VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00248
Package ID: USCOURTS-cofc-1_21-vv-00248
Petitioner: Nathan Mostow
Filed: 2021-01-07
Decided: 2025-08-15
Vaccine: influenza
Vaccination date: 2020-01-04
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: dismissed
Award amount USD: 

AI-assisted case summary:
Nathan Mostow filed a petition alleging that he suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine he received on January 4, 2020. He sought compensation under the National Vaccine Injury Compensation Program, alleging a Table injury. The court reviewed the medical records and declarations submitted by Mr. Mostow and the respondent. The primary issue was whether the onset of Mr. Mostow's shoulder pain occurred within 48 hours of vaccination, as required for a Table SIRVA claim. Contemporaneous medical records indicated that his pain began insidiously weeks prior to vaccination or around December 27, 2019, which predates the January 4, 2020 vaccination. While Mr. Mostow and his wife provided declarations alleging immediate post-vaccination onset, the court found these declarations were inconsistent with the medical records and were drafted after the claim was initiated. The court also noted that Mr. Mostow did not attribute his pain to the vaccination during numerous medical visits over the following year. Consequently, the court found that Mr. Mostow failed to establish by a preponderance of the evidence that his injury manifested within 48 hours of vaccination. His Table claim was therefore dismissed, though the case was not dismissed in its entirety, allowing for the possibility of pursuing an off-Table, causation-in-fact claim.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00248-0
Date issued/filed: 2025-08-15
Pages: 12
Docket text: PUBLIC ORDER/RULING (Originally filed: 07/07/2025 ) regarding 43 Findings of Fact & Conclusions of Law, Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00248-UNJ Document 46 Filed 08/15/25 Page 1 of 12
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-248V
NATHAN MOSTOW, Chief Special Master Corcoran
Petitioner,
v. Filed: July 7, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jeffrey S. Pop, Jeffrey S. Pop & Associates, Beverly Hills, CA, for Petitioner.
Nina Ren, U.S. Department of Justice, Washington, DC, for Respondent.
FACT RULING DISMISSING TABLE CLAIM1
On January 7, 2021, Nathan Mostow filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), alleging that he suffered a shoulder injury related to vaccine administration
(“SIRVA”) – a Table injury – as a result of an influenza (“flu”) vaccine administered to him
on January 4, 2020.3 Pet. at 1, ECF No. 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters (the “SPU”).
For the reasons set forth below, I find it more likely than not that the onset of
Petitioner’s injury did not occur within 48 hours of vaccination. Petitioner’s Table claim is
1 Because this Ruling 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 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).
3 Petitioner alternatively alleges that his subject flu vaccination was the cause-in-fact of his SIRVA. Am.
Pet. at 1, ECF No. 12.

Case 1:21-vv-00248-UNJ Document 46 Filed 08/15/25 Page 2 of 12
therefore DISMISSED (although the matter may remain viable as a causation-in-fact
claim).
I. Relevant Procedural History
Upon Respondent’s medical review of the instant claim, the parties made a
tentative effort to settle the case but were ultimately unsuccessful. See ECF Nos. 30-34.
Respondent thereafter filed his Rule 4(c) Report defending this case in July 2023, arguing
that the filed record does not support a showing of 48-hour onset. ECF No. 36 at 7
(internal citations omitted). I thereafter issued an Order to Show Cause, highlighting the
specific deficiencies in the record related to Petitioner’s ability to establish Table-
consistent onset. ECF No. 37.
In response (and following one extension of time (ECF No. 38)), Petitioner
submitted two supplemental declarations – one authored by his wife, and the other from
Petitioner himself. ECF No. 39. He also submitted a written brief, arguing that he can
establish a Table SIRVA claim. ECF No. 40. Respondent subsequently filed his response
maintaining his argument that the evidence does not support Table onset. ECF No. 41.
Petitioner filed his reply in June 2024. ECF No. 42. This matter is now ripe for
consideration.
II. Relevant Medical Evidence
I have reviewed all of the medical records and evidence filed to date. Only such
information related to onset will be discussed herein.
Respondent does not dispute that Petitioner’s medical history is noncontributory,
and that he “was not being seen by a health care provider for left shoulder concerns”
around the time of vaccination.4 ECF No. 41 at 2 (citing Ex. 11 at 11-12; Ex. 26 at 7-8).
However, Respondent highlights that Petitioner was using an upper body ergometer
(“UBE”) – a device “designed to train or rehabilitate the upper body” - both pre and post
vaccination. Id. (citing Ex. 26 at 7-8; Ex. A (defining an UBE)).
At age 73, Petitioner received the flu vaccine alleged as causal on January 4, 2020.
Ex. 2 at 2. Petitioner’s first post-vaccination visit for left shoulder pain occurred on January
17, 2020 (13 days post vaccination), with an orthopedist (Dr. Bottiglieri). Ex. 4 at 10. Dr.
Bottiglieri noted that Petitioner’s left shoulder “[p]ain began INSIDIOUSLY week [sic] ago.”
4 For instance, Petitioner had a December 26, 2019 cardiology visit and did not mention left shoulder
complaints; and during a December 30, 2019 annual PCP visit, he likewise did not complain of left shoulder
symptoms. Ex. 11 at 11-12; Ex. 26 at 7-8.
2

