VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_22-vv-00716
Package ID: USCOURTS-cofc-1_22-vv-00716
Petitioner: Shavannah Ervin
Filed: 2022-06-28
Decided: 2024-01-04
Vaccine: influenza
Vaccination date: 2020-09-15
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 52574

AI-assisted case summary:
Shavannah Ervin filed a petition for compensation under the National Vaccine Injury Compensation Program on June 28, 2022. She alleged that she suffered a shoulder injury related to vaccine administration (SIRVA) as a result of receiving an influenza vaccination on September 15, 2020. Petitioner also alleged that she suffered the residual effects of her injury for more than six months. The case was assigned to the Special Processing Unit of the Office of Special Masters. On September 29, 2023, the respondent filed a Rule 4(c) Report, conceding that Petitioner's alleged injury was consistent with SIRVA as defined by the Vaccine Injury Table and that Petitioner had satisfied all legal prerequisites for compensation. On October 3, 2023, Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement, finding Petitioner entitled to compensation. Subsequently, on December 4, 2023, the respondent filed a Proffer on award of compensation. The respondent proposed an award of $52,500.00 for pain and suffering and $74.07 to satisfy a State of Wisconsin Medicaid lien. The petitioner agreed with this proffered award. On January 4, 2024, Chief Special Master Brian H. Corcoran issued a Decision awarding these amounts. Petitioner received a lump sum payment of $52,500.00 for pain and suffering, and a lump sum payment of $74.07 to satisfy the State of Wisconsin Medicaid lien. The total award was $52,574.07, paid in two lump sum payments. Petitioner was represented by Jerome A. Konkel of Samster, Konkel & Safran, S.C., and respondent was represented by Sarah Black Rifkin of the U.S. Department of Justice.

Theory of causation field:
Petitioner Shavannah Ervin alleged a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccination on September 15, 2020. The respondent conceded that the injury was consistent with SIRVA as defined by the Vaccine Injury Table and that Petitioner met the legal prerequisites for compensation. The public decision does not describe the specific mechanism of injury, onset, symptoms, diagnostic tests, or treatments. No experts were named in the public text. The case proceeded as a Table injury. On October 3, 2023, Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement finding Petitioner entitled to compensation. On December 4, 2023, Respondent filed a Proffer on award of compensation, proposing $52,500.00 for pain and suffering and $74.07 to satisfy a State of Wisconsin Medicaid lien. Petitioner agreed to the award. On January 4, 2024, Chief Special Master Corcoran issued a Decision awarding a total of $52,574.07 in two lump sum payments: $52,500.00 to Petitioner and $74.07 jointly to Petitioner and Wisconsin Casualty Recovery for the Medicaid lien. Petitioner was represented by Jerome A. Konkel, and Respondent was represented by Sarah Black Rifkin.

