VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00590
Package ID: USCOURTS-cofc-1_21-vv-00590
Petitioner: Ciara Nielsen
Filed: 2021-01-12
Decided: 2024-12-27
Vaccine: influenza
Vaccination date: 2019-12-13
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 55218

AI-assisted case summary:
Ciara Nielsen, an adult, received an influenza vaccine on December 13, 2019. Approximately two weeks later, she began experiencing progressively worsening pain in her left shoulder, radiating from the injection site. She was diagnosed with a left shoulder injury related to vaccine administration (SIRVA). The medical records documented pain, limited range of motion, and tenderness in her left shoulder, consistent with rotator cuff tendinitis or a mild strain. She underwent physical therapy and received a cortisone injection, but her symptoms persisted. Due to the COVID-19 pandemic, she stopped formal physical therapy in March 2020, but continued home exercises. She returned to physical therapy in January 2021, reporting that her pain had not fully resolved. The respondent initially questioned the severity requirement due to a treatment gap. However, the court found that the evidence preponderantly established that Ms. Nielsen suffered residual effects for more than six months, satisfying the statutory severity requirement. The case proceeded as a Table claim for SIRVA. The parties stipulated to an award of $55,000.00 for pain and suffering and $218.30 to satisfy a state of Maryland Medicaid lien, for a total award of $55,218.30.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00590-0
Date issued/filed: 2024-09-27
Pages: 10
Docket text: PUBLIC ORDER/RULING (Originally filed: 08/23/2024) regarding 37 Ruling on Entitlement, Order on Motion for Ruling on the Record. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 1 of 10
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0590V
CIARA NIELSEN, Chief Special Master Corcoran
Petitioner, Filed: August 23, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Amy A. Senerth, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Mallori Browne Openchowski, U.S. Department of Justice, Washington, DC, for
Respondent.
RULING ON ENTITLEMENT1
On January 12, 2021, Ciara Nielsen 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 left shoulder injury related to vaccine
administration (“SIRVA”) resulting from an influenza (“flu”) vaccine received on December
13, 2019. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
1 Because this 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-00590-UNJ Document 40 Filed 09/27/24 Page 2 of 10
For the reasons discussed below, I find that record evidence preponderantly
establishes that Petitioner suffered the residual effects of her injury for more than six
months, and has satisfied the remaining requirements for entitlement.
I. Relevant Procedural History
Two months after the case was activated, Respondent’s counsel informally
identified the statutory severity requirement as a possible obstacle to the claim (ECF No.
20). After Petitioner filed additional evidence, I reviewed the record and stated my
preliminary view that the Petition was unlikely to be dismissed based on the severity
requirement, and directed Petitioner to serve a demand (ECF No. 24). Over a year after
the case was activated, Respondent stated that he would defend the claim, and filed his
Rule 4(c) Report (ECF Nos. 32, 33). Thereafter, the parties briefed the issue of
Petitioner’s entitlement to compensation (ECF Nos. 35, 36).3 The matter is now ripe for
resolution.
II. Factual Findings and Ruling on Entitlement
A. Legal Standards
Before compensation can be awarded under the Vaccine Act, a petitioner must
demonstrate, by a preponderance of evidence, all matters required under Section
11(c)(1), including the factual circumstances surrounding his or her claim. Section
13(a)(1)(A). In making this determination, the special master or court should consider the
record as a whole. Section 13(a)(1). Petitioner’s allegations must be supported by medical
records or by medical opinion. Id.
To resolve factual issues, the special master must weigh the evidence presented,
which may include contemporaneous medical records and testimony. See Burns v. Sec'y
of Health & Human Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (explaining that a special
master must decide what weight to give evidence including oral testimony and
contemporaneous medical records). “Medical records, in general, warrant consideration
as trustworthy evidence. The records contain information supplied to or by health
professionals to facilitate diagnosis and treatment of medical conditions. With proper
treatment hanging in the balance, accuracy has an extra premium. These records are
also generally contemporaneous to the medical events.” Cucuras v. Sec’y of Health &
Human Servs., 993 F.2d 1525, 1528 (Fed. Cir. 1993).
