VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00561
Package ID: USCOURTS-cofc-1_21-vv-00561
Petitioner: Camilla Butler
Filed: 2021-01-11
Decided: 2024-08-13
Vaccine: influenza
Vaccination date: 2020-09-02
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 20083

AI-assisted case summary:
Camilla Butler filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccine on September 2, 2020. She stated the vaccine was administered in the United States, she experienced residual effects for over six months, and had no prior award or settlement for this condition. Respondent denied that Petitioner sustained a SIRVA Table injury, denied that the vaccine caused her injury, and denied that her current condition was a sequela of a vaccine-related injury. Despite these denials, the parties filed a joint stipulation agreeing that a decision should be entered awarding compensation. The court adopted the stipulation as its decision. Camilla Butler was awarded a lump sum of $20,000 for pain and suffering and $83.18 to reimburse a Medicaid lien for vaccine injury-related services. These amounts represent compensation for all damages available under the Vaccine Act. The parties agreed that this stipulation expressed a full and complete negotiated settlement of liability and damages, and Camilla Butler released the United States and the Secretary of Health and Human Services from all claims related to the flu vaccination.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00561-0
Date issued/filed: 2024-08-13
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 07/12/2024) regarding 73 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-561V
CAMILLA BUTLER, Chief Special Master Corcoran
Petitioner, Filed: July 12, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Alexa Roggenkamp, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 11, 2021, Camilla Butler 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”) following an influenza (“flu”) vaccine administered on September
2, 2020. Petition at 1; Stipulation, filed at July 8, 2024, ¶¶ 1, 2. Petitioner further alleges
that the vaccine was administered within the United States, that she experienced the
residual effects of her injury for more than six months, and that there has been no prior
award or settlement of a civil action for damages as a result of her condition. Petition at
1-2; Stipulation at ¶¶ 3-5. Respondent denies that Petitioner sustained a SIRVA Table
injury; denies that the vaccine caused Petitioner’s alleged right shoulder injury or any
other injury, and denies that her current condition is a sequela of a vaccine-related injury.
Stipulation at ¶ 6.
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-00561-UNJ Document 77 Filed 08/13/24 Page 2 of 8
Nevertheless, on July 8, 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:
(cid:120) A lump sum of $20,000 in the form of a check payable to Petitioner;
and
(cid:120) A lump sum of $83.18,3 which amount represents reimbursement for
a Medicaid lien for vaccine injury-related services rendered on behalf
of Petitioner, in the form of a check payable jointly to Petitioner and
Treasurer, state of Ohio4:
Ohio Tort Recovery Unit
5475 Rings Road Suite 125
Dublin, OH 43017
Stipulation at ¶ 8. These amounts 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.5
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 This amount represents full satisfaction of any right of subrogation, assignment, claim, lien, or cause of
action the State of Ohio may have against any individual as a result of any Medicaid payments the Ohio
Program has made on behalf of petitioner as a result of her alleged vaccine-related injury suffered on or
about October 10, 2019, under Title XIX of the Social Security Act, see 42 U.S.C. § 300aa-15(g), (h).
4 Petitioner agrees to endorse this check to the Treasurer, state of Ohio.
5 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-00561-UNJ Document 77 Filed 08/13/24 Page 3 of 8
IN THE UNITED ST ATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
CAMILLA BUTLER,
Petitioner,
v. No. 21-56IV
Chief Special Master Corcoran
SECRETARY OF HEALTH AND ECF
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
1. Camilla Butler ("petitioner") filed 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 injuries allegedly related to petitioner's receipt
of an influenza ("flu") vaccine, which is a vaccine contained in the Vaccine Injury Table (the
"Table"), 42 C.F.R. § 100.3 (a).
2. Petitioner received the flu vaccine on October 10, 2019.
3. The vaccination was administered within the United States.
4. Petitioner alleges that she sustained a right shoulder injury related to vaccination
administration ("SIRVA") within the time period set forth in the Table following administration
of the flu vaccine, or in the alternative, that her alleged shoulder injury was caused by the flu
vaccine. She further alleges that she experienced the residual effects of this alleged injury for
more than six months.

Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 4 of 8
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages on her behalf as a result of her alleged injury or condition.
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the
vaccine caused petitioner's alleged right shoulder injury or any other injury, and denies that her
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 payments:
a. A lump sum of $83 .18, 1 which amount represents reimbursement for a Medicaid
lien for vaccine injury-related services rendered on behalf of petitioner, in the
form of a check payable jointly to petitioner and Treasurer, State of Ohio.
Ohio Tort Recovery Unit
5475 Rings Road Suite 125
Dublin, OH 43017
Petitioner agrees to endorse this check to Treasurer, State of Ohio.
b. A lump sum of $20,000.00, in the form of a check payable to petitioner, for all
remaining elements of compensation.
1
This amount represents full satisfaction of any right of subrogation, assignment, claim, lien, or
cause of action the State of Ohio may have against any individual as a result of any Medicaid
payments the Ohio Program has made to or on behalf of Camilla Butler as a result of her alleged
vaccine-related injury suffered on or about October 10, 2019, under Title XIX of the Social
Security Act, see 42 U.S.C. § 300aa-15(g), (h).
2

Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 5 of 8
These amounts represent compensation for all damages that would be available
under42 U.S.C. § 300aa-l5(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-2 l (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 her 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-l5(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.
11. Payments made pursuant to paragraph 8 of this Stipulation 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 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-l 5(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in her
individual capacity, and on behalf of her heirs, executors, administrators, successors or assigns,
3

Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 6 of 8
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. § 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 flu vaccination administered on or about October I 0,
2019, as alleged by petitioner in a petition for vaccine compensation filed on or about January
11, 2021, in the United States Court of Federal Claims as petition No. 21-561 V.
14. If petitioner should die prior to entry of judgment, 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 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 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 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
4

Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 7 of 8
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 SIRVA
injury or any other injury or her current condition, 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
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Case 1:21-vv-00561-UNJ Document 77 Filed 08/13/24 Page 8 of 8
Respectfully submilled.
PETITIONER:
A.
,'l
L;'f/.b 4l 41 c M AZt 1.A /
CAMILLA BUTLER
ATTORNEY OF RECORD AUTHORIZED REPRESENTATIVE
FOR PETITIO~ER: OF THE ATTORNEY GENERAL:
tu~cf~~
~ -s ~
~e.~,7~ ~
RONALD C. HOMER j(.// i$ J(c){a.\ I IEATI l[ R I.. PEARLMAN
Counsel for the Petitioner C.. • '/ l)cputy Director
Con" ay Homer. P. C. Tort~ Rranch
16 Shawmut Street Civil Division
Hoston. MA 02 1I 6 L; .S. Department of Justice
Phone: (617) 695-1990 P.O. 80, 146
fn:-.: (617) 695-0880 lknjnmin Franklin Station
\\'ashing.ton, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEALTH RESPONDENT:
AND HUMAN SERVICES:
Ge Or g e R. 019 tally 1lgncd by George ll
Grimes -S1 4 o G a r, , m ~ r i S1◄
102400•1114411-04'00'
CDR GEORGE RF,ED GRIMES. MO. YIPH
Director. Di, is ion of Injury Trial /\ 11ornc)
Compensation Programs Torb Brnnch
l lcalth Systems Bureau Civil Division
Hc.ilth Resources and Services U.S. Department of Justice
Administration P.O. 80:-. 146
U.S. Department of I lcalth Benjamin Franklin Station
and Human Sen ices Washington. DC 20044-0146
5600 rishcrs Lane. 08\V-25/\ 202-616-11179
Rockville, MD 20857 alexa.roggcnka111p'a111sdoj .gov
Dated: _~ - - ·
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