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Id. (emphasis in original). Petitioner “state[d] that the only thing that he feels may have
provoked [the] pain would be using the UBE. He denie[d] trauma/injury.” Id. Petitioner
underwent an x-ray during this visit (which showed glenohumeral osteoarthritis), with the
reason being listed as “left shoulder pain for 3 weeks with decreased range of motion
[(“ROM”)]” – which would have been since December 27, 2019 (meaning prior to
vaccination). Id. at 14. Petitioner did not attribute the pain to his vaccination at this time.
On January 27, 2020, Petitioner presented for an initial physical therapy (“PT”)
evaluation. Ex. 5 at 105. On the intake form, Petitioner wrote that his pain began a “month
ago” (meaning around December 27, 2019) – but he did not describe the date of onset
with any more particularity. Id. Petitioner was asked to document how the injury occurred,
to which he handwrote “unknown.” Id. The visit notes at the time of Petitioner’s discharge
from PT on February 24, 2020, list the date of onset of his injury as “12/28/2019[,]” and
state that he had “not responded to therapy as his rotator cuff is clinically torn.” Id. at 188.
Between February 14 and August 19, 2020, Petitioner had several follow-up visits
for left shoulder symptoms – a majority with his orthopedist, Dr. Bottiglieri. See, e.g., Ex.
4 at 85 (a February 14, 2020 orthopedic visit, concluding with an assessment of rotator
cuff tendinitis, impingement, subacromial subdeltoid bursitis, and reactive biceps
tendinitis); Ex. 4 at 82 (an April 2, 2020 orthopedic telehealth visit with an assessment
including chronic rotator cuff tendinopathy/arthropathy); Ex. 11 at 9-10 (a June 2, 2020
cardiology visit); Ex. 4 at 79 (a June 12, 2020 orthopedic visit with an assessment
including adhesive capsulitis secondary to chronic rotator cuff tendinosis); Ex. 4 at 78 (a
June 24, 2020 telehealth orthopedic visit); Ex. 6 at 5 (a July 6, 2020 visit with a hand
surgeon); Ex. 4 at 77 (a July 17, 2020 orthopedic visit); Ex. 4 at 69 (an August 19, 2020
telehealth orthopedic visit). Petitioner did not mention the date of onset or attribute his
pain to the subject flu vaccination at any of these visits.
Notably, during a September 16, 2020 initial evaluation with an orthopedic
surgeon, Petitioner complained of “chronic left shoulder pain,” noting his ongoing pain at
night. Ex. 4 at 65. He did not link his pain to the subject vaccination at this time, however,
or otherwise describe the duration or onset of his pain. See id. The assessment included
left shoulder rotator cuff tendinosis and mild arthritis. Id. Petitioner attended regular follow-
up orthopedic visits with Dr. Bottiglieri through December 2020 – still without linking his
pain to the flu vaccine. See, e.g., id. at 54, 64; Ex. 7 at 5-6; Ex. 24 at 12-13.
A year after vaccination, on January 6, 2021 (one day before the filing of this claim),
Petitioner saw his primary care provider (“PCP”) for an annual visit and now complained
of left shoulder pain after receiving a flu shot “in Jan[uary].” Ex. 26 at 10. Petitioner
described “pain at shot site.” Id. The visit note does not contain a date of onset.
3

