRVA") as a result of receiving the flu vaccine within the Table time frame,
and that he experienced residual effects of this injury for more than six months.
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages on his behalf as a result of his condition.

Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 4 of 7
6. Respondent denies that petitioner sustained a SIRVA, as defined in the Table; denies
that the vaccine caused petitioner's alleged shoulder injury, or any other injury; and denies that
his 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 of judgment 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-2 I (a)( 1) , the Secretary of Health and Human Services will issue
the following compensation payment:
A lump sum of $98,500.00 in the form of a check payable to petitioner. This
amount 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 ofj udgment 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 his attorney represent that compensation to be provided pursuant to
this Stipulation is not for any items or services for which the Program is not primarily liable
under 42 U.S.C. § 300aa-15(g), to the extent that payment has been made or can reasonably be
expected to be made under any State compensation programs, insurance policies, Federal or
State health benefits programs (other than Title XIX of the Social Security Act (42 U.S.C.
§ 1396 et seq.)), or by entities that provide health services on a pre-paid basis.
2

Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 5 of 7
11. Payment made pursuant to paragraph 8 of this Stipulation, and any amounts awarded
pursuant to paragraph 9 of this Stipulation, will be made in accordance with 42 U.S.C. § 300aa-
l 5(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-l 5(a) and (d), and subject to the conditions of 42 U.S.C.
§§ 300aa-l 5(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in his
individual capacity and on behalf of his 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, 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 IO 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 or about November 22, 2019, as
alleged by petitioner in a petition for vaccine compensation filed on January 5, 2021, in the
United States Court of Federal Claims as petition No. 21-101 V.
14. If petitioner should die prior to entry ofj udgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
3

Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 6 of 7
15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete confonnity 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 to 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 to suffer a
shoulder injury or his current disabilities, or any other injury or condition, or that petitioner
sustained an injury contained in the Vaccine Injury Table.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
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Case 1:21-vv-00101-UNJ Document 54 Filed 02/27/24 Page 7 of 7
Respectfully submitted,
PETITIONER:
s £ ~
ATTORNEY OF RECORD FOR AUTHORIZED REPRSENTA TJVE
PETITIONER: OF THE ATTORNEY GENERAL:
--MJ~~pl ~
JE~ HEATHER L. PEARLMAN
Jeffrey S. Pop & Associates Deputy Director
9150 Wilshire Blvd., Suite 241 Torts Branch
Beverly Hills, CA 90212 Civil Division
{310) 273-5462 U.S. Department of Justice
E-mail: jpop@poplawyer.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SEC~ETARY OF HEALTH RESPONDENT:
AND HUMAN SERVICES:
George R. Dlgltally signed by
George R. Grimes -S14
Grimes-S14 Date: 2024.01.09 12:20:14 ~mo~~
-05'00'
IV)
CDR GEORGE REED GRIMES, MD, MPH
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 FrankJin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08W-25A Tel: (202) 305-4117
Rockville, MD 20857 E-mail: Bridget.Corridon@usdoj.gov
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Dated:
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