VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00237
Package ID: USCOURTS-cofc-1_23-vv-00237
Petitioner: Lisa Kurdziel
Filed: 2023-02-17
Decided: 2026-04-08
Vaccine: influenza
Vaccination date: 2021-11-24
Condition: right shoulder injury related to vaccine administration (SIRVA)
Outcome: entitlement_granted_pending_damages
Award amount USD: 

AI-assisted case summary:
Lisa Kurdziel filed a petition alleging a right shoulder injury related to vaccine administration (SIRVA) from an influenza vaccination received on November 24, 2021. She was born in 1981 and was an active athlete. She experienced right shoulder pain and reduced range of motion starting within 48 hours of the vaccination, which persisted for more than six months. Medical records documented her symptoms, including pain, reduced range of motion, and positive tests suggestive of SIRVA. She received various treatments, including NSAIDs, steroid injections, and physical therapy. The respondent initially opposed compensation, arguing that the severity and onset requirements were not met. However, the court found that Petitioner established entitlement to compensation for a Table SIRVA, noting that her injury persisted for at least six months and had an onset within 48 hours of vaccination. The case is now in the damages phase, with the court to consider her return to athletic activities and treatment gaps in determining the award.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_23-vv-00237-0
Date issued/filed: 2026-04-08
Pages: 14
Docket text: PUBLIC ORDER/RULING (Originally filed: 03/02/2026) regarding 46 Ruling on Entitlement, Damages Order, Order on Motion for Judgment on the Record. ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:23-vv-00237-UNJ Document 47 Filed 04/08/26 Page 1 of 14
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 23-0237V
LISA KURDZIEL, Chief Special Master Corcoran
Petitioner,
v. Filed: March 2, 2026
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jessica E. Choper, Britcher Leone & Sergio, L.L.C., Glen Rock, NJ, for Petitioner.
Jeremy Mauritzen, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On February 17, 2023, Lisa Kurdziel 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 right shoulder injury related to
vaccine administration (“SIRVA”) resulting from adverse effects of an influenza (“flu”)
vaccination she received on November 24, 2021. Petition at 1. The case was assigned to
the Special Processing Unit (“SPU”) of the Office of Special Masters.
For the reasons set forth below, I find that Petitioner has preponderantly
established 1) a shoulder injury and/or its residual effects lasting for more than six months;
and 2) the onset of shoulder pain occurring 48 hours after the at-issue vaccination. In the
1 Because this opinion 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 opinion 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 “§” references to the Vaccine Act will be to the pertinent subparagraph of 42 U.S.C. § 300aa
(2012).

Case 1:23-vv-00237-UNJ Document 47 Filed 04/08/26 Page 2 of 14
absence of any other objections from Respondent, and based on an independent review
of the evidence, I conclude that Petitioner has established entitlement to compensation
for a Table SIRVA, and Petitioner’s motion at ECF No 39 is GRANTED.
I. Procedural History
After the claim was assigned to SPU in June 2023, Petitioner filed evidence, ECF
Nos. 20-29, and Respondent formally opposed any Vaccine Program compensation
award, ECF No. 30. Respondent argued that Petitioner had not established the threshold
statutory severity requirement or the Table SIRVA requirement of onset within forty-eight
(48) hours after the vaccination. Rule 4(c) Report filed Apr. 1, 2024, ECF No. 31 at 9-12.
Petitioner filed some additional evidence along with a Motion for Judgment on the
Administrative Record on Sept. 19, 2024, ECF No. 39 (hereinafter “Brief”); see also
Response filed Nov. 1, 2024, ECF No. 40; Reply filed Nov. 19, 2024, ECF No. 42.
Petitioner’s Program eligibility and her entitlement for a Table SIRVA are now ripe for
adjudication.3
II. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1).
As a threshold matter for Vaccine Program eligibility, a potential petitioner must
establish that he or she “suffered the residual effects or complications of such illness,
disability, injury, or condition for more than 6 months after the administration of the
vaccine”. Section 11(c)(1)(D)(i)4; see also Black v. Sec’y of Health & Human Servs., 33
Fed. Cl. 546, 550 (1995) (reasoning that the “potential petitioner” must not only make a
prima facie case, but clear a jurisdictional threshold, by “submitting supporting
documentation which reasonably demonstrates that a special master has jurisdiction to
hear the merits of the case”), aff’d, 93 F.3d 781 (Fed. Cir. 1996) (internal citations
omitted). “[T]he fact that a Petitioner has been discharged from medical care does not
necessarily indicate that there are no remaining or residual effects from her alleged
3 Petitioner also requested permission “to file expert reports” prior to briefing the disputed issues. ECF No.
32, 36. I advised that no experts were authorized while the case was in SPU. Order on June 5, 2024 (NON-
PDF). Petitioner acceded to briefing the disputed issues, while maintaining her request to retain experts in
support of the severity and onset allegations “[i]n the event the Court is inclined” to decide such issues
against her. Brief at 21.
4 Section 11(c)(1)(D) presents two alternative grounds for eligibility to compensation if a petitioner does not
meet the six months threshold: (ii) death from the vaccine, and (iii) inpatient hospitalization and surgical
intervention. Neither alternative is alleged or implicated in this claim.
2

