VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00365
Package ID: USCOURTS-cofc-1_21-vv-00365
Petitioner: Grace Wang
Filed: 2021-01-08
Decided: 2024-10-03
Vaccine: Td
Vaccination date: 2020-08-09
Condition: Shoulder Injury Related to Vaccine Administration (SIRVA)
Outcome: compensated
Award amount USD: 115476

AI-assisted case summary:
Grace Wang filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a right shoulder injury related to vaccine administration (SIRVA) from a Tetanus diphtheria (Td) vaccine received on August 9, 2020. The respondent conceded that Ms. Wang was entitled to compensation, agreeing that her injury met the criteria for SIRVA as defined by the Vaccine Injury Table. The respondent also confirmed that the case was timely filed, the vaccine was administered in the United States, and Ms. Wang satisfied the statutory severity requirement by suffering residual effects for more than six months. A ruling on entitlement was issued on May 11, 2023, finding Ms. Wang entitled to compensation. Subsequently, on August 28, 2024, the parties reached a proffer on the award of damages. The court awarded Ms. Wang a total of $115,476.49. This amount includes $112,000.00 for pain and suffering and $1,957.49 for documented out-of-pocket expenses. Additionally, $1,518.93 was awarded to satisfy a State of Wisconsin Medicaid lien. Ms. Wang, an adult, agreed with the proffered award, and the court directed judgment accordingly.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00365-0
Date issued/filed: 2023-06-12
Pages: 2
Docket text: PUBLIC DECISION (Originally filed: 05/11/2023) regarding 31 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00365-UNJ Document 34 Filed 06/12/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0365V
UNPUBLISHED
GRACE WANG, Chief Special Master Corcoran
Petitioner, Filed: May 11, 2023
v.
Special Processing Unit (SPU);
SECRETARY OF HEALTH AND Ruling on Entitlement; Concession;
HUMAN SERVICES, Table Injury; Tetanus Diphtheria (Td)
Vaccine; Shoulder Injury Related to
Respondent. Vaccine Administration (SIRVA)
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Andrew Henning, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On January 8, 2021, Grace Wang 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 9, 2023, Petitioner filed an amended petition. Petitioner alleges
that she suffered a right shoulder injury related to vaccine administration (“SIRVA”)
resulting from the adverse effects of a Tetanus diphtheria (“Td”) vaccine received on
August 9, 2020. Amended Petition at 1. Petitioner further alleges that she received the
vaccine in the United States, she suffered the residual effects of her injury for more than
1 Because this unpublished 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 (2018).

