VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_22-vv-00326
Package ID: USCOURTS-cofc-1_22-vv-00326
Petitioner: Staci Arnold
Filed: 2022-03-25
Decided: 2023-11-14
Vaccine: influenza
Vaccination date: 2020-10-19
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 92667

AI-assisted case summary:
Staci Arnold filed a petition for compensation under the National Vaccine Injury Compensation Program on March 25, 2022. She alleged that she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine administered on October 19, 2020. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report conceding that the petitioner's injury was consistent with SIRVA as defined by the Vaccine Injury Table and that she suffered residual effects for more than six months. Based on the respondent's concession and the evidence of record, Chief Special Master Brian H. Corcoran issued a ruling on entitlement on September 8, 2023, finding Ms. Arnold entitled to compensation. Subsequently, on October 11, 2023, the respondent filed a proffer on the award of compensation, which the petitioner agreed to. On November 14, 2023, Chief Special Master Corcoran issued a decision awarding damages. The award consisted of a lump sum payment of $85,000.00 for pain and suffering, payable to the petitioner, and a lump sum payment of $7,667.38 to satisfy a New York Medicaid lien, payable jointly to the petitioner and the New York State Department of Health. The total award was $92,667.38. Petitioner was represented by Jerome A. Konkel of Samster, Konkel & Safran, S.C., and respondent was represented by Steven Santayana of the U.S. Department of Justice. The public decision does not describe the specific onset of symptoms, medical examinations, diagnostic tests, or treatments received by the petitioner, nor does it name any medical experts.

Theory of causation field:
Petitioner Staci Arnold alleged a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccine on October 19, 2020. The case proceeded as a Table claim. The respondent conceded that the injury was consistent with SIRVA as defined by the Vaccine Injury Table and that residual effects lasted more than six months. No specific medical experts or detailed causation theories beyond the Table definition were presented in the public text. The Special Master found entitlement based on the respondent's concession. An award was stipulated and granted on November 14, 2023, totaling $92,667.38, comprising $85,000.00 for pain and suffering and $7,667.38 to satisfy a New York Medicaid lien. Chief Special Master Brian H. Corcoran presided. Petitioner was represented by Jerome A. Konkel, and respondent by Steven Santayana.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_22-vv-00326-0
Date issued/filed: 2023-10-10
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 09/08/2023) regarding 25 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:22-vv-00326-UNJ Document 28 Filed 10/10/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-0326V
STACI ARNOLD, Chief Special Master Corcoran
Petitioner, Filed: September 8, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, S.C., Milwaukee, WI, for Petitioner.
Steven Santayana, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On March 25, 2022, Staci Arnold 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”) as a result of an influenza (“flu”) vaccine that was administered
on October 19, 2020. Petition at 3. The case was assigned to the Special Processing Unit
of the Office of Special Masters.
On September 7, 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. Specifically, Respondent has concluded that “[P]etitioner’s injury is consistent with
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 1:22-vv-00326-UNJ Document 28 Filed 10/10/23 Page 2 of 2
SIRVA as defined by the Vaccine Injury Table.” Id. at 5. Respondent further agrees that
Petitioner suffered the residual effects of her injury 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