To overcome the presumptive accuracy of medical records testimony, a petitioner
may present testimony which is “consistent, clear, cogent, and compelling.” Sanchez v.
Sec'y of Health & Human Servs., No. 11-685V, 2013 WL 1880825, at *3 (Fed. Cl. Spec.
3 Although the parties were directed to brief both Petitioner’s entitlement to compensation and the amount
of damages to which Petitioner was entitled, they briefed only the issue of whether Petitioner is entitled to
compensation.
2

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 3 of 10
Mstr. Apr. 10, 2013) (citing Blutstein v. Sec'y of Health & Human Servs., No. 90-2808V,
1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)). The Federal Circuit has
“reject[ed] as incorrect the presumption that medical records are accurate and complete
as to all the patient’s physical conditions.” Kirby v. Sec’y of Health & Human Servs., 997
F.3d 1378, 1383 (Fed. Cir. 2021) (explaining that a patient may not report every ailment,
or a physician may enter information incorrectly or not record everything he or she
observes).
In addition to requirements concerning the vaccination received and the lack of
other award or settlement,4 a petitioner must establish that he or she suffered an injury
meeting the Table criteria, in which case causation is presumed, or an injury shown to be
caused-in-fact by the vaccination he or she received. Section 11(c)(1)(C). The Vaccine
Act further includes a “severity requirement,” pursuant to which a petitioner demonstrate
that they:
(i) suffered the residual effects or complications of such illness, disability,
injury, or condition for more than 6 months after the administration of the
vaccine, or (ii) died from the administration of the vaccine, or (iii) suffered
such illness, disability, injury or condition from the vaccine which resulted in
inpatient hospitalization and surgical intervention.
Section 11(c)(1)(D).
“[T]he fact that a petitioner has been discharged from medical care does not
necessarily indicate that there are no remaining or residual effects from her alleged
injury.” Morine v. Sec’y of Health & Human Servs., No. 17-1013, 2019 WL 978825, at *4
(Fed. Cl. Spec. Mstr. Jan. 23, 2019); see also Herren v. Sec’y of Health & Human Servs.,
No. 13-1000V, 2014 WL 3889070, at *3 (Fed. Cl. Spec. Mstr. July 18, 2014) (“a discharge
from medical care does not necessarily indicate there are no residual effects”). “A
treatment gap . . . does not automatically mean severity cannot be established.” Law v.
Sec’y of Health & Human Servs., No. 21-0699V, 2023 WL 2641502, at *5 (Fed. Cl. Spec.
Mstr. Feb. 23, 2023) (finding severity requirement met where petitioner sought care for
under three months and had met physical therapy goals but still lacked full range of motion
and experienced difficulty with certain activities, then returned to care nearly five months
later reporting stiffness and continuing restrictions in motion); see also Peeples v. Sec’y
of Health & Human Servs., No. 20-0634V, 2022 WL 2387749 (Fed. Cl. Spec. Mstr. May
26, 2022) (finding severity requirement met where the petitioner sought care for four
months, followed by fifteen month gap); Silvestri v. Sec’y of Health & Human Servs., No.
19-1045V, 2021 WL 4205313 (Fed. Cl. Spec. Mstr. Aug. 16, 2021) (finding severity
4 In summary, a petitioner must establish that he received a vaccine covered by the Program, administered
either in the United States and its territories or in another geographical area but qualifying for a limited
exception and has not filed a civil suit or collected an award or settlement for his or her injury. Section
11(c)(1)(A)(B)(E).
3

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 4 of 10
requirement satisfied where petitioner did not seek additional treatment after the five
month mark.
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria
establishing a SIRVA under the accompanying Qualifications and Aids to Interpretation
(“QAI”) are as follows:
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time-frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
4

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 5 of 10
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
B. Relevant Factual History
This ruling contains only a brief overview of facts most relevant to the parties’
dispute.
