VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00200
Package ID: USCOURTS-cofc-1_21-vv-00200
Petitioner: Jennifer Rivera
Filed: 2021-01-07
Decided: 2023-01-17
Vaccine: Tdap
Vaccination date: 2020-04-14
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 61782

AI-assisted case summary:
Jennifer Rivera filed a petition for compensation under the National Vaccine Injury Compensation Program on January 7, 2021, alleging that she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of a Tdap vaccine administered on April 14, 2020. She stated that she received the vaccine in the United States, experienced residual effects for more than six months, and had no prior award or settlement for her condition. Respondent denied that Ms. Rivera sustained a SIRVA Table injury, denied that the vaccine caused her alleged shoulder injury or any other injury, and denied that her current condition was a sequela of a vaccine-related injury. Despite these denials, the parties filed a joint stipulation on November 30, 2022, agreeing that compensation should be awarded. The Chief Special Master found the stipulation reasonable and adopted it as the decision awarding damages. Ms. Rivera was awarded a lump sum of $57,500.00 payable to her, and an additional $4,282.85 to reimburse a Medicaid lien for services rendered, payable jointly to her and the New York State Department of Health. This total award of $61,782.85 represents compensation for all items of damages available under Section 15(a) of the Vaccine Act.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00200-0
Date issued/filed: 2023-01-17
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 12/13/2022) regarding 47 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kp) Service on parties made.
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Case 1:21-vv-00200-UNJ Document 50 Filed 01/17/23 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0200V
UNPUBLISHED
JENNIFER RIVERA, Chief Special Master Corcoran
Petitioner, Filed: December 13, 2022
v.
Special Processing Unit (SPU); Joint
SECRETARY OF HEALTH AND Stipulation on Damages; Tetanus
HUMAN SERVICES, Diphtheria acellular Pertussis (Tdap)
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Administration (SIRVA)
Bruce William Slane, Law Office of Bruce W. Slane, P.C., White Plains, NY, for
Petitioner.
Madelyn Weeks, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 7, 2021, Jennifer Rivera 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 a shoulder injury related to vaccine
administration (“SIRVA”) as a result of a tetanus-diphtheria-acellular pertussis (“Tdap”)
vaccine that was administered on April 14, 2020. Petition at 1; Stipulation, filed on
November 30, 2022, at ¶¶ 2, 4. Petitioner further alleges that she received the vaccine in
the United States, that she experienced the residual effects of her injury for more than six
months, and there has been no prior award or settlement of a civil action for damages as
a result of her alleged condition. Petition at 1, 16; Stipulation at ¶¶ 3-5. “Respondent
denies that petitioner sustained a SIRVA Table injury; denies that the vaccine caused
petitioner’s alleged shoulder injury, neurological injuries, or any other injury; and denies
that her current condition is a sequela of a vaccine-related injury.” Stipulation at ¶ 6.
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-00200-UNJ Document 50 Filed 01/17/23 Page 2 of 8
Nevertheless, on November 30, 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. A lump sum of $$57,500.00 in the form of a check payable to Petitioner;
and
B. A lump sum of $4,282.85, representing reimbursement of a Medicaid lien for
services rendered to Petitioner, in the form of a check payable jointly to
petitioner and the New York State Department of Health:
New York State Department of Health
PO Box 415874
Boston, MA 02241-5874
Case #178497
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

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