VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00645
Package ID: USCOURTS-cofc-1_21-vv-00645
Petitioner: Marie Belanger
Filed: 2021-01-12
Decided: 2023-09-05
Vaccine: influenza
Vaccination date: 2020-10-12
Condition: left-sided shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 15000

AI-assisted case summary:
Marie Belanger filed a petition for compensation under the National Vaccine Injury Compensation Program on January 12, 2021, alleging she suffered a left-sided shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on October 12, 2020. The influenza vaccine is listed on the Vaccine Injury Table. Respondent denied that Petitioner sustained a SIRVA or any other injury caused by the vaccine. Despite maintaining their positions, the parties filed a joint stipulation on September 5, 2023, agreeing to settle the case. Chief Special Master Brian H. Corcoran adopted the stipulation as the decision awarding damages. The court awarded Marie Belanger a lump sum of $15,000.00 as compensation for all damages available under the program. This award represents a negotiated settlement of liability and damages. Petitioner was represented by Ronald Craig Homer of Conway, Homer, P.C., and Respondent was represented by Joseph Douglas Leavitt of the U.S. Department of Justice. The public decision does not describe the onset of symptoms, specific medical tests, or treatments.

Theory of causation field:
Petitioner Marie Belanger received an influenza vaccine on October 12, 2020. The influenza vaccine is listed on the Vaccine Injury Table. Petitioner alleged a left-sided shoulder injury related to vaccine administration (SIRVA) and that residual effects lasted more than six months. Respondent denied that Petitioner sustained a SIRVA or any other injury caused by the vaccine. The parties filed a joint stipulation agreeing to settle the case. Chief Special Master Brian H. Corcoran adopted the stipulation as the decision. The award was a lump sum of $15,000.00 for all damages available under 42 U.S.C. § 300aa-15(a). The stipulation was dated September 5, 2023, and the decision was issued on September 5, 2023. Petitioner's counsel was Ronald Craig Homer, and Respondent's counsel was Joseph Douglas Leavitt. The public text does not detail the specific mechanism of injury, expert testimony, or the specific Table theory relied upon, other than the vaccine being listed on the Table.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_21-vv-00645-0
Date issued/filed: 2023-10-06
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 09/05/2023) regarding 51 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:21-vv-00645-UNJ Document 55 Filed 10/06/23 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 21-0645V
MARIE BELANGER, Chief Special Master Corcoran
Petitioner,
v. Filed: September 5, 2023
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Ronald Craig Homer, Conway, Homer, P.C., Boston, MA, for Petitioner.
Joseph Douglas Leavitt, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 12, 2021, Marie Belanger 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 received an influenza (“flu”) vaccine, which vaccine is contained
in the Vaccine Injury Table (the “Table”), 42 C.F.R. § 100.3(a), on October 12, 2020.
Petitioner alleges that she suffered a left-sided shoulder injury related to vaccine
administration (“SIRVA”) as a result of her vaccination. She further alleges that she
experienced the residual effects of this injury for more than six months.
Respondent denies that Petitioner sustained a SIRVA as a result of her flu vaccine
and denies that the vaccine caused her any other injury.
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 (2012).

Case 1:21-vv-00645-UNJ Document 55 Filed 10/06/23 Page 2 of 7
Nevertheless, on September 5, 2023, 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 $15,000.00 in the form of a check payable to Petitioner. This
amount represents compensation for all items of damages that would be available
under Section 15(a). Stipulation at ¶ 8.
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-00645-UNJ Document 55 Filed 10/06/23 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
MARIE BELANGER,
Petitioner,
V. No. 21-645V (ECF)
Chief Special Master Corcoran
SECRETA RY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
1. On January 12, 2021, petitioner filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-l Oto -34 (the "Program").
The petition seeks compensation for an injury allegedly related to petitioner's receipt of the
influenza vaccine, which vaccine is contained in the Vaccine Injury Table, 42 C.F.R. § 100.3(a)
(the "Table").
2. Petitioner received an influenza vaccine on October 12, 2020.
3. The vaccine was administered within the United States.
4. Petitioner alleges that she suffered a left-sided SIRVA as a result of her vaccination.
Petitioner further alleges that she experienced the residual effects of this injury for more than six
months.
5. Petitioner represents that there has been no prior award or settlement of a civil action for
damages as a result of her alleged injury.

Case 1:21-vv-00645-UNJ Document 55 Filed 10/06/23 Page 4 of 7
6. Respondent denies that petitioner suffered a SIRVA as a result of her influenza vaccine
and denies that the vaccine caused her any other injury.
7. Maintaining their above-stated positions, the parties nevertheless now agree that the issue
between them shall be settled and that a decision should be entered awarding the compensation
described in paragraph eight of this Stipulation.
8. As soon as practicable after an entry of judgment reflecting a decision consistent with the
tenns 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. A lump sum of $15,000.00 in the fonn 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.
I 0. Petitioner and her attorney represent that the 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-l S(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-00645-UNJ Document 55 Filed 10/06/23 Page 5 of 7
11. Payment made pursuant to paragraph eight and any amounts awarded pursuant to
paragraph nine of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-l 5(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 unreimbursable 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-15(g) and (h).
13. In return for the compensation described in paragraphs eight and nine, petitioner, in her
individual capacity, and on behalf of her heirs, executors, administrators, successors, or assigns,
does forever and 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-l Oe t 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 influenza vaccination administered on October 12,
2020, as alleged in a petition for vaccine compensation filed on or about January 12, 2021, in the
United States Court of Federal Claims as petition No. 2 l-645V.
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-00645-UNJ Document 55 Filed 10/06/23 Page 6 of 7
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, expect
as otherwise noted in paragraph nine 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 influenza vaccine caused petitioner's alleged
injury or any other injury, 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-00645-UNJ Document 55 Filed 10/06/23 Page 7 of 7
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