1. Medical Records
Petitioner received the flu vaccine at issue in her left deltoid on December 13,
2019, during an urgent care visit for other concerns. Ex. 1 at 2. Two weeks later
(December 27, 2019), she returned to urgent care, stating that since her vaccination two
weeks earlier, she was experiencing progressively worsening pain originating at the
injection site and radiating up over her shoulder. Ex. 2 at 6. The pain was slightly better
in the morning, but by the evening her shoulder was “very painful” and she could not raise
her arm, impairing her work as a hairstylist. Id. She had tried heat, ibuprofen, and Tylenol,
with no improvement. Id. On examination, she was tender to palpation in her left bicep
and above her shoulder joint, and her range of motion (“ROM”) was limited due to pain.
Id. at 8. Petitioner was referred for an MRI of her shoulder. Id.
Five days later (January 2, 2020), Petitioner underwent a left shoulder MRI. Ex. 2
at 42. The MRI showed mild tendinosis of the supraspinatus and infraspinatus tendons
without a tear. Id. Petitioner had a mild widening of the acromioclavicular joint without
surrounding edema or fluid that was interpreted as a possible chronic joint separation. Id.
Petitioner’s deltoid muscle and overlying subcutaneous tissues were normal. Id.
The following week (January 10, 2020), Petitioner saw orthopedic physician
assistant (“PA”) Kelly O’Neal. Ex. 3 at 7. She explained that on December 13th, she
received a flu vaccination in her left deltoid, followed by almost immediate pain that
worsened over several days. Id. She was still having pain that she rated as six out of ten.
Id. On examination, she had tenderness of the supraspinatus and deltoid, and pain with
overhead motions. Id. at 9. Her active ROM was normal in forward flexion, extension,
external rotation, internal rotation, and abduction. Id. PA O’Neal read her MRI as showing
evidence of a chronic acromioclavicular joint sprain but no acute injury. Id. Her rotator cuff
was fully intact without significant inflammatory process, and there were no soft tissue
abnormalities. Id. PA O’Neal determined her symptoms were consistent with rotator cuff
tendinitis that could have been brought on by the inflammatory process of her flu
vaccination. Id. Petitioner was given exercises to do at home and referred to physical
therapy (“PT”). Id. at 10.
Petitioner underwent a PT evaluation on February 7, 2020. Ex. 4 at 4. She
complained of left shoulder pain that started after her flu vaccination in December 2019.
Id. She described the pain as “constant achiness.” Id. Her pain was four out of ten at best
5

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 6 of 10
and seven out of ten at worst. Id. She had difficulty making her bed, lifting her shoulder,
and dressing. Id. Her shoulder would sometimes start to feel better, but worsened by the
end of the day. Id. Her left shoulder active ROM was within normal limits in flexion and
extension, but limited to 150 degrees in abduction, and she had reduced strength. Id. at
4-5. She had positive results on the subscapularis lift off test on her left shoulder. Id. at 5.
The therapist noted that her symptoms were consistent with a mild left rotator cuff strain.
Id. She had painful active ROM at end-range and limited functional tolerances. Id.
Petitioner returned to orthopedic PA O’Neal on February 25, 2020, for a follow up
on her left shoulder reporting “a little bit of improvement” with PT. Ex. 3 at 4. Her pain
remained significant, seven out of ten, and she requested a cortisone injection. Id.
Petitioner received a cortisone injection and was advised to continue PT. Id. at 6.
Petitioner continued PT, attending a total of five sessions between February 7 and
March 18, 2020. Ex. 4 at 4-17. On March 10th, she told her therapist that she had received
a cortisone injection on February 25th that helped alleviate her pain with sleeping. Id. at
12. However, raising her arm higher than shoulder level was worsening, and she was
again having difficulty sleeping. Id. Her pain level was five out of ten, with a constant dull
pain. Id. She had positive impingement signs on the Hawkins/Kennedy and Neer tests,
and a positive subscapularis lift off test. Id. at 13-14. She was approved to continue
physical therapy twice weekly until April 20, 2020. Id. at 14-15.