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After initiating his claim, and during a July 23, 2021 orthopedic follow-up visit with
Dr. Bottiglieri, Petitioner “reviewed with [Dr. Bottiglieri] today as [sic] history of SIRVA after
flu vaccine.” Ex. 32 at 16. After assessing Petitioner with “SIRVA left shoulder,” rotator
cuff tendinitis-chronic, cervical spondylosis, and subscapular bursitis, under “plan” Dr.
Bottiglieri noted that he “reviewed [Petitioner’s] history with him in relation to post vaccine
left shoulder pain[.]” Id. Thus, this is the first time the term “SIRVA” was used to describe
Petitioner’s injury – though the date of onset is not included.
Also after initiating his claim, on July 27, 2021, Petitioner submitted a letter
authored by Dr. Bottiglieri, dated July 23, 2021. Ex. 31. Dr. Bottiglieri wrote that during
Petitioner’s first visit with him on January 17, 2020, Petitioner “indicated that his pain
began after he received a flu vaccine from his local pharmacy in the arm in question a
couple of weeks earlier.” Id. Dr. Bottiglieri also wrote that Petitioner “questioned if the
vaccine could be the cause of his discomfort” at that time. Id. No other medical records
related to the onset of Petitioner’s left shoulder symptoms have been filed.
III. Declaration Evidence
In his original declaration, Petitioner states that “[s]hortly following the flu
vaccination, [he] developed left shoulder soreness and pain.” Ex. 1 ¶ 5. “The day following
[his] vaccination,” he maintains, his pain “continued[,]” and “[w]ithin a few days” worsened,
leading to shoulder stiffness. Id. Specifically, he had “noticeable left shoulder pain and
soreness within a day of getting [his] flu shot,” and he called his orthopedist’s office within
a few days to schedule an appointment. Ex. 27 ¶ 6. While waiting for an appointment, he
used ice packs and Tylenol to treat his shoulder pain. Id.
Despite a contrary indication in the medical records, Petitioner maintains that he
told Dr. Bottiglieri on January 17, 2020, that he had left shoulder pain “since receipt of the
flu vaccination.” Ex. 1 ¶ 6. And in response, Dr. Bottiglieri told Petitioner that he “believes
vaccinations should be administered into the buttocks rather than shoulders.” See id.; see
also Ex. 27 ¶ 7.
In his supplemental declaration, drafted in 2024 and in response to my Order to
Show Cause, Petitioner explains that during his first visit with Dr. Bottiglieri (on January
17, 2020), he “provided an estimate of when onset of [his] pain occurred and estimated
three weeks even though [his] flu shot was given closer to two weeks before [his]
appointment.” Ex. 34 ¶ 9. He emphasizes it was a “rough estimate[,]” as was the estimate
he gave during his first PT visit of onset in “early January.” Id. ¶¶ 9-10. Additionally,
Petitioner asserts that his “shoulder pain did not predate receiving [his] flu shot.” Id. ¶¶ 9-
10, 12.
4

Case 1:21-vv-00248-UNJ Document 46 Filed 08/15/25 Page 5 of 12
Also following my Order to Show Cause, Petitioner’s wife submitted a declaration
wherein she states that when Petitioner “came home from getting his shot he told [her]
that his shoulder was hurting[.]” Ex. 35 ¶ 6. She recalls that “[w]ithin a day of getting his
shot, [she] had to help him put on his outer jacket because he could not move his left arm
back to get it through the arm sleeve.” Id. ¶ 9. She had to assist him putting on his coat
“for the remainder of the winter.” Id. ¶ 10. No other declaration evidence regarding the
onset of Petitioner’s pain has been submitted.
IV. 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). In addition to requirements concerning the vaccination received, the
duration and severity of petitioner’s injury, and the lack of other award or settlement,5 a
petitioner must establish that she suffered an injury meeting the Table criteria, in which
case causation is presumed, or an injury shown to be caused-in-fact by the vaccination
she received. Section 11(c)(1)(C).
Section 11(c)(1) also contains requirements concerning the type of vaccination
received and where it was administered, the duration or significance of the injury, and the
lack of any other award or settlement. See Section 11(c)(1)(A), (B), (D), and (E). With
regard to duration, a petitioner must establish that he suffered the residual effects or
complications of such illness, disability, injury, or condition for more than six months after
the administration of the vaccine. Section 11(c)(1)(D).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of an influenza vaccine. 42 C.F.R. § 100.3(a)(XIV)(B). A
vaccine recipient shall be considered to have suffered SIRVA if such recipient manifests
all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
5 In summary, a petitioner must establish that she received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception; suffered the residual effects of her injury for more than six months, died from her injury, or
underwent a surgical intervention during an inpatient hospitalization; and has not filed a civil suit or collected
an award or settlement for her injury. See § 11(c)(1)(A)(B)(D)(E).
5