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injury.” Morine v. Sec’y of Health & Human Servs., No. 17-1013, 2019 WL 978825, at *4
(Fed. Cl. Spec. Mstr. Jan. 23, 2019); see also Herren v. Sec’y of Health & Human Servs.,
No. 13-1000V, 2014 WL 3889070, at *3 (Fed. Cl. Spec. Mstr. July 18, 2014) (“a discharge
from medical care does not necessarily indicate there are no residual effects”). “A
treatment gap . . . does not automatically mean severity cannot be established.” Law v.
Sec’y of Health & Human Servs., No. 21-0699V, 2023 WL 2641502, at *5 (Fed. Cl. Spec.
Mstr. Feb. 23, 2023) (finding severity requirement met where Petitioner sought care for
under three months and had met physical therapy goals but still lacked full range of motion
and experienced difficulty with certain activities, then returned to care nearly five months
later reporting stiffness and continuing restrictions in motion); see also Peeples v. Sec’y
of Health & Human Servs., No. 20-0634V, 2022 WL 2387749 (Fed. Cl. Spec. Mstr. May
26, 2022) (finding severity requirement met where Petitioner sought care for four months,
followed by fifteen-month gap); Silvestri v. Sec’y of Health & Human Servs., No. 19-
1045V, 2021 WL 4205313 (Fed. Cl. Spec. Mstr. Aug. 16, 2021) (finding severity
requirement satisfied where Petitioner did not seek additional treatment after the five-
month mark).
In addition to requirements concerning the vaccination received, and the lack of
other award or settlement,5 a petitioner must establish that he or she either suffered an
injury meeting the Table criteria, in which case causation is presumed, or he or she
suffered an injury shown to be caused-in-fact by the vaccination received. Section
11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of an influenza vaccine. 42 C.F.R. § 100.3(a)(XIV)(B). A
vaccine recipient shall be considered to have suffered SIRVA if such recipient manifests
all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
5 In summary, a petitioner must establish that he or she received a vaccine covered by the Program,
administered either in the United States and its territories or in another geographical area but qualifying for
a limited exception; and he or she has not filed a civil suit or collected an award or settlement for the injury.
See § 11(c)(1)(A)(B), (E).
3

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(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
A special master must consider, but is not bound by, any diagnosis, conclusion,
judgment, test result, report, or summary concerning the nature, causation, and
aggravation of petitioner’s injury or illness that is contained in a medical record. Section
13(b)(1). “Medical records, in general, warrant consideration as trustworthy evidence.
The records contain information supplied to or by health professionals to facilitate
diagnosis and treatment of medical conditions. With proper treatment hanging in the
balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, the
Federal Circuit has recently “reject[ed] as incorrect the presumption that medical records
are always accurate and complete as to all of the patient’s physical conditions.” Kirby v.
Sec'y of Health & Hum. Servs., 997 F.3d 1378, 1383 (Fed. Cir. 2021). Medical
professionals may not “accurately record everything” that they observe or may “record
only a fraction of all that occurs.” Id.
Medical records may be outweighed by testimony that is given later in time that is
“consistent, clear, cogent, and compelling.” Camery v. Sec’y of Health & Hum. Servs., 42
Fed. Cl. 381 at 391 (1998) (citing Blutstein v. Sec’y of Health & Hum. Servs., No. 90-
2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998). The credibility of the
individual offering such testimony must also be determined. Andreu v. Sec’y of Health &
Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley v. Sec’y of Health & Hum.
Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
4

