VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00608
Package ID: USCOURTS-cofc-1_21-vv-00608
Petitioner: Douglas Rouse
Filed: 2021-01-12
Decided: 2024-01-03
Vaccine: influenza
Vaccination date: 2020-11-10
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 67228

AI-assisted case summary:
Douglas Rouse filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) from an influenza vaccination he received on November 10, 2020. The respondent conceded that Mr. Rouse is entitled to compensation, agreeing that his injury was consistent with SIRVA as defined by the Vaccine Injury Table. Specifically, the respondent noted that Mr. Rouse had no prior shoulder issues, the pain occurred within 48 hours of vaccination, was limited to the injection site shoulder, and no other condition explained the pain. The respondent also agreed that the effects of his condition lasted more than six months. Based on the entitlement ruling and the respondent's concession, the court awarded Mr. Rouse compensation. The award included a lump sum of $65,000.00 for pain and suffering and $2,228.62 to satisfy a State of Colorado Medicaid lien, totaling $67,228.62. The parties stipulated to this award, and Mr. Rouse, being a competent adult, agreed to the terms.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00608-0
Date issued/filed: 2023-12-06
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 09/18/2023) regarding 29 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (sw) Service on parties made.
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Case 1:21-vv-00608-UNJ Document 36 Filed 12/06/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-608V
DOUGLAS ROUSE, Chief Special Master Corcoran
Petitioner, Filed: September 18, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On January 12, 2021, Douglas Rouse 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 he suffered a shoulder injury related to vaccine
administration (SIRVA) resulting from adverse effects of an influenza (flu) vaccination he
received on November 10, 2020. Petition at 1. Petitioner further alleges that the
vaccination was administered within the United States, the effects of his injury lasted more
than six months, and neither h, nor any other party, has ever received compensation in
the form of an award or settlement for his vaccine-related injury. See Petition at 2; see
also Petitioner’s Affidavit (Exhibit 6). 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:21-vv-00608-UNJ Document 36 Filed 12/06/23 Page 2 of 2
On August 21, 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. Respondent concluded that Petitioner’s alleged injury is consistent with SIRVA as
defined by the Vaccine Injury Table. Specifically, Respondent determined that
“[P]etitioner had no history of pain, inflammation, or dysfunction of his left shoulder prior
to vaccination; pain occurred within 48 hours after receipt of an intramuscular vaccination;
pain was limited to the shoulder in which the vaccine was administered; and no other
condition or abnormality has been identified to explain his shoulder pain.” Id. at 5.
Respondent further agrees that Petitioner suffered the residual effects of his condition for
more than six months. 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-00608-1
Date issued/filed: 2024-01-03
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 11/28/2023) regarding 35 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:21-vv-00608-UNJ Document 40 Filed 01/03/24 Page 1 of 5
CORRECTED
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-608V
DOUGLAS ROUSE, Chief Special Master Corcoran
Petitioner, Filed: November 28, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On January 12, 2021, Douglas Rouse 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) resulting from adverse effects of an influenza (“flu”) vaccination
he received on November 10, 2020. Petition at 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
On September 18, 2023, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. On November 28, 2023, Respondent filed a proffer
on award of compensation (“Proffer”) indicating Petitioner should be awarded $65,000.00
for pain and suffering. Proffer at 1. Respondent also proffers that Petitioner should be
awarded funds to satisfy the State of Colorado Medicaid lien in the amount of $2,228.62.
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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:21-vv-00608-UNJ Document 40 Filed 01/03/24 Page 2 of 5
Id. at 2. In the Proffer, Respondent represented that Petitioner agrees with the proffered
award. Id. at 1-2. 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 compensation:
1. A lump sum payment of $65,000.00 in the form of a check payable to
Petitioner, Douglas Rouse.
2. A lump sum payment of $2,228.62, representing compensation for
satisfaction of a State of Colorado Medicaid lien, payable jointly to
Petitioner and the Colorado Department of Health Care Policy and
Financing, and mailed to:
Colorado Department of Health Care Policy and Financing
Colorado Medical Assistance
Tort and Casualty Recovery Program
333 W. Hampden Ave., Suite # 425
Englewood, CO 80110
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-00608-UNJ Document 40 Filed 01/03/24 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DOUGLAS ROUSE,
Petitioner,
No. 21-608V (ECF)
v. Chief Special Master Corcoran
SECRETARY OF HEALTH
AND HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On January 12, 2021, Douglas Rouse (“petitioner”) filed a petition for compensation
under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34
(“Vaccine Act” or “Act”), alleging that he suffered a Shoulder Injury Related to Vaccine
Administration (“SIRVA”), as defined in the Vaccine Injury Table, following administration of
an influenza vaccine he received on November 10, 2020. Petition at 1. On August 21, 2023, the
Secretary of Health and Human Services (“respondent”) filed a Rule 4(c) Report indicating that
this case is appropriate for compensation under the terms of the Act for a SIRVA Table injury,
and on September 18, 2023, the Chief Special Master issued a Ruling on Entitlement finding
petitioner entitled to compensation. ECF No. 28; ECF No. 29.
I. Items of Compensation
A. Pain and Suffering
Based upon the evidence of record, respondent proffers that petitioner should be awarded
a lump sum of $65,000.00 for pain and suffering, in the form of a check payable to petitioner.
Petitioner agrees.

Case 1:21-vv-00608-UNJ Document 40 Filed 01/03/24 Page 4 of 5
B. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy the State of
Colorado Medicaid lien in the amount of $2,228.62, which represents full satisfaction of any
right of subrogation, assignment, claim, lien, or cause of action the State of Colorado may have
against any individual as a result of any Medicaid payments the State of Colorado has made to or
on behalf of petitioner from the date of his eligibility for benefits through the date of judgment in
this case as a result of his alleged vaccine-related injury suffered on or about November 10,
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.
II. Form of the Award
The parties recommend that compensation provided to petitioner should be made through
two lump sum payments described below, and request that the Chief Special Master’s decision
and the Court’s judgment award the following: 1
A. A lump sum payment of $65,000.00 in the form of a check payable to petitioner; and
B. A lump sum payment of $2,228.62, representing compensation for satisfaction of the
State of Colorado Medicaid lien, in the form of a check payable jointly to petitioner
and:
Colorado Department of Health Care Policy and Financing
Colorado Medical Assistance
Tort and Casualty Recovery Program
333 W. Hampden Ave., Suite # 425
Englewood, CO 80110
Petitioner agrees to endorse the check to Colorado Department of Health Care Policy and
1 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 medical
expenses, future pain and suffering, and future lost wages.
2

Case 1:21-vv-00608-UNJ Document 40 Filed 01/03/24 Page 5 of 5
Financing 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
LARA A. ENGLUND
Assistant Director
Torts Branch, Civil Division
/s/ Alec Saxe
ALEC SAXE
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) 353-7722
E-mail: Alec.Saxe@usdoj.gov
DATED: November 28, 2023
3