Case 1:21-vv-00248-UNJ Document 46 Filed 08/15/25 Page 6 of 12
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
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, the
Federal Circuit has recently “reject[ed] as incorrect the presumption that medical records
are always accurate and complete as to all of the patient’s physical conditions.” Kirby v.
Sec'y of Health & Hum. Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021). Medical
professionals may not “accurately record everything” that they observe or may “record
only a fraction of all that occurs.” Id.
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 at 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 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).
6

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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
Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 204 (2013) (citing § 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).
V. Respondent’s Objections and Findings of Fact
A. Factual Findings Regarding QAI Criteria for Table SIRVA
After a review of the entire record, I find that a preponderance of the evidence
demonstrates that Petitioner has failed to establish one QAI requirement for a Table
SIRVA. As a result, his Table claim cannot succeed.
1. Prior Condition
The first QAI requirement for a Table SIRVA is lack of a history revealing problems
associated with the affected shoulder which were experienced prior to vaccination and
would explain the symptoms experienced after vaccination. 42 C.F.R. § 100.3(c)(10)(i).
Respondent has not disputed that Petitioner can satisfy this Table criterion,6 and without
sufficient evidence to the contrary I find this requirement met.
6 In arguing that Petitioner cannot establish Table-consistent onset, Respondent argues (in part) that
Petitioner’s contemporaneous medical records place the onset of his left shoulder pain as pre-dating the
subject vaccination. Respondent’s Response at 7 (internal citations omitted). He has not, however, explicitly
raised a dispute concerning whether Petitioner had pre-existing shoulder pain that would explain his post-
vaccination condition, but rather agrees that Petitioner was not under the care of a physician at the time of
his receipt of the subject vaccination. Id. at 2.
7

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2. Onset of Pain
A petitioner alleging a SIRVA claim must also show that he experienced the first
symptom or onset within 48 hours of vaccination (42 C.F.R. § 100.3(a)(XIV)(B)), and that
his pain began within that same 48-hour period (42 C.F.R. § 100.3(c)(10)(ii) (QAI
criteria)). Respondent argues that the “only evidence that specifically places [P]etitioner’s
shoulder symptoms as beginning within the required timeframe lies in his and his
spouse’s declarations.” Respondent’s Response at 5.
Specifically, Respondent argues that the contemporaneous medical records show
that for “almost an entire year,” and over the course of approximately 20 medical visits,
Petitioner sought treatment for his left shoulder without attributing his symptoms to his
vaccination. Respondent’s Response at 6-7 (internal citations omitted) (emphasis added).
He thereafter provided “various estimates” of when his shoulder pain began, attributed
such pain to other or “unknown” causes, and/or did not link his pain to the vaccination
until the day before this claim’s initiation. Id. Respondent thus argues that the declaration
statements and treater letter filed in support of litigation (alleging immediate pain)
“contradict” the contemporaneous medical records, and should be afforded “far less
weight.” Id. at 7-8. Further, Respondent asserts that Petitioner’s suspicion that his pain
stemmed from the use of the UBE likewise “refutes his [declaration] that he immediately
suspected the flu vaccination.” Id. at 9.
The specific issue of determining the onset of symptoms in a SIRVA case has
arisen repeatedly. Important to that point, the Vaccine Act instructs that the special master
may find the time period for the first symptom or manifestation of onset required for a
Table Injury is satisfied “even though the occurrence of such symptom or manifestation
was not recorded or was incorrectly recorded as having occurred outside such a period.”
Section 13(b)(2). However, consistent with Petitioner’s burden of proof overall, that finding
must be supported by preponderant evidence. Id.
Here, despite Petitioner’s declaration contentions, Petitioner’s medical records do
not provide any support for onset occurring within 48 hours of vaccination.7 For instance,
during Petitioner’s first post-vaccination visit for left shoulder pain (on January 17, 2020),
Dr. Bottiglieri recorded that Petitioner’s pain began “INSIDIOUSLY week [sic] ago.” Ex. 4
at 10. The parties reasonably dispute the meaning of this entry: whether it literally can be
read as “a” week ago (as initially suggested in my Order to Show Cause), or “weeks” ago
– consistent with the x-ray note from the same day that states Petitioner had “left shoulder
7 In fact, Petitioner himself acknowledged that “the medical records cannot pinpoint onset exactly on
January 4-6, 2020,” but urged that the declarations should carry his burden for a finding of Table-consistent
onset. Reply at 3.
8