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the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La Londe
Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184 at 204 (2013) (citing § 12(d)(3); Vaccine
Rule 8); see also Burns v. Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir.
1993) (holding that it is within the special master’s discretion to determine whether to
afford greater weight to medical records or to other evidence, such as oral testimony
surrounding the events in question that was given at a later date, provided that such
determination is rational).
I am resolving the parties’ current disputes on the written record. The Vaccine Act
and Rules not only contemplate but encourage special masters to decide many matters
on the papers where, in the exercise of their discretion, they conclude that doing so will
properly and fairly resolve the issue. See 42 U.S.C. § 12(d)(2)(D); Vaccine Rule 8(d).
Indeed, the decision to rule on the record in lieu of a hearing has been affirmed on appeal.
Kreizenbeck v. Sec’y of Health & Hum. Servs., 945 F.3d 1362, 1366 (Fed. Cir. 2020);
Hooker v. Sec’y of Health & Hum. Servs., No. 02-472V, 2016 WL 3456435, at *21 n.19
(Fed. Cl. Spec. Mstr. May 19, 2016) (citing numerous cases where special masters
decided cases on the papers in lieu of hearing and those decisions were upheld).
III. Findings of Fact and Conclusions of Law
The record preponderantly supports findings that 1) the alleged injury and/or its
residual effects occurred for at least six months, and 2) that the injury’s onset was within
48 hours after the November 24, 2021 vaccination. I reach these conclusions after a
complete review of the record to include all medical records, testimonial evidence,
Respondent’s Rule 4(c) Report, and both parties’ briefing. I highlight the following:
(cid:120) Medical Records. Petitioner was born in 1981. She regularly ran, biked, and
swam – sometimes even in competitive triathlons or “Iron Man” events. See e.g.,
Ex. 3 at 23-24 (October 12, 2021 primary care record, reporting that Petitioner was
“in the best shape of her life”). There is not preponderant evidence of prior right
shoulder pain or dysfunction.6
6 Respondent notes that Petitioner’s active lifestyle was connected with “orthopedic issues.” Response at
2 and n.1. Many of the cited medical records concern Petitioner’s legs. Id., citing Ex. 3 at 61 (diagnosing
Petitioner with a “[l]ikely stress fracture given recent intensity of running”); id. at 58 (describing “chronic right
knee pain with recurrent effusion requiring multiple injections”); Ex. 5 at 55-333 (physical therapy for lower
extremities). Certain other records contain isolated references to possible right shoulder issues, but without
confirming any actual intervention or treatment in the three years before the November 24, 2021
vaccination. See Ex. 3 at 63 (August 2013 primary care record suggesting prior “surgical history: knee and
5