================================================================================
DOCUMENT 2: USCOURTS-cofc-1_22-vv-00326-1
Date issued/filed: 2023-11-14
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 10/12/2023) regarding 30 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
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Case 1:22-vv-00326-UNJ Document 34 Filed 11/14/23 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-00326V
STACI ARNOLD, Chief Special Master Corcoran
Petitioner, Filed: October 12, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, S.C., Milwaukee, WI, for Petitioner.
Steven Santayana, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On March 25, 2022, Staci Arnold 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”) as a result of an influenza (“flu”) vaccine administered on
October 19, 2020. Petition at 3. The case was assigned to the Special Processing Unit of
the Office of Special Masters.
On September 8, 2023, a ruling on entitlement was issued, finding Petitioner
entitled to compensation for SIRVA. On October 11, 2023, Respondent filed a proffer on
award of compensation (“Proffer”) indicating Petitioner should be awarded (a) a lump sum
payment of $85,000.00, representing compensation for pain and suffering; and (b) a lump
sum payment of $7,667.38, representing compensation for satisfaction of the State of
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 1:22-vv-00326-UNJ Document 34 Filed 11/14/23 Page 2 of 5
New York Medicaid lien. Proffer at 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:
A. A lump sum payment of $85,000.00, representing compensation for pain and
suffering in the form of a check payable to Petitioner; and
B. A lump sum payment of $7,667.38, representing compensation for
satisfaction of the State of New York Medicaid lien, in the form of a check
payable jointly to Petitioner and the New York Department of Health.
Petitioner agrees to endorse and mail this payment to:
NEW YORK STATE DEPARTMENT OF HEALTH
P.O. Box 415874
Boston, MA 02241-5874
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 1:22-vv-00326-UNJ Document 34 Filed 11/14/23 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
____________________________________
)
STACI ARNOLD, )
)
Petitioner, )
) No. 22-326V
v. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
____________________________________)
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On March 25, 2022, Staci Arnold (“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 she suffered a Table shoulder injury related to vaccine administration
(“SIRVA”) as the result of an influenza (“flu”) vaccination received on October 19, 2020.
Petition at 3, 7. On September 7, 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 Table SIRVA, and the next day, the Chief Special Master issued
a Ruling on Entitlement finding petitioner entitled to compensation. ECF No. 24; ECF No. 25.
I. Items of Compensation
A. Pain and Suffering
Respondent proffers that petitioner should be awarded $85,000.00 in pain and suffering.
See 42 U.S.C. § 300aa-15(a)(4). Petitioner agrees.

Case 1:22-vv-00326-UNJ Document 34 Filed 11/14/23 Page 4 of 5
B. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy the State of New
York Medicaid lien in the amount of $7,667.38, which represents full satisfaction of any right of
subrogation, assignment, claim, lien, or cause of action the State of New York may have against
any individual as a result of any Medicaid payments the State of New York has made to or on
behalf of petitioner from the date of her eligibility for benefits through the date of judgment in
this case as a result of her alleged vaccine-related injury suffered on or about October 19, 2020,
under Title XIX of the Social Security Act. Petitioner agrees.
These amounts represent all elements of compensation to which petitioner is entitled
under 42 U.S.C. § 300aa-15(a). Petitioner agrees.
II. Form of the Award
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
Respondent recommends that the compensation provided to petitioner should be made through
two lump sum payments as described below and requests that the Chief Special Master’s
decision and the Court’s judgment award the following1:
A. A lump sum payment of $85,000.00, in the form of a check payable to petitioner; and
B. A lump sum payment of $7,667.38, representing compensation for satisfaction of the
State of New York Medicaid lien, in the form of a check payable jointly to petitioner
and the New York State Department of Health.
Petitioner agrees to endorse the check to the State of New York Department of Health for
satisfaction of the Medication lien and mail it to the following address:
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 lost earnings
and future pain and suffering.
2

Case 1:22-vv-00326-UNJ Document 34 Filed 11/14/23 Page 5 of 5
NEW YORK STATE DEPARTMENT OF HEALTH
P. O. Box 415874
Boston, MA 02241-5874
III. Summary of Recommended Payments Following Judgment
A. Lump sum payable to petitioner, Tiffany Wentworth: $85,000.00
B. Lump sum payable jointly to petitioner and the New York State
Department of Health: $7,667.38
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
TRACI R. PATTON
Assistant Director
Torts Branch, Civil Division
s/ Steven C. Santayana _____
STEVEN C. SANTAYANA
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) 451-7675
steven.c.santayana@usdoj.gov
Dated: October 11, 2023
3