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pain for 3 weeks” (Ex. 4 at 14).8 But I do find it necessary to definitively resolve the
meaning of this entry, because it does not support 48-hour onset regardless of its
interpretation. Thus, if the notation is interpreted as onset occurring “a” week prior to this
visit, that would place onset around January 10, 2020 (six days post vaccination). On the
other hand, if it is interpreted as “weeks” ago, that would place onset around December
27, 2019 – pre-vaccination. Neither interpretation supports 48-hour onset. And, most
notably, Petitioner did not link his left shoulder pain to the subject vaccination at all during
this visit.
While Petitioner offered his own declarations and a letter from his treating
orthopedist to overcome (in part) this missing link, such filings deserve little weight. For
example, Dr. Bottiglieri’s July 2021 letter describes Petitioner’s January 17, 2020 visit and
asserts that Petitioner reported pain beginning “after” a vaccination “a couple of weeks
earlier,” – thus fitting the timeline created by the ambiguousness in the medical record (“a
couple of weeks,” with the vaccination being 13 days prior). But the letter was crafted
after the claim’s initiation - and over a year-and-a-half after the original visit. See generally
Ex. 31. More so, Petitioner’s declarations maintaining that he told Dr. Bottiglieri of pain
linked to the subject vaccine far earlier, but that this reference was not included in the
actual record, do not make a compelling point. Ex. 1 ¶ 6; Ex. 27 ¶ 7. Not only were his
declarations also drafted over a year after this visit and in pursuit of litigation, but
Petitioner’s statements contrast with the medical records. In fact, the visit notes from the
January 2020 encounter reflect that Petitioner posited a potential cause of his pain aside
from the subject vaccination, and that he explicitly “denie[d] trauma/injury.” Ex. 4 at 10. It
is unlikely that Dr. Bottiglieri would have recorded a purported origin of Petitioner’s pain
but without also noting Petitioner’s link to the subject vaccination if it had been raised, as
alleged.
More so, some of Petitioner’s other contemporaneous medical records reflect an
onset before his January 4, 2020 vaccination. See, e.g., Ex. 5 at 105 (a January 27, 2020
PT evaluation note reporting onset a “month ago” – or around December 27, 2019); Ex.
5 at 188 (a February 24, 2020 PT discharge note reflecting onset on “12/28/2019”). These
consistent reports of the onset of Petitioner’s pain beginning around December 27-28,
2019, (pre-vaccination) thus fail to provide support for 48-hour onset. Although I credit
Petitioner’s assertions in his declarations that such reports might reflect mere “estimates”
of when his pain began, the reports nonetheless contradict a finding of post-vaccination
onset. This is especially troublesome when more often than not in the Vaccine Program,
petitioners who are successful in establishing Table onset estimate the beginning of their
8 I am not persuaded by Petitioner’s argument that the varying interpretation of this entry creates an
inconsistency in the medical records. Petitioner’s Br. at 14. Rather, consistent with his own
acknowledgment, if the entry is interpreted to mean “weeks” ago – a reasonable interpretation put forth by
Petitioner himself – that is consistent with the latter x-ray note describing onset three weeks earlier.
9

