Jack Momchilovich v. HHS - Tdap, right shoulder injury related to vaccine administration (SIRVA) (2023)

Jack Momchilovich filed a petition for vaccine compensation alleging that he suffered a right shoulder injury related to vaccine administration (SIRVA) as a result of receiving a tetanus-diphtheria-acellular pertussis (Tdap) vaccine on April 2, 2020. He further alleged that he experienced residual effects of his injury for more than six months.

Respondent denied that the petitioner sustained a Table SIRVA within the Table timeframe and denied that the Tdap vaccine caused his alleged shoulder injury. Nevertheless, the parties filed a joint stipulation agreeing that a decision should be entered awarding compensation.

The court adopted the stipulation as its decision, awarding Jack Momchilovich a lump sum of $30,000.00. This amount represents compensation for all items of damages available under Section 15(a) of the Vaccine Act.

The case proceeded as a Table claim, and the parties stipulated to the damages.