VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_21-vv-00767 Package ID: USCOURTS-cofc-1_21-vv-00767 Petitioner: Robin Siemiatkoski Filed: 2021-01-19 Decided: 2023-01-06 Vaccine: influenza Vaccination date: 2019-11-01 Condition: shoulder injury related to vaccine administration (SIRVA) Outcome: compensated Award amount USD: 65462 AI-assisted case summary: Robin Siemiatkoski filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) caused by an influenza vaccine administered on November 1, 2019. She stated that the vaccine was administered in the United States, that she experienced residual effects for more than six months, and that she had not received a prior award or settlement for civil action damages. Respondent denied that Petitioner sustained a SIRVA Table injury, denied that the flu vaccine caused her alleged shoulder injury or any other injury, and denied that her current condition was a sequelae of a vaccine-related injury. Despite these denials, the parties filed a joint stipulation on November 22, 2022, agreeing that compensation should be awarded. Chief Special Master Corcoran found the stipulation reasonable and adopted it as the decision awarding damages. The award included a lump sum of $65,000.00 payable to Petitioner and an additional $462.02 to reimburse a Medicaid lien for services rendered by the state of Connecticut. This total amount of $65,462.00 represents compensation for all items of damages available under Section 15(a) of the Vaccine Act. Theory of causation field: Table Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_21-vv-00767-0 Date issued/filed: 2023-01-06 Pages: 8 Docket text: PUBLIC DECISION (Originally filed: 11/28/2022) regarding 36 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kp) Service on parties made. -------------------------------------------------------------------------------- Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 1 of 8 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 21-767V UNPUBLISHED ROBIN SIEMIATKOSKI, Chief Special Master Corcoran Petitioner, Filed: November 28, 2022 v. Special Processing Unit (SPU); Joint SECRETARY OF HEALTH AND Stipulation on Damages; Influenza HUMAN SERVICES, (Flu) Vaccine; Shoulder Injury Related to Vaccine Administration Respondent. (SIRVA) Jimmy A. Zgheib, Zgheib Sayad, P.C., White Plains, NY, for Petitioner. Mitchell Jones, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON JOINT STIPULATION1 On January 19, 2021, Robin Siemiatkoski 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”) caused by an influenza (“flu”) vaccine administered on November 1, 2019. Petition at 1; Stipulation, filed at November 22, 2022, ¶¶ 1-4. Petitioner further alleges that the vaccine was administered within the United States, that she experienced the residual effects of her condition for more than six months, and that there has been no prior award or settlement of a civil action for damages on her behalf. Petition at 4-5; Stipulation at ¶¶ 3-5. Respondent denies that Petitioner sustained a SIRVA Table injury; denies that the flu vaccine caused Petitioner’s alleged shoulder injury, or any other injury; and denies that Petitioner’s current condition is a sequelae of a vaccine- related injury.” Stipulation at ¶ 6. 1 Because this unpublished Decision contains a reasoned explanation for the action in this case, I am required to post it on the United States Court of Federal Claims' website in accordance with the E- Government Act of 2002. 44 U.S.C. § 3501 note (2012) (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-00767-UNJ Document 42 Filed 01/06/23 Page 2 of 8 Nevertheless, on November 22, 2022, 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. A lump sum of $65,000.00 in the form of a check payable to Petitioner. B. A lump sum payment of $462.02,3 representing reimbursement of a Medicaid lien for services rendered to petitioner by the state of Connecticut in the form of a check payable jointly to petitioner and the Connecticut Department of Administrative Services: Department of Administrative Services 450 Columbus Boulevard, Suite 1001 Hartford, Connecticut 06103 Case # 2110754 Petitioner agrees to endorse the check to the Department of Administrative Services. Stipulation at ¶ 8. This amount 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.4 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 Connecticut may have against any individual as a result of any Medicaid payments the Connecticut Program has made to or on behalf of Robin Siemiatkoski as a result of her alleged vaccine- related injury suffered on or about November 1, 2019, under Title XIX of the Social Security Act, see 42 U.S.C. § 300aa-15(g), (h). 4 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-00767-UNJ Document 42 Filed 01/06/23 Page 3 of 8 Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 4 of 8 Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 5 of 8 Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 6 of 8 Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 7 of 8 Case 1:21-vv-00767-UNJ Document 42 Filed 01/06/23 Page 8 of 8