At her last PT session on March 18th, she said she had been “very sore” after her
last session. Ex. 4 at 16. She felt relief two days later, and felt as though she was
improving. Id. It was no longer painful to sleep on her left shoulder, but still hurt to reach
overhead. Id. She tolerated treatment well with mild pain. Id. She continued to have
decreased ROM and strength, pain with activities of daily living and decreased tolerance
to sitting, standing, walking, and sleeping. Id. The therapist determined that she required
continued skilled therapy to restore her prior level of function. Id. She had met two short
term goals, but not met two others. Id.
Petitioner saw a gynecologist for a telemedicine visit on March 30, 2020, and an
annual exam on August 18, 2020. Ex. 6 at 2, 13. At the August appointment three
medications were prescribed. Id. at 2. She did not report any shoulder problems during
these appointments, nor was a musculoskeletal examination done – nor would one be
expected for this specialist. Id.
Petitioner returned to PT for left shoulder pain ten months after her last shoulder
treatment, on January 19, 2021. Ex. 7 at 4. The record again noted an onset date of
December 13, 2019 (the date of her flu vaccination). Id. Her left shoulder pain had
improved overall. Id. She stated that she wanted to make sure her shoulder was okay,
explaining that if she did too much or slept on her left shoulder her symptoms worsened,
with her soreness increasing by the end of the day. Id. Her pain was one out of ten at best
and three out of ten at worst. Id. By this time, her left shoulder active ROM was within
6

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 7 of 10
normal limits and impingement signs were negative, although she continued to have pain
at end range in abduction and somewhat decreased strength. Id. at 4-5. She continued
to have tenderness to palpation in her left rotator cuff biceps long head and the insertion
at her greater tubercle and lesser tubercle. Id. She was assessed with mild left shoulder
pain, limitations in left shoulder stabilization, and tenderness to palpation in her pectoralis
major, subscapularis, and infraspinatus. Id. at 6. A treatment plan was established for her
to undergo physical therapy once a week for four weeks. Id. Petitioner attended a total of
five PT sessions between January 19 and March 17, 2021. Ex. 7 at 4-19; Ex. 8 at 4.
2. Petitioner’s Statements
Petitioner filed two unsworn statements in support of her claim. Exs. 11, 12.
Although both are titled as affidavits, neither is notarized or sworn under penalty of perjury
pursuant to 28 U.S.C. § 1746.5 Instead, they acknowledge only that Petitioner
understands they will be filed in this case. As such, they are treated as unsworn witness
statements, and entitled to somewhat less weight.
Petitioner contends that she stopped formal physical therapy on March 18, 2020,
due to the COVID-19 Pandemic. Ex. 12 at ¶ 4. Her pain had not really improved at that
time, remaining at about seven or eight, and she still could not dress or undress by herself
or work the same using her arm. Id. Throughout 2020, she continued to do stretches at
home and use ice, heat, and ibuprofen for pain relief three to five times a week. Id. at ¶ 5.
She returned to PT in January 2021 because the pain had not gone away. Id. at ¶ 6.
C. The Parties’ Arguments
Petitioner argues that the medical records and statements demonstrate by
preponderant evidence that she experienced residual effects and complications of her left
shoulder injury for more than six months. Petitioner’s Motion for a Ruling on the Record,
filed July 31, 2023 (ECF No. 35) (“Mot.”). Although Petitioner stopped treating after March
18, 2020, this was not voluntary, but was instead due to the COVID-19 Pandemic. Mot.
at *7-8. Thereafter, she continued to follow her orthopedist’s advice and continued with
exercises at home three to five times a week. Id. at *8.
In January 2021, she returned to treatment because her pain had not yet abated.
Mot. at *8. The PT record continued to note an onset date of December 13, 2019, further
corroborating that this treatment was related to her SIRVA. Id. Although Petitioner saw
her gynecologist twice in the interim, once virtually and once in person, she argues that it
is “unreasonable” to assume that she would discuss her shoulder pain with her
gynecologist, especially when she was already receiving treatment from an orthopedist
and physical therapist. Id.
