VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00079
Package ID: USCOURTS-cofc-1_23-vv-00079
Petitioner: Nancy Ancowitz
Filed: 2023-01-20
Decided: 2025-11-10
Vaccine: influenza
Vaccination date: 2021-12-15
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 35390

AI-assisted case summary:
On January 20, 2023, Nancy Ancowitz filed a petition alleging that an influenza vaccination administered on December 15, 2021 caused a Table shoulder injury related to vaccine administration. She alleged that the vaccine was administered in the United States, that residual effects lasted more than six months, and that no prior civil award or settlement had been received for the injury.

Respondent denied that Ms. Ancowitz sustained a Table SIRVA, denied that the flu vaccine caused her alleged shoulder injury or any other injury, and denied that her current condition was vaccine-related. The public stipulation does not describe onset, shoulder findings, imaging, injections, therapy, or daily-life limitations.

On November 10, 2025, Chief Special Master Brian H. Corcoran adopted the parties' joint stipulation and awarded Ms. Ancowitz $35,390.00 as a lump sum through counsel's IOLTA account for all damages available under the Vaccine Act. She was represented by Christopher Williams of Siri & Glimstad, LLP.

Theory of causation field:
Adult petitioner; influenza vaccine December 15, 2021; alleged Table SIRVA/off-Table shoulder injury. COMPENSATED by stipulation. Respondent denied Table SIRVA and causation; public text lacks clinical chronology. SM Corcoran November 10, 2025. Award $35,390.00 lump sum. Petition filed January 20, 2023. Attorney: Christopher Williams.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_23-vv-00079-0
Date issued/filed: 2025-12-15
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 11/10/2025) regarding 43 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (cr) Service on parties made.
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Case 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 23-79V
NANCY ANCOWITZ, Chief Special Master Corcoran
Petitioner, Filed: November 10, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Christopher Williams, Siri & Glimstad, LLP, New York, NY, for Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 20, 2023, Nancy Ancowitz 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 Table injury - shoulder injury related
to vaccine administration (“SIRVA”) as a result of the administration of her December 15,
2021 influenza (“flu”) vaccination. Petition at 1; Stipulation, filed November 10, 2025, at
¶¶ 1-2, 4. Petitioner further alleges that she received the vaccine in the United States,
that she suffered the residual effects of her injury for more than six months, and that there
has been no prior award or settlement of a civil action on her behalf as a result of her
injury. Stipulation at ¶¶ 3-5; see Petition at ¶¶ 3, 25, 27-28. “Respondent denies that
[P]etitioner sustained a SIRVA Table injury, denies that [P]etitioner's alleged shoulder
injury was caused-in-fact by the flu vaccine, and denies that the flu vaccine caused
[P]etitioner any other injury or her current condition.” Stipulation at ¶ 6.
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 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 2 of 7
Nevertheless, on November 10, 2025, 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,3 I award the following
compensation:
A lump sum of $35,390.00, to be paid through an ACH deposit to Petitioner’s
counsel’s IOLTA account for prompt disbursement 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.4
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 The parties’ Stipulation at page six included an audit trail form from Dropbox Sign that has been omitted
from the attached copy of the parties’ Stipulation. ECF No. 42.
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 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 3 of 7
IN THE UNITED ST ATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
NANCY ANCOWITZ,
Petitioner, No. 23-79V
Chief Special Master Corcoran
V. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate lo the following matters:
I. Nancy Ancowitz ("petitioner") filed a petition for vaccine compensation under the
*
National Vaccine Injury Compensation Program, 42 U.S.C. 300aa-10 er seq. ( the "Vaccine
Program"). The petition seeks compensation for an injury allegedly related to petitioner's receipt
of an influenza ('•flu'') vaccine, which is contained in the Vaccine Injury Table (the "Table"), 42
C.F.R. § I00.3(a).
2. Petitioner received a nu vaccine on December 15. 2021.
3. The vaccine was administered within the United States.
4. Petitioner alleges that she sustained a shoulder injury related to vaccine administration
("SlRVA") within the time period set forth in the Table. Petitioner further alleges that she
suffered the residual effects of the alleged injury for more than six months.
5. Petitioner represents that there has been no prior award or settlement of a civil action
for damages on petitioner's behalf as a result of the alleged injury.
