VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_22-vv-00667
Package ID: USCOURTS-cofc-1_22-vv-00667
Petitioner: Ronald Poulin
Filed: 2022-06-15
Decided: 2024-07-23
Vaccine: influenza
Vaccination date: 2021-10-28
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 47500

AI-assisted case summary:
Ronald Poulin filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging he suffered a shoulder injury related to vaccine administration (SIRVA) after receiving an influenza vaccine on October 28, 2021. He further alleged that the residual effects of his injury lasted for more than six months. The respondent conceded that Mr. Poulin's injury was consistent with SIRVA as defined by the Vaccine Injury Table, noting he had no prior shoulder issues, the pain occurred within 48 hours of vaccination, was limited to the injection site, and no other condition explained the pain. The respondent also agreed that the injury's effects persisted for over six months and that Mr. Poulin was entitled to compensation. Based on the respondent's concession and the evidence, entitlement was granted. Subsequently, the parties filed a joint stipulation agreeing to a settlement. The court adopted the stipulation, awarding Mr. Poulin a lump sum of $47,500.00 for all damages available under the Vaccine Act. This award represents a full and complete settlement of the claim, with the stipulation not constituting an admission by the respondent that the vaccine caused the injury, but acknowledging that Mr. Poulin met the Table criteria for entitlement.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_22-vv-00667-0
Date issued/filed: 2023-12-05
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 11/03/2023) regarding 21 Ruling on Entitlement ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:22-vv-00667-UNJ Document 24 Filed 12/05/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-0667V
RONALD POULIN,
Chief Special Master Corcoran
Petitioner,
v.
Filed: November 3, 2023
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Emily H. Manoso, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On June 15, 2022, Ronald Poulin 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 Table shoulder injury related to
vaccine administration (“SIRVA”), as the result of an influenza (“flu”) vaccination received
on October 28, 2021. Petition at 1. Petitioner further alleges that he suffered the sequela
of his vaccine related injury for more than six months. Petition at 1-2. The case was
assigned to the Special Processing Unit of the Office of Special Masters.
On November 2, 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 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-00667-UNJ Document 24 Filed 12/05/23 Page 2 of 2
1. Specifically, Respondent states that “petitioner’s alleged injury is consistent with SIRVA
as defined by the Vaccine Injury Table. Specifically, petitioner 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 petitioner’s 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_22-vv-00667-1
Date issued/filed: 2024-07-23
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 06/18/2024) regarding 35 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:22-vv-00667-UNJ Document 39 Filed 07/23/24 Page 1 of 7
(cid:36)(cid:48)(cid:51)(cid:51)(cid:38)(cid:36)(cid:53)(cid:38)(cid:37)
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-0667V
RONALD POULIN,
Chief Special Master Corcoran
Petitioner,
v.
Filed: June 18, 2024
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Leah VaSahnja Durant, Law Offices of Leah V. Durant, PLLC, Washington, DC, for
Petitioner.
Parisa Tabassian, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On June 15, 2022, Ronald Poulin 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 left shoulder injury related to vaccine
administration as a result of an influenza (“flu”) vaccine he received on October 28, 2021.
Petition at 1; Stipulation, filed at June 18, 2024, ¶¶3-4. Petitioner further alleges that he
suffered the residual effects of her SIRVA injury for more than six months. Petition at 1;
Stipulation at ¶4. Respondent agrees that “Petitioner sustained a left shoulder injury
related to vaccination administration (‘SIRVA’) within the time period set forth in the Table
following receipt of the flu vaccine and experienced the residual effects of a SIRVA injury
for more than six months.” Stipulation at ¶ 4. Respondent further agrees that there is not
a preponderance of the evidence demonstrating that Petitioner’s injury is due to a factor
unrelated to vaccination, and thus Petitioner is entitled to compensation under the terms
of the Vaccine Act. Id.
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-00667-UNJ Document 39 Filed 07/23/24 Page 2 of 7
On June 18, 2024, 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 $47,500.00, in the form of a check payable to Petitioner.
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.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-00667-UNJ Document 39 Filed 07/23/24 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
)
RONALD POULIN, )
)
Petitioner, )
) No. 22-667V
V. ) Chief Special Master Corcoran
) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )
STIPULATION
The parties hereby stipulate to the following matters:
I. Ronald Poulin, petitioner, filed a petition for vaccine compensation under the National
Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-l Oto -34 (the "Vaccine Program").
The petition seeks compensation for injuries allegedly related to petitioner's receipt of an
influenza ("flu") vaccine, which is a vaccine contained in the Vaccine Injury Table (the "Table"),
42 C.F.R. § I 00J(a).
2. Petitioner received the flu vaccine on October 28, 2021.1
3. The vaccination was administered within the United States.
1 On November 18, 202 I, petitioner received a COVID-19 booster vaccine. Vaccines against
COVID-19 are not contained in the Vaccine Injury Table. See 42 U.S.C. § 300aa-14 and 42
C.F.R. § I 00.3(a). Pursuant to the declaration issued by the Secretary of Health and Human
Services under the Public Readiness and Emergency Preparedness Act (4 2 U. S.C. §§ 24 7d-6d,
247d-6e), claims for alleged injuries from COVID-19 countermeasures, including vaccines, may
be compensable under the Countermeasures Injury Compensation Program ("CICP"). See 85
Fed. Reg. 15198, 15202 (March I 7, 2020).