5 Counsel should ensure in the future to offer a either a proper affidavit or a declaration that complies with
28 U.S.C. §1746.
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Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 8 of 10
Respondent argues that Petitioner treated her left shoulder pain for only three
months before stopping in March 2020. Respondent’s Response, filed Sept. 29, 2023, at
*5 (ECF No. 36) (“Resp.”). In Respondent’s view, the lack of objective evidence that
Petitioner’s pain persisted until June 13, 2020 (six months after vaccination) is fatal to
Petitioner’s claim. Resp. at *5.
Although Petitioner asserts that she discontinued care due to the Pandemic, the
record reflects that she sought treatment from another provider – demonstrating her ability
to obtain medical care, remotely or in person, during this time. Resp. at *5. Moreover,
there is no corroboration of Petitioner’s claim that she continued home exercises or
otherwise treated during this time. Id. Instead, the record shows that Petitioner had
substantially improved by March 18, 2020, making it more likely (in Respondent’s view)
that her pain abated on its own. Id. Respondent argues that the ten month treatment gap
is too long to connect her January 2021 PT to her prior injury, especially given that she
explained her visit then was to make sure her shoulder was okay. Id. Respondent further
notes that this resumption of care occurred one week after this petition was filed. Id.
Respondent adds that Petitioner’s statement is “particularly bare” in explaining the
circumstances or deciding to terminate care and how she was impacted during this time.
Resp. at *6. For instance, Petitioner asserts that she could not dress or undress by herself
or work the same using her arm – but does not explain her work, the actual impact or
impairment, or how she circumvented these deficits for ten months. Id. Under these
circumstances, the medical records should not be evidentiarily outweighed by later
testimony that is consistent, clear, cogent, and compelling. Id. (citing Camery v. Sec’y of
Health & Human Servs., 42 Fed. Cl. 381, 391 (1998)).
D. Factual Finding Regarding QAI Criteria for Table SIRVA
Respondent does not contest the four primary SIRVA QAI criteria, and I find that
they are satisfied. There is no evidence that Petitioner had a pre-vaccination left shoulder
condition, or another condition or abnormality, that would explain her symptoms after
vaccination. Ex. 2. The onset of her shoulder pain most likely occurred within 48 hours of
vaccination. Ex. 2 at 6; Ex. 3 at 9; Ex. 4 at 4. And her symptoms were limited to her left
shoulder, where she received the flu vaccine. Exs. 2, 3, 4.
E. Statutory Severity Requirement
I find that preponderant evidence supports a finding that the statutory severity
requirement is satisfied – although the temporal treatment gap and other evidence
relating to the limited persistence of Petitioner’s symptoms into 2021 all establishes a mild
SIRVA, and therefore presents a case in which any pain and suffering award should be
minimal.
8

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 9 of 10
Petitioner sought care two weeks after vaccination, complaining of shoulder pain
since her flu vaccination. Ex. 2 at 6. Thereafter, she persistently sought care for her pain
until March 18, 2020, just over three months after vaccination. At that point, she abruptly
stopped seeking treatment – not because her shoulder pain resolved, but due to the
COVID-19 Pandemic.6 Ex. 12 at ¶ 4. When she stopped PT due to the Pandemic on
March 18th, her pain was still at a level of five out of ten, with a constant dull ache, positive
impingement signs, and limited ROM. Ex. 4 at 12-16. Significantly, at the prior session,
she had just been approved for another six weeks of PT. Id.
Petitioner did not again seek care for her shoulder pain until ten months later
(January 19, 2021). Ex. 7 at 4. Importantly, however, at that time she continued to relate
her pain to her December 2019 vaccination. Id. Although her ROM was now normal, she
continued to have pain ranging between one and three out of ten. Id. at 4-5. Taken
together, the March 2020 and January 2021 PT records support a finding that Petitioner’s
shoulder pain had not resolved in March 2020, then started anew sometime between that
date and January 2021. Instead, the record suggests that her injury continued, albeit with
demonstrated improvement, during the ten-month treatment gap.