Case 1:21-vv-00365-UNJ Document 34 Filed 06/12/23 Page 2 of 2
six months, and neither Petitioner nor any other party has ever received compensation in
the form of an award or settlement for her vaccine-related injury. Amended Petition at
¶¶ 1, 10, 11. The case was assigned to the Special Processing Unit of the Office of
Special Masters.
On April 20, 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.
Specifically, Respondent agrees that “petitioner has satisfied the criteria set forth in the
Vaccine Injury Table (“Table”) and the Qualifications and Aids to Interpretation (“QAI”) for
SIRVA.” Id. at 5. Respondent further agrees that “the records show that petitioner timely
filed her case, that she received the Td vaccination in the United States, and that she
satisfies the statutory severity requirement by suffering the residual effects or
complications of her injury for more than six months after vaccine administration.” 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-00365-1
Date issued/filed: 2024-10-03
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 08/28/2024) regarding 54 DECISION Stipulation/Proffer, Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00365-UNJ Document 58 Filed 10/03/24 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0365V
GRACE WANG, Chief Special Master Corcoran
Petitioner, Filed: August 28, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Katherine Carr Esposito, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On January 8, 2021, Grace Wang 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 9, 2023, Petitioner filed an amended petition. Petitioner alleges
that she suffered a right shoulder injury related to vaccine administration (“SIRVA”)
resulting from the adverse effects of a Tetanus diphtheria (“Td”) vaccine received on
August 9, 2020. Amended Petition at 1. Petitioner further alleges that she received the
vaccine in the United States, she suffered the residual effects of her injury for more than
six months, and neither Petitioner nor any other party has ever received compensation in
the form of an award or settlement for her vaccine-related injury. Amended Petition at
¶¶ 1, 10, 11. The case was assigned to the Special Processing Unit of the Office of
Special Masters.
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-00365-UNJ Document 58 Filed 10/03/24 Page 2 of 5
On May 11, 2023, a ruling on entitlement was issued, finding Petitioner entitled to
compensation for SIRVA. On August 28, 2024, Respondent filed a proffer on award of
compensation (“Proffer”) indicating Petitioner should be awarded $113,957.49, in addition
to funds to satisfy a Medicaid lien. Proffer at 2-3. 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 the
following:
a) A lump sum payment of $113,957.49 (comprised of $112,000.00 in pain and
suffering and $1,957.49 for out of pocket expenses) in the form of a check
payable to Petitioner, and
b) A lump sum payment of $1,518.93, representing compensation for
satisfaction of the State of Wisconsin Medicaid lien, in the form of a check
jointly payable to Petitioner and
Anthem
Attention: Susan Tanner, Subrogation Analyst Sr.
P.O. Box 659940
San Antonio, TX 78625-9939
Petitioner agrees to endorse this check to Anthem for satisfaction of the
Medicaid lien.
These amounts represent 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-00365-UNJ Document 58 Filed 10/03/24 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
GRACE WANG,
Petitioner,
No. 21-365V
v. Chief Special Master Corcoran
ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
PROFFER ON AWARD OF COMPENSATION1
I. Procedural History
On January 8, 2021, Grace Wang (“petitioner”) filed a petition for compensation
(“petition”) under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -
34, as amended. She alleges that, as a result of receiving a tetanus diphtheria (“Td”) vaccination
on August 9, 2020, she sustained injuries, including a Shoulder Injury Related to Vaccine
Administration (“SIRVA”). See Petition (ECF No. 1); Amended Petition (ECF No. 30). On
April 20, 2023, respondent filed his Vaccine Rule 4(c) report, concluding that petitioner suffered
a SIRVA as defined by the Vaccine Injury Table and that she met the other statutory and
jurisdictional requirements. ECF No. 27. On May 11, 2023, Chief Special Master Corcoran
issued a ruling on entitlement, finding that petitioner was entitled to compensation for a Table
SIRVA injury. ECF No. 31.
1 This Proffer does not include attorneys’ fees and costs, which the parties intend to address after
the Damages Decision is issued.

Case 1:21-vv-00365-UNJ Document 58 Filed 10/03/24 Page 4 of 5
II. Items of Compensation
A. Pain and suffering
Based upon the evidence of record, respondent proffers that petitioner should be awarded
a lump sum of $112,000.00 in actual pain and suffering.
B. Out of pocket expenses
Based upon the evidence of record, respondent proffers that petitioner should be awarded
$1,957.49 for documented out-of-pocket expenses.
C. Medicaid lien
Based upon the evidence of record, respondent proffers that petitioner should be awarded
funds to satisfy the State of Wisconsin Medicaid lien in the amount of $1,518.93, which
represents full satisfaction of any right of subrogation, assignment, claim, lien, or cause of action
the State of Wisconsin may have against any individual as a result of any Medicaid payments the
State of Wisconsin has made to or on behalf of petitioner from the date of her eligibility for
benefits through the date of judgment in this case as a result of her alleged vaccine-related injury
suffered on or about August 9, 2020 under Title XIX of the Social Security Act.
The above amounts represent all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
III. Form of the Award
Respondent recommends that the compensation provided to petitioner should be made
through lump sum payments, as described below, and requests that the Chief Special Master’s
decision and the Court’s judgment award the following:2
2 Should petitioner die prior to entry of judgment, respondent would oppose any award for
future medical expenses, future lost earnings, and future pain and suffering, and the parties
reserve the right to move the Court for appropriate relief.
2

Case 1:21-vv-00365-UNJ Document 58 Filed 10/03/24 Page 5 of 5
a. A lump sum payment of $113,957.49 in the form of a check payable to petitioner, and
b. A lump sum payment of $1,518.93, representing compensation for satisfaction of the
State of Wisconsin Medicaid lien, in the form of a check jointly payable to petitioner
and Anthem, Attention: Susan Tanner, Subrogation Analyst Sr., P.O. Box 659940,
San Antonio, TX 78625-9939. Petitioner agrees to endorse this check to Anthem for
satisfaction of the Medicaid lien.
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
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
JULIA M. COLLISON
Assistant Director
Torts Branch, Civil Division
s/Katherine C. Esposito
Katherine C. Esposito
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) 305-3774
katherine.esposito@usdoj.gov
Dated: August 28, 2024
3