VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00341
Package ID: USCOURTS-cofc-1_21-vv-00341
Petitioner: Donna Fagan
Filed: 2021-01-08
Decided: 2023-07-10
Vaccine: influenza
Vaccination date: 2019-11-11
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 45477

AI-assisted case summary:
Donna Fagan filed a petition for compensation on January 8, 2021, alleging she sustained a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on November 11, 2019. The influenza vaccine is listed on the Vaccine Injury Table, and Fagan alleged her injury occurred within the Table's specified timeframe and resulted in residual effects for more than six months. The respondent, the Secretary of Health and Human Services, denied that Fagan sustained a Table-defined shoulder injury, denied that the vaccine caused her alleged 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 June 6, 2023, agreeing to settle the case and award compensation. The court adopted the stipulation as its decision. Fagan was awarded a lump sum of $45,000.00 for pain and suffering and $476.96 to reimburse a Medicaid lien, totaling $45,477.00. This award represents compensation for all damages available under the Vaccine Act. The decision was issued on July 10, 2023.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00341-0
Date issued/filed: 2023-07-10
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 06/07/2023) regarding 49 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0341V
DONNA FAGAN, Chief Special Master Corcoran
Petitioner,
v. Filed: June 7, 2023
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Amy A. Senerth, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Julia Marter Collison, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 8, 2021, Donna Fagan 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 November
11, 2019. Petitioner alleges that she sustained a shoulder injury related to vaccine
administration (“SIRVA”) within the time period set forth in the Table. She further alleges
that she experienced the residual effects of this alleged injury for more than six months.
Respondent denies that Petitioner sustained a shoulder injury as defined in the
Vaccine Injury Table; 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.
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 (2012).

Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 2 of 7
Nevertheless, on June 6, 2023, 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 $45,000.00 in the form of a check payable to Petitioner.
b) A lump sum of $476.96, representing reimbursement of a Medicaid lien
for services rendered to Petitioner by the State of Pennsylvania, in the
form of a check payable jointly to Petitioner and Equian:
Equian
P.O. Box 182643
Columbus, OH 43218
Event # 67820581
Petitioner agrees to endorse this check to Equian.
These amounts represent 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

inesign Document ID: D330D58F-21C9-4436--AAC5-82E3C57D169C
Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 3 of 7
IN THE UNITED ST ATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DONNA FAOAN,
No. 21-341V
Petitioner, Chief Special Master Corcoran
v. SPU
SECRETARY OF HEALTII AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
1. Donna Fagan ("petitioner") tiled 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 an influen7.a ('"flu") vaccine, which is contained in the Vaccine Injury Table (the "Table"), 42
C.F.R. § 100.3(a).
2. On November 11, 2019, petitioner received a flu vaccine.
3. The vaccine was administered in the United States.
4. Petitioner alleges that she sustained a shoulder injury related to vaccine
administration ("SIRVA") within the time-period set forth in the Table. She further alleges that
she experienced the residual effects of this condition for more than six months.
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 shoulder injury as defined in the
Vaccine Injury Table; denies that the vaccine caused petitioner's alleged shoulder injury, or any
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he signed document can be validated at https://app.vinesign.comNerify

Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 4 of 7
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)(I). the Secretary of Health and Human Services will issue the
following vaccine compensation payment:
a. a lump sum of $45,000.00 in the form of a check payable to petitioner.
b. A lump sum of 5476.96,1 representing reimbursement of a Medicaid lien for
services rendered to petitioner by the State of Pennsylvania, in the form of a
check payable jointly to petitioner and Equian:
Equian
PO Box 182643
Columbus, OH 43218
Event# 67820581
Petitioner agrees to endorse this check to Equian.
These amounts represent compensation for all damages that would be available under 42 U.S.C.
§ 300aa-15(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 applicatio~ the parties will submit to further proceedings before
1 This amount represents full satisfaction of any right of subrogatio~ assignment, claim, lie~ or
cause of action the State of Pennsylvania may have against any individual as a result of any
Medicaid payments Equian has made to or on behalf of Donna Fagan as a result of her alleged
vaccine-related injury suffered on or about November 11, 2019, under Title XIX of the Social
Security Act, see 42 U.S.C. § 300aa-15(g), (h).
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Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 5 of 7
the special master to award reasonable attorneys' fees and costs incwred 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-1S(g), including 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 entities that provide health services on a pre-paid basis.
11. Payment made pursuant to paragraph 8 of this Stipulatio~ and any amount
awarded pursuant to paragraph 9, will he 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 unreimbursed 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 (b).
13. In return for the payments described in paragraph 8, and any amount awarded
pursuant to paragraph 9, petitioner, in her individual capacity, and on behaJf 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. § J00aa-10 et seq., on account of, or
in any way growing out of, any and all known or unkno~ suspected or unsuspected persona}
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Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 6 of 7
injuries to or death of petitioner resulting from, or alleged to have resulted from the vaccine
administered on November 11, 2019, as alleged in a Petition filed on January 8, 2021, in the
United States Court of Federal Claims as petition No. 21-341 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.
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
confonnity 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 amend~ 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 or her current condition.
18. All rights and obligations of petitioner shall apply equally to petitioner's heirs,
executors, administrators, successors, and/or assigns.
END OF STIPULATION
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Case 1:21-vv-00341-UNJ Document 53 Filed 07/10/23 Page 7 of 7
Respectfully submitted,
PETITIONER:
~ _,_
DONNAFAGAN
AITORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
PETITIONER: OF THE ATTORNEY GENERAL:
ty1_k
~~~~
AMYSENERTH
Muller Brazil Deputy Director
715 Twining Road, Suite 208 Torts Branch
Dresher, PA 19025 Civil Division
(215) 885-1655 U.S. Department of Justice
amy@mullerbrazil.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OFTHESECRETARYOFHEALTH RESPONDENT:
AND HUMAN SERVICES:
,
Henry P. :T"~"""'>''·
vifi.cfltrw
by Mcmillan -S3 :,.:imJ>ui
t4,l&l9
CDR GEORGE REED GRJMES, 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 Franklin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08Nl46B (202) 305-0 I 02
Rockville, MD 20857 julia.collison@usdoj.gov
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