This case has many similarities to Black v. Sec’y of Health & Human Servs., No.
21-09V, 2023 WL 4446500 (Fed. Cl. Spec. Mstr. May 22, 2023). That petitioner also
sought care for three months, until January 2020, followed by an 18 month gap in
treatment for his shoulder pain. Additionally, the petitioner’s return to care occurred after
he filed his petition – as in this case. The petitioner in Black argued that he did not follow
up after January 2020 due to the COVID-19 Pandemic. Id. at *4. I acknowledged that in
many cases I had allowed that the Pandemic reasonably caused people to defer
treatment, but found that an 18 month gap starting in January 2020 – somewhat before
the more severe impacts of the Pandemic had begun – was simply too attenuated. Id.
Here, the treatment gap was shorter, less than a year. And importantly, Ms. Nielsen
abruptly stopped care in mid-March 2020 – shortly after COVID-19 was declared a
pandemic.
I base my ruling primarily on the medical records, and place little weight on
Petitioner’s unsworn witness statements. That the statements were not made under
penalty of perjury reduces their evidentiary value. And Respondent correctly notes that
Petitioner’s statements are not detailed. However, the statements are consistent with, and
corroborate the medical records, and thus provide some weak support for Petitioner’s
severity contentions. Petitioner states that throughout 2020 she did her home exercises,
6 The World Health Organization declared COVID-19 a pandemic on March 11, 2020. Centers for Disease
Control Museum COVID-19 Timeline, https://www.cdc.gov/museum/timeline/covid19.html (last visited Aug.
23, 2024).
9

Case 1:21-vv-00590-UNJ Document 40 Filed 09/27/24 Page 10 of 10
ice/heat, and ibuprofen at home three to five times a week – which credibly explains the
improvement in her shoulder condition during this time period.
Although Petitioner sought care during the ten-month treatment gap from a single
other provider, her gynecologist, this does not negate a finding that her shoulder injury
persisted for more than six months. That she sought other care does establish that she
was able to obtain medical care during this time, as Respondent asserts. But it does not
presumptively establish that her failure to do so means that her shoulder pain no longer
existed. Instead, I interpret her seeking gynecological care – but not shoulder treatment
– to mean that her shoulder condition was less pressing at the time.
F. Other Requirements for Entitlement
The record contains preponderant evidence that other requirements for entitlement
are satisfied as well. Petitioner received a covered vaccine in the United States. Ex. 1 at
2. Petitioner states that she has never received an award or settlement, or filed a civil
action, for her vaccine-related injuries. Ex. 11 at ¶ 7.
Conclusion
Based on my review of the record as a whole, I find that it is more likely than not
that all SIRVA Table requirements are met. I find that the statutory severity requirement
is satisfied by preponderant evidence, as are other requirements for entitlement.
Therefore, Petitioner’s motion for a ruling on the record that she is entitled to
compensation is GRANTED.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
10

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DOCUMENT 2: USCOURTS-cofc-1_21-vv-00590-1
Date issued/filed: 2024-12-27
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 11/27/2024) regarding 44 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made.
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Case 1:21-vv-00590-UNJ Document 48 Filed 12/27/24 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0590V
CIARA NIELSEN, Chief Special Master Corcoran
Petitioner, Filed: November 27, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Amy A. Senerth, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Mallori Browne Openchowski, U.S. Department of Justice, Washington, DC, for
Respondent.
DECISION AWARDING DAMAGES1
On January 12, 2021, Ciara Nielsen 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 left shoulder injury related to vaccine
administration (“SIRVA”) resulting from an influenza (“flu”) vaccine received on December
13, 2019. Petition at 1. The case was assigned to the Special Processing Unit of the
Office of Special Masters.