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_22-vv-00716-0
Date issued/filed: 2023-11-06
Pages: 2
Docket text: PUBLIC ORDER/RULING (Originally filed: 10/03/2023 ) regarding 29 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
--------------------------------------------------------------------------------
Case 1:22-vv-00716-UNJ Document 31 Filed 11/06/23 Page 1 of 2
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-716V
SHAVANNAH ERVIN, Chief Special Master Corcoran
Petitioner, Filed: October 3, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, S.C., Wauwatosa, WI, for Petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On June 28, 2022, Shavannah Ervin (“Petitioner”) 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 from a shoulder injury related to
vaccine administration (“SIRVA”) as a result of receiving an influenza (“flu”) vaccination
on September 15, 2020. Pet. at 1, ECF No. 1. Petitioner further alleges that she suffered
the residual effects of her injury for more than six months. Id. at 6. The case was assigned
to the Special Processing Unit of the Office of Special Masters.
On September 29, 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, ECF No. 28. Specifically, Respondent indicated that “[P]etitioner’s alleged
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-00716-UNJ Document 31 Filed 11/06/23 Page 2 of 2
injury is consistent with SIRVA as defined by the Vaccine Injury Table.” Id. at 4.
Respondent further agrees that Petitioner “has satisfied all legal prerequisites for
compensation under the Act.” 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-00716-1
Date issued/filed: 2024-01-04
Pages: 5
Docket text: PUBLIC DECISION (Originally filed: 12/05/2023) regarding 33 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (tlf) Service on parties made.
--------------------------------------------------------------------------------
Case 1:22-vv-00716-UNJ Document 37 Filed 01/04/24 Page 1 of 5
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-716V
SHAVANNAH ERVIN, Chief Special Master Corcoran
Petitioner, Filed: December 5, 2023
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jerome A. Konkel, Samster, Konkel & Safran, Wauwatosa, WI, for Petitioner.
Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION AWARDING DAMAGES1
On June 28, 2022, Shavannah Ervin 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 to her on
September 15, 2020. Pet. at 1, ECF No. 1. Petitioner further alleges that the vaccine was
received in the United States, she suffered sequela of her injury for more than six months,
and neither Petitioner nor any other party has ever received compensation in the form of
an award or settlement for her vaccine-related injury. Id. at 6. The case was assigned to
the Special Processing Unit of the Office of Special Masters.
On October 3, 2023, a Ruling on Entitlement was issued, finding Petitioner entitled
to compensation for her SIRVA. ECF No. 29. On December 4, 2023, Respondent filed a
Proffer on award of compensation (“Proffer”) stating Petitioner should be awarded
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-00716-UNJ Document 37 Filed 01/04/24 Page 2 of 5
$52,500.00 in pain and suffering. Proffer at 1, ECF No. 32. Respondent also stated
Petitioner should be awarded funds to satisfy the State of Wisconsin Medicaid lien in the
amount of $74.07. 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 two lump
sum payments as follows:
A. A lump sum payment of $52,500.00 for pain and suffering, in the form of a
check payable to Petitioner; and
B. A lump sum payment of $74.04, representing compensation for
satisfaction of the State of Wisconsin Medicaid Lien, in the form of a check
payable jointly to Petitioner and:
Wisconsin Casualty Recovery
5615 High Point Drive Suite 100
Irving, TX 75038-9984
Petitioner has agreed to endorse the check to the State of Wisconsin for
satisfaction of the Medicaid lien.
This amount represents 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-00716-UNJ Document 37 Filed 01/04/24 Page 3 of 5
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
SHAVANNAH ERVIN,
Petitioner, No. 22-716V (ECF)
Chief Special Master Corcoran
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
RESPONDENT’S PROFFER ON AWARD OF COMPENSATION
On June 28, 2022, Shavannah Ervin (“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 September 15, 2020.
Petition at 1, 6.
On September 29, 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 October 3, 2023, the Chief Special Master issued a
Ruling on Entitlement finding petitioner entitled to compensation. ECF Nos. 28, 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 $52,500.00 for pain and suffering, in the form of a check payable to petitioner.
Petitioner agrees.

Case 1:22-vv-00716-UNJ Document 37 Filed 01/04/24 Page 4 of 5
B. Medicaid Lien
Respondent proffers that petitioner should be awarded funds to satisfy the State of
Wisconsin Medicaid lien in the amount of $74.07, which represents full satisfaction of any right
of subrogation, assignment, claim, lien, or cause of action the State of Wisconsin may have
against any individual as a result of any Medicaid payments the State of Wisconsin 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
September 15, 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 $52,500.00 in the form of a check payable to petitioner; and
B. A lump sum payment of $74.07, representing compensation for satisfaction of the
State of Wisconsin Medicaid lien, in the form of a check payable jointly to petitioner
and:
Wisconsin Casualty Recovery
5615 High Point Drive Suite 100
Irving, TX 75038-9984
Petitioner agrees to endorse the check to the State of Wisconsin (Wisconsin Casualty
Recovery) for satisfaction of the Medicaid lien.
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 1:22-vv-00716-UNJ Document 37 Filed 01/04/24 Page 5 of 5
Petitioner is a competent adult. Evidence of guardianship is not required in this case.
II. Summary of Recommended Payments Following Judgment
Lump sum payable to petitioner, Shavannah Ervin: $52,500.00
Lump sum payable jointly to petitioner and Wisconsin Casualty Recovery: $74.07
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/Sarah B. Rifkin
SARAH B. RIFKIN
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) 305-5997
Sarah.Rifkin@usdoj.gov
Dated: December 4, 2023
3