Case 1:22-vv-00667-UNJ Document 39 Filed 07/23/24 Page 4 of 7
4. Petitioner sustained a left shoulder injury related to vaccination administration
("SIRVA") within the time period set forth in the Table following receipt of the flu vaccine and
experienced the residual effects of a SIRVA injury for more than six months.
5. There is not a preponderance of evidence demonstrating that petitioner's injury is due
to a factor unrelated to vaccination.
6. Petitioner represents that there has been no prior award or settlement of a civi I action
for damages on petitioner's behalf as a result of petitioner's condition.
7. Accordingly, petitioner is entitled to compensation under the terms of the Vaccine Act
for her SIRVA Table injury. Therefore, a decision should be entered awarding the compensation
described in paragraph 8 of this Stipulation.
8. As soon as practicable after an entry of judgment reflecting a decision consistent with
the terms of this Stipulation, and after petitioner has filed an election to receive compensation
pursuant to 42 U.S.C. § 300aa-2 l (a)(l ), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of$47,500.00 in the form of a check payable to petitioner. This
amount represents compensation for all damages that would be available under 42
U.S.C. § 300aa-l 5(a).
9. As soon as practicable after the entry of judgment 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-21(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 petitioner's attorney represent that compensation to be provided
pursuant to this Stipulation is not for any items or services for which the Program is not
2

Case 1:22-vv-00667-UNJ Document 39 Filed 07/23/24 Page 5 of 7
primarily liable under 42 U.S.C. § 300aa-l 5(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.
11. Payment made pursuant to paragraph 8 of this Stipulation and any amounts awarded
pursuant to paragraph 9 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 attorneys' fees and litigation costs, and past unreimbursed 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-I 5(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in petitioner's
individual capacity, and on behalfof petitioner's heirs, executors, administrators, successors or
assigns, (a) does forever 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
hereafter could be timely brought in the Court of Federal Claims, under the Vaccine Injury
Compensation Program, 42 U.S.C. § 300aa-10 et seq., (i) 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 that may be alleged to have resulted from, the vaccinations
administered on October 28 and November 18, 2021, and (ii) that petitioner has had, now has, or
3

Case 1:22-vv-00667-UNJ Document 39 Filed 07/23/24 Page 6 of 7
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, except
as otherwise noted in paragraph 9 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 the 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. The Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the flu vaccine caused petitioner's shoulder injury
or any other injury or her current condition; however, petitioner has satisfied the Table criteria to
establish entitlement to compensation.
18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
5

Case 1:22-vv-00667-UNJ Document 39 Filed 07/23/24 Page 7 of 7
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