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Case 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 4 of 7
6. Respondent denies that petitioner sustained a SIRVA Table injury, denies that
petitioner's alleged shoulder it~ury was caused-in-fact by the flu vaccine, and denies that the flu
vaccine caused petitioner any other injury or her current cundition.
7. Maintaining their above-stated positions, the patties nevertheless now agree that the
issues between them shall be settled and that a decision should be entered awarding the
compensation described in paragraph 8 of this Stipulation.
8. As soon as practicable after an cntty of judgment reflecting a decision consistent with
the terms of this Stipulation, and after petitioner has tiled an election to receive compensation
pursuant to 42 U .S.C. § 300aa-2 I (a)( I), the Secretary of Health and Human Services wi 11 issue
the following vaccim: compensation payment:
A lump sum of $35,390.00 to be paid through an ACH deposit to petitioner's counsel's
lOLTA account for prompt disbursement 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 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-2 l (a)( I), and an application, the pa1ties will submit to further proceedings before
the special master to award reasonable attorneys' fees and costs incurred in any 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
primarily liable under 42 U.S.C. § 300aa-15(g), to the extent that payment has been made or can
reasonably be expected to be made under any State compensation programs, insurance policies,
2
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Case 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 5 of 7
Federal or State health benefits programs (other than Title XIX of the Social Security Act (42
U.S.C. § 1396 el seq.)), or by entities that provide health scn1iccs on a pre-paid basis.
l I. Payment made pursuant tu parab'Taph 8 and any amounts awarded pursuant to
paragraph 9 of this Stipulation will be made in accordance with 42 U.S.C. § 300aa-15(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 unrcimbur.. . cd expenses, the money provided
pursuant to this Stipulation will be used solely for the benefit of petitioner as contemplated by a
*
strict constrnction of 42 U.S.C. 300aa-I 5(a) and (d), and subject to the conditions of 42 U.S.C.
*
300aa-15(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in petitioner's
individual capacity, and on hehalf of petitioner's heirs, executors, administrators, successors or
assigns, 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 haw been brought, could have been brought, or could
be timely brought in the Court of Federal Claims, under the National Vaccine Jnjury
Compensation Program, 42 U.S.C. § 300aa-l0 et seq., on account of, or in any way growing out.
ot: 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 flu vaccination administered on
December 15, 2021, as alleged by petitioner in a petition for vaccine compensation filed on or
about January 20, 2023, in the United States Court of Federal Claims as petition No. 23-79V.
3
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Case 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 6 of 7
14. lf petitioner should die prior to entry of judgment, this agreement shall be voidabk
upon proper notice to the Court on behalf of either or both of the parties.
15. Ifthc special master fails to issue a <.lccision in complete conformity with the tcnm;
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 tem1s 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, 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 liability and/or
amount of damages, and fu11her, 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 constrncd as an admission by the United States or the
Secretary of Health and Human Ser\'ices that the flu vaccine caused petitioner's alleged shoulder
injury or any other injury or petitioner's current disabilities, 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.
ENO OF STIPULATION
i
I
4
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Case 1:23-vv-00079-UNJ Document 47 Filed 12/15/25 Page 7 of 7
Respectfully submitted,
PETITIONER:
NA CY ANCOWITZ
ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
OF THE ATTORNEY G ERAL:
PEG--~-
. .-siM ~ ~:Pt.. 4J.JJvl---.
CHRISTOPHER WILLIAMS HEATHER L. PEARLMAN
Siri & Glimstad, LLP Deputy Director
745 Fifth A enue Torts Brnnch, Civil Division
Suite 500 lJ.S. lkpartment of Justice
New York, NY 10151 P.O. Rox 146
(929) 581-0187 Benjamin Franklin Station
cwilliams(<_!..sirillp.com Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEALTH RESPONDENT:
AND HUMAN SERVIC S:
Jeffrey 5.
Digitally signed by Jeffrey
S. lleach•S
-S
Beach :1~202s.11.0314:06:3a for
CAPT GEORGE REED GRIMES, MD, MPI I ALEC SAXE
Director, Division of Injury Trial Attorney
Compcnsntion Programs Tori Brunch
Health Systems Bureuu Civil Division
Health Resources and Services U . . Department of Justice
Administration P.O. Box M6
U.S. Department of Health Benjamin Franklin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, J4W-18 (202) 353-7722
Rockville, MD 20857 a!cc.saxc(!.~usdoj .gov
l
{0 ~a5
Dated:
5
Doc ID: 9ea28dd22bf09238909135de5f9376c7ae43fb2b