VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00387
Package ID: USCOURTS-cofc-1_21-vv-00387
Petitioner: Thomas Anderson
Filed: 2021-01-08
Decided: 2024-06-17
Vaccine: Tdap
Vaccination date: 2019-07-30
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 40000

AI-assisted case summary:
Thomas Anderson filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) resulting from a tetanus diphtheria acellular pertussis (Tdap) vaccine he received on July 30, 2019. He stated that the vaccine was administered in the United States and that he experienced residual effects of the injury for more than six months. Respondent denied that Mr. Anderson sustained a SIRVA Table injury or that the vaccine caused his alleged shoulder injury. Despite these differing positions, the parties filed a joint stipulation agreeing that the case should be settled. Chief Special Master Corcoran found the stipulation reasonable and adopted it as his decision. Mr. Anderson was awarded a lump sum of $40,000.00 as compensation for all items of damages available under the Vaccine Act. This award represents a settlement of liability and damages, and the parties agreed to release the United States and the Secretary of Health and Human Services from further claims related to this vaccination.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_21-vv-00387-0
Date issued/filed: 2024-06-17
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 05/16/2024) regarding 54 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
--------------------------------------------------------------------------------
Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0387V
THOMAS ANDERSON, Chief Special Master Corcoran
Petitioner, Filed: May 16, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
James Vincent Lopez, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 8, 2021,Thomas Anderson 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 December 29, 2022, Petitioner filed an amended petition. Petitioner
alleges that he suffered a shoulder injury related to vaccine administration (“SIRVA”)
resulting from a tetanus diphtheria acellular pertussis (“Tdap”) vaccine received on July
30, 2019. Amended Petition at 1; Stipulation, filed May 16, 2024, at ¶¶ 2-4. Petitioner
further alleges that he received the vaccine in the United States, he suffered the residual
effects of his injury for more than six months, and no lawsuits have been filed or
settlements or awards accepted by anyone, including Petitioner, due to his vaccine-
related injury. Amended Petition at ¶¶ 18-20; Stipulation at ¶¶ 3-5. “Respondent denies
that petitioner sustaineda SIRVA Table injury; denies that the vaccine caused petitioner’s
alleged shoulder injury, or any other injury; and denies that his current condition is a
sequela of a vaccine-related injury.” Stipulation at ¶ 6.
1Because 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.
2National 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-00387-UNJ Document 58 Filed 06/17/24 Page 2 of 7
Nevertheless, on May 16, 2024, 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 lump sum of $40,000.00 in the form of a check payable to Petitioner.
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

Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
THOMAS ANDERSON,
Petitioner, No. 21-387V
Chief Special Master Corcoran
v. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the fo11owing matters:
l . Thomas Anderson ("petitioner"), filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U. S.C. § 300aa-l 0 to 34 (the "Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of the tetanus, diphtheria, and acellular pertussis ("Tdap") vaccine, which is contained in the
Vaccine Injury Table (the "Table"), 42 C.F.R. § 100.3(a)
2. Petitioner received the Tdap vaccine on July 30, 2019, in his left arm.
3. The vaccine was administered within the United States.
4. Petitioner alleges that he sustained a shoulder injury related to vaccine administration
("SIRVA") within the time period set forth in the Table. He further alleges that he 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 on his behalf as a result of his alleged injury.

Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 4 of 7
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the
vaccine caused petitioner's alleged shoulder injury, or any other injury; and denies that his
current condition is a sequela 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)(l), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of $40,000.00 in the form of a check payable to petitioner. This amount
represents 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 application, the parties will submit to further proceedings before
the special master to award reasonable attorneys' fees and costs incurred in proceeding upon this
petition.
10. Petitioner and his attorney represent that compensation to be provided pursuant to
this Stipulation is not for any items or services for which the Program is not primarily liable
under 42 U.S.C. § 300aa-15(g), to the extent that payment has been made or can reasonably be
expected to be made under any 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 by entities that provide health services on a pre-paid basis.
2

Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 5 of 7
11. Payment made pursuant to paragraph 8 and any amounts awarded pursuant to
paragraph 9 of this Stipulation will be 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 attorney's fees and litigation costs, and past unreirnbursable 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-l 5(g) and (h}.
13. In return for the payments described in paragraphs 8 and 9, petitioner, in his
individual capacity, and on behalf of his heirs, executors, administrators, successors or assigns,
does forever irrevocably and unconditionally release, acquit and discharge the United States and
the Secretary of Health and Hwnan 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. § 300aa-10 et seq., on account of, or in any way growing out of, any and all
known or unknown, suspected or unsuspected personal injuries to or death of petitioner resulting
from, or alleged to have resulted from, the Tdap vaccination administered on July 30, 2019, as
alleged in a petition for vaccine compensation filed on or about January 8, 2021, and an amended
petition filed on December 29, 2022, in the United States Court of Federal Claims as petition No.
21-387V.
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.
3

Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 6 of 7
15. If the special master fails to issue a decision in complete conformity with the tenns
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete conformity with the terms of this Stipulation, then the parties'
settlement and this StipuJation shall be voidable at the sole discretion of either party.
16. Titis Stipulation expresses a full and complete negotiated settlement of liability and
damages claimed under the National Childhood Vaccine Injury Act of 1986, as amended, 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 to 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 Tdap vaccine caused petitioner's alleged injury
or any other injury or his current disabilities, or that petitioner suffered an injury contained in the
Vaccine Injury Table.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
4

Case 1:21-vv-00387-UNJ Document 58 Filed 06/17/24 Page 7 of 7
Respectfully submitted.
PETITIONER;
~~
THOMAS ANDERSON
ATTORNEYOFRECORDFOR AUTHORIZED IU:PRSENTATIVE
PETITIONER: OP THE ATTORNEY GENERAL:
'°tr
c_.
~ HOl"t(lf
L®~ G~ ~,,
ip.l(l)(Z.) ~~~~~~~
RONALD C. HOMER .
CHRISTINA CIAMPOLILLO Deputy Director
Conway Homer, P,C. Torts Branch
16 Shawmut S~ Civil Division
Boaton, MA 02116 U.S. Department of Justice
Phone: (617) 695-1990 P.O. Box 1'46
Btnail: cclampolillo@cc8ndh.com Beqjamin Franklin Station
Wuhingtort. DC 20044-0146
AllTHORIZED REPRESENTATIVE AlTORNEY OF RECORD FOR
OFTBES£CRETARYOFIIEAL'tH RESPONDENT:
AND HUMAN SERVICES:
George R. Grimes -~11vnec1 ~o-v•
R.
Grtnw~1•
514 01tr. 2024.04.28 ~,es -o4W
CDR OBOROE REBD GRIMES, MD. MPH J
Director, Division of Injury rlalAnbfflO'f
Compensation Programs T Bran • i1 Division
Health Sylteml Bureau .S. Department of Juaticc
Health Resources and Service8 P.O.Box 146
Admini&ttatioD Benjamin Franlclin Station
U.S. Department ofH ealth Waahington, DC 20044-0146
and Human Services Tel: (202) 616-3655
5600 Fiabera Lane. 08W-25A Email: james.lopez@usdoj,1ov
Rookv11lc, MD 20857
1~r
s] \
6
Dated:
5