VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00178
Package ID: USCOURTS-cofc-1_21-vv-00178
Petitioner: Jacob Kovarskiy
Filed: 2021-01-07
Decided: 2023-03-13
Vaccine: Tdap
Vaccination date: 2020-02-19
Condition: shoulder injury related to vaccine administration
Outcome: compensated
Award amount USD: 47500

AI-assisted case summary:
On January 7, 2021, Jacob Kovarskiy filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that he suffered a shoulder injury related to vaccine administration (SIRVA) as a result of a tetanus, diphtheria, and acellular pertussis (Tdap) vaccine administered on February 19, 2020. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on March 1, 2023, conceding that the petitioner's claim met the Table criteria for SIRVA and that the petitioner satisfied the statutory and jurisdictional requirements. On March 13, 2023, Chief Special Master Brian H. Corcoran issued a ruling on entitlement, finding the petitioner entitled to compensation. Subsequently, on March 13, 2023, the respondent filed a proffer recommending an award of $47,500.00 for pain and suffering, which the petitioner agreed to. The public decision, also issued on March 13, 2023, by Chief Special Master Corcoran, awarded the petitioner a lump sum payment of $47,500.00 for pain and suffering. Petitioner was represented by Leah VaSahnja Durant of the Law Offices of Leah V. Durant, PLLC, and the respondent was represented by Jamica Marie Littles of the U.S. Department of Justice. The public decision does not describe the specific onset of symptoms, medical examinations, or treatments received by the petitioner.

Theory of causation field:
Petitioner Jacob Kovarskiy alleged a Shoulder Injury Related to Vaccine Administration (SIRVA) following a Tetanus, Diphtheria, and acellular Pertussis (Tdap) vaccine administered on February 19, 2020. The respondent conceded that the claim met the Table criteria for SIRVA. The case resulted in a compensated outcome. The theory of causation relied on the "Table" provision of the Vaccine Injury Table. No specific medical experts were named in the provided text. The respondent filed a proffer recommending an award of $47,500.00 for pain and suffering, which the petitioner agreed to. Chief Special Master Brian H. Corcoran issued the ruling on entitlement on March 13, 2023, and the decision awarding damages on March 13, 2023. Petitioner was represented by Leah VaSahnja Durant and respondent by Jamica Marie Littles.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00178-0
Date issued/filed: 2023-04-17
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/13/2023) regarding 33 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00178-UNJ Document 38 Filed 04/17/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0178V
UNPUBLISHED
JACOB KOVARSKIY, Chief Special Master Corcoran
Petitioner, Filed: March 13, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Tetanus Diphtheria
acellular Pertussis (Tdap) Vaccine;
Respondent. Shoulder Injury Related to Vaccine
Administration (SIRVA)
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Jamica Marie Littles, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On January 7, 2021, Jacob Kovarskiy 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 that he suffered a shoulder injury related to vaccine
administration (“SIRVA”) as a result of a tetanus, diphtheria, and acellular pertussis
(“Tdap”) vaccine administered on February 19, 2020. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On March 1, 2023, 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.
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 1:21-vv-00178-UNJ Document 38 Filed 04/17/23 Page 2 of 2
Specifically, Respondent has “concluded that petitioner’s claim meets the Table criteria
for SIRVA.” Id. at 6. Respondent further agrees that Petitioner has satisfied the statutory
and jurisdictional requirements. 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_21-vv-00178-1
Date issued/filed: 2023-04-18
Pages: 4
Docket text: PUBLIC DECISION (Originally filed: 03/13/2023) regarding 34 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00178-UNJ Document 39 Filed 04/18/23 Page 1 of 4
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0178V
UNPUBLISHED
JACOB KOVARSKIY, Chief Special Master Corcoran
Petitioner, Filed: March 13, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Damages Decision Based on Proffer;
HUMAN SERVICES, Tetanus Diphtheria acellular
Pertussis (Tdap) Vaccine; Shoulder
Respondent. Injury Related to Vaccine
Administration (SIRVA)
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Jamica Marie Littles, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On January 7, 2021, Jacob Kovarskiy 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 shoulder injury related to vaccine
administration (“SIRVA”) as a result of a tetanus, diphtheria, and acellular pertussis
(“Tdap”) vaccine administered on February 19, 2020. Petition at 1. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On March 13, 2023, a ruling on entitlement was issued, finding Petitioner entitled
to compensation for SIRVA. On March 13, 2023, Respondent filed a proffer on award of
compensation (“Proffer”) indicating Petitioner should be awarded $47,500.00 in pain and
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 1:21-vv-00178-UNJ Document 39 Filed 04/18/23 Page 2 of 4
suffering. Proffer at 1-2. In the Proffer, Respondent 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 attached Proffer, I award Petitioner a lump
sum payment of $47,500.00 (for pain and suffering) in the form of a check payable
to Petitioner. This amount represents compensation for all damages that would be
available under Section 15(a).
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-00178-UNJ Document 39 Filed 04/18/23 Page 3 of 4
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
JACOB KOVARSKIY,
Petitioner, No. 21-178V
Chief Special Master Corcoran
v. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On January 7, 2021, Jacob Kovarskiy (“petitioner”) 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”), as amended. See ECF No. 1. Petitioner alleges that he suffered a left
Shoulder Injury Related to Vaccine Administration (“SIRVA”), as defined in the Vaccine Injury
Table, following administration of a tetanus, diphtheria, and acellular pertussis (“Tdap”) vaccine
that he received on February 19, 2020. Petition at 1-2. Petitioner alternatively alleges that his
2020 Tdap vaccination caused in fact and/or significantly aggravated his left shoulder injury. Id.
at 1-2. On March 1, 2023, 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 SIRVA Table injury. ECF No. 31.
I. Items of Compensation
Pain and Suffering
Based on the evidence of record, respondent proffers that petitioner should be awarded
$47,500.00 in pain and suffering. See 42 U.S.C. § 300aa-15(a)(4). This amount represents all

Case 1:21-vv-00178-UNJ Document 39 Filed 04/18/23 Page 4 of 4
elements of compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a). 1
Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the Court provide petitioner a lump sum payment of $47,500.00, in
the form of a check payable to petitioner. Petitioner agrees.
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
LARA A. ENGLUND
Assistant Director
Torts Branch, Civil Division
/s/ Jamica M. Littles
JAMICA M. LITTLES
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) 305-4014
Email: jamica.m.littles@usdoj.gov
Dated: March 13, 2023
1 Should petitioner die prior to the 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