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injury at least around the general timeframe of vaccination, often without proposing a time
of onset that preceded the vaccine in question. See, e.g., Callies v. Sec’y of Health &
Hum. Servs., No. 22-301V, 2024 WL 5408181, at *3-4 (Fed. Cl. Spec. Mstr. Dec. 19,
2024) (finding a petitioner satisfied the Table onset requirement where, despite a delay
in seeking care, she related the onset of her pain to the subject vaccination at her first
visit for shoulder complaints and provided a general timeframe of onset “since” her receipt
of the vaccine, including providing the correct month and year corresponding to the
vaccine in question).
Relatedly, the argument that because Petitioner attended two visits around late
December 2019 without mentioning issues in the vaccinated shoulder, his rough
estimates on when his pain began (late December 2019), are consistent with a January
4, 2020 onset, and therefore merit weight, is not persuasive. See, e.g., Petitioner’s Br. at
18-19. The mere absence of a complaint of symptoms in the left shoulder prior to
vaccination, followed by post-vaccination reports of shoulder pain, is not sufficient to
satisfy Petitioner’s burden for Table-consistent onset here.
Most detrimental to Petitioner’s Table onset claim is the fact that the medical
records in which Petitioner first attributed his pain to his vaccination were from treatment
obtained more than a year after vaccination – and on the eve of the claim’s initiation. Ex.
26 at 10. Petitioner’s January 6, 2021 complaint to his PCP of shoulder pain after a flu
shot “in Jan[uary]” of the previous year is the first mention of a timeframe for the onset of
Petitioner’s left shoulder pain attributable to his vaccination in the medical records. Ex. 26
at 10. This report came at the tail end of his left shoulder treatment. Likewise, by the July
23, 2021 visit, when Petitioner’s orthopedist first “reviewed” Petitioner’s “history of SIRVA
after flu vaccine” (Ex. 32 at 16), this claim had been pending for over six months. Still, it
similarly does not place onset as beginning within 48 hours of the subject vaccination and
thus does not advance Petitioner’s argument with respect to Table onset.
Petitioner’s contentions of immediate pain following his receipt of the subject flu
vaccination in his declarations (Exs. 1, 27, 34) are ultimately inconsistent with his
treatment course consisting of over 20 visits, mostly with his orthopedist, without once
mentioning his January 2020 vaccination. Not only did Petitioner not offer his vaccination
as a potential cause of his pain, but he wholly did also not even mention his prior receipt
of a flu vaccine to any of his treaters throughout his treatment course. It indeed strains
credulity to believe that then, one day prior to initiation of the instant claim and thereafter,
Petitioner questioned to his treaters if his discomfort was a result of a flu vaccine, thus
recalling the missing causal link even after previously asserting it was “unknown” or a
result of the use of his UBE. Ex. 4 at 10; Ex. 5 at 105 (reverse order). Petitioner and his
10

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treater’s notations from 2021, more than a year after the original visit (and beyond), thus
cannot overcome the contemporaneous records closest in time to vaccination.
Finally, as with Petitioner’s declarations, I cannot find Petitioner’s wife’s declaration
(describing immediate post-vaccination onset) overcomes the significant weight of the
filed medical records in this case, as it was drafted in direct response to my Order to Show
Cause. See generally Ex. 35. To the extent that the declaration describes Petitioner’s
pain and difficulties during the early winter of 2020, I will award it some weight, but I do
not find it sufficient to carry Petitioner’s burden for a showing of Table onset here.
In light of the above, there is not preponderant evidence that Petitioner
experienced left shoulder pain within 48 hours of his January 4, 2020 flu vaccination.
3. Scope of Pain and Limited Range of Motion
The third QAI requirement for a Table SIRVA requires a petitioner’s pain and
reduced range of motion to be “limited to the shoulder in which the intramuscular vaccine
was administered.” 42 C.F.R. § 100.3(c)(10)(iii). Respondent has not contested this
criterion and there is no evidence in the filed record to suggest it cannot be met.
4. Other Condition or Abnormality
The last QAI criteria for a Table SIRVA states that there must be no other condition
or abnormality which would explain a petitioner’s current symptoms. 42 C.F.R. §
100.3(c)(10)(iv). Respondent likewise has not disputed this criterion, and I do not find the
record reveals sufficient evidence to find this requirement not met.
Conclusion
At bottom, it is the overall mix of evidence herein that causes me to find Petitioner’s
Table claim cannot be preponderantly established. Petitioner has not provided
preponderant evidence that the onset of his shoulder pain was within 48 hours of the
subject vaccination. Nevertheless, a non-Table claim could be viable, and I therefore do
not dismiss the case in its entirety at this time. I urge the parties to make one final brief
attempt at settlement, since the case will otherwise be transferred out of SPU so that
Petitioner can attempt to establish a causation-in-fact claim – likely requiring the retention
of experts to amplify Petitioner’s claim.
Accordingly, Petitioner’s Table SIRVA claim is DISMISSED. Petitioner shall file a
joint status report indicating that he has provided Respondent with a revised settlement
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Case 1:21-vv-00248-UNJ Document 46 Filed 08/15/25 Page 12 of 12
demand for his off-Table claim (and one that takes into account litigative risk in attempting
to prove a non-Table SIRVA that did not begin within two days of the subject vaccination),
and the parties’ efforts towards informal resolution, by no later than Wednesday,
August 6, 2025. If the parties do not report progress in their efforts soon thereafter, the
matter will be transferred out of SPU.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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