On August 23, 2024, a ruling on entitlement was issued, finding Petitioner entitled
to compensation for SIRVA. On November 27, 2024, Respondent filed a proffer on award
of compensation (“Proffer”) indicating Petitioner should be awarded $55,000.00, as well
as funds to satisfy a state of Maryland Medicaid lien in the amount of $218.30. Proffer at
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-00590-UNJ Document 48 Filed 12/27/24 Page 2 of 5
1-2. 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:
1) A lump sum payment of $55,000.00 in the form of a check payable to
Petitioner; and
2) A lump sum payment of $218.30, representing compensation for satisfaction
of the state of Maryland Medicaid lien, payable jointly to Petitioner and to:
Wellpoint Maryland
P.O. Box 659940
San Antonio, TX 78265-9939
Petitioner agrees to endorse this payment to Wellpoint Maryland.
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-00590-UNJ Document 48 Filed 12/27/24 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
CIARA NIELSEN,
Petitioner, No. 21-590V
Chief Special Master Corcoran
v. SPU
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On February 21, 2023, respondent filed a Rule 4(c) report and motion to dismiss
petitioner’s claim. ECF No. 33. Thereafter, on July 31, 2023, petitioner moved for a ruling on
the record, to which respondent responded. ECF No. 35, 36. On August 23, 2024, the Chief
Special Master issued a Ruling on Entitlement finding that petitioner was entitled to vaccine
compensation for her left Shoulder Injury Related to Vaccine Administration (“SIRVA”). ECF
Nos. 37-38.
I. Compensation for Vaccine Injury-Related Items
Based on the evidence of record, respondent proffers that petitioner should be awarded
$55,000.00. This amount represents all elements of compensation to which petitioner would be
entitled under 42 U.S.C. § 300aa-15(a), with the exception of the reimbursement of the Medicaid
lien, below. Petitioner agrees.
Respondent further proffers that petitioner should be awarded funds to satisfy a state of
Maryland Medicaid lien in the amount of $218.30, which represents full satisfaction of any right
of subrogation, assignment, claim, lien, or cause of action the state of Maryland may have

Case 1:21-vv-00590-UNJ Document 48 Filed 12/27/24 Page 4 of 5
against any individual as a result of any Medicaid payments that the state of Maryland has made
to or on behalf of Ciara Nielsen from the date of her eligibility for benefits through the date of
judgment in this case as a result of her vaccine-related injury suffered on or about December 13,
2019, under Title XIX of the Social Security Act. Petitioner agrees.1
II. Form of the Award
Respondent recommends that the compensation provided to petitioner be made through
two lump sum payments as described below:
(1) The parties recommend that compensation provided to petitioner should be made
through a lump sum payment of $55,000.00, in the form of a check payable to
petitioner.2 Petitioner agrees.
(2) A lump sum payment of $218.30, representing compensation for satisfaction of
the state of Maryland Medicaid lien, payable jointly to petitioner and to:
Wellpoint Maryland
P.O. Box 659940
San Antonio, TX 78265 - 9939
Petitioner agrees to endorse this payment to Wellpoint Maryland.
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
1 The parties have no objection to the amount of the proffered award of damages. However,
respondent reserves his right, pursuant to 42 U.S.C. § 300aa-12(e), to seek review of the Chief
Special Master’s August 23, 2024 entitlement decision.
2 Should petitioner die prior to entry of judgment, the parties reserve the right to move the Court
for appropriate relief. In particular, respondent would oppose any award for future pain and
suffering.
2

Case 1:21-vv-00590-UNJ Document 48 Filed 12/27/24 Page 5 of 5
HEATHER L. PEARLMAN
Deputy Director
Torts Branch, Civil Division
COLLEEN C. HARTLEY
Assistant Director
Torts Branch, Civil Division
s/ Mallori B. Openchowski
MALLORI B. OPENCHOWSKI
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146, Ben Franklin Station
Washington, DC 20044-0146
Tel.: (202) 305-0660
mallori.b.openchowski@usdoj.gov
DATED: November 27, 2024
3