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(cid:120) On November 24, 2021 at a CVS pharmacy, Petitioner received the at-issue flu
vaccine in her right arm, as well as a Moderna COVID-19 vaccine in her left arm.
Ex. 20 at 2.7
(cid:120) Eight days post-vaccination, on December 2, 2021, Petitioner received a COVID-
19 PCR test at the office of her established primary care provider (“PCP”). Ex. 3 at
19-20. A registered nurse conducted the PCR test, but did not record any other
complaints, physical examination, diagnosis, or treatment. Id. at 20.
(cid:120) Twenty (20) days post-vaccination, on December 14, 2021, Petitioner saw a
primary care physician’s assistant (“PA”) for a chief complaint of right shoulder
pain. Ex. 3 at 16. Petitioner was concerned that on November 24th, the pharmacist
had applied too much pressure upon administering her vaccines. Id. Afterwards,
Petitioner had experienced left-sided pain for 1 week (now “resolved”), and
“persisten[t]” right-sided pain, plus reduced range of motion (“ROM”), with her
symptoms worst in the morning. Id. A physical examination confirmed that the right
shoulder had “significantly reduced active ROM [range of motion] with abduction,
flexion” with normal findings on the left side. Id. at 17. The PA “suspected SIRVA,”
for which he provided a short course of NSAIDs as well as sports medicine
evaluations and formal PT. Id.
(cid:120) At a December 15, 2021 sports medicine initial evaluation, Petitioner again
reported that her right-sided flu shot had caused persistent pain. Ex. 3 at 14.
Petitioner added that during a work trip overseas8 with up to 18-hour days, she
“didn’t notice pain in Rt arm at first, but then [it] started getting worse,” specifically
making it hard to pull luggage and put on a sports bra. Id. Petitioner had been
taking Advil 400-600mg each morning to try to manage the pain. Id. On exam, the
right shoulder displayed significantly decreased active ROM in all planes limited
by 25% due to pain; full passive ROM with mild pain; and positive Hawkins and
empty-can tests. Id. at 14-15. An ultrasound of the right shoulder was suggestive
of subacromial bursitis and impingement, which the sports medicine physician
believed was “likely related to SIRVA from administration of the flu vaccine too
high.” Id. at 15. To alleviate Petitioner’s “significant discomfort,” he administered a
shoulder arthroscopy”), id. at 39-40, 29-31, 67 (later primary care records with the same notation); Ex. 5 at
238 (2019 report of “return onset” of right shoulder pain without any corresponding diagnosis or treatment,
during a physical therapy course focused on the lower extremities); id. at 159 (2020 physical therapy
diagnosis of “pain in right shoulder” on “missed appointment” form).
7 Petitioner does not allege injury from the Moderna COVID-19 vaccine administered in her left arm, and
COVID-19 vaccines are not covered in the Vaccine Program. See generally Petition; Response at 3, n. 1.
8 Petitioner states that she was employed as a community and partnerships manager for the non-profit arm
of a large corporation. She typically worked from home but executed “high-level leadership gatherings”
several times a year at various locations. Ex. 9 at ¶ 5.
6

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subacromial steroid injection; prescribed Voltaren; and recommended rest from
swimming for at least two weeks. Id. The sports medicine physician instructed
Petitioner to follow up in two to three weeks to reassess the injury and discuss a
return to swimming as part of her Ironman training. Id.
(cid:120) At the January 3, 2022 sports medicine follow-up,9 Petitioner reported that her right
shoulder had “significant ongoing pain” during the week of Christmas and had kept
her from traveling home over the holidays, but she had started feeling much better
in the past week. Ex. 3 at 11. Petitioner’s biggest concerns were limited ROM; pain
with certain motions; and loss of function especially being unable to swim, as she
was scheduled to attempt an Ironman Texas competition in April 2022. Id. at 12.
The sports medicine physician recorded that Petitioner’s shoulder was 50%
improved overall, but it still displayed slight ROM and strength deficits. Id. at 13.
The physician recommended “aggressive PT” and “feeling at least 90% improved”
before returning to swimming, hopefully in another 2+ weeks. Id. An earlier,
premature return to swimming “could potentially cause more harm” or slow her
progress. Id. Additionally Petitioner would switch from Voltaren orally to a topical
gel; apply heat and ice; and consider massage and/or acupuncture treatments. Id.
There are no further records from the sports medicine practice.
(cid:120) One day later, on January 4, 2022, Petitioner obtained an orthopedics initial
evaluation for treatment of “right shoulder pain since receiving the flu shot on
11/24/2021,” now improved “about 50%.” Ex. 4 at 5. Petitioner reported training for
an upcoming Ironman competition, except for the swimming component. Id.10 After
reviewing Petitioner’s existing medical records and more general information about
impingement syndrome and SIRVA, the orthopedist ordered an MRI of the right
shoulder to rule out a full-thickness rotator cuff tear. Ex. 4 at 6; see also Ex. 7 at
2-3 (January 21, 2022 MRI report indicative of only marrow signal abnormality in
the posterior greater tuberosity, and edema or contusion in the supraspinatus
tendon).
9 This sports medicine record incorrectly states that Petitioner’s symptoms started after a Moderna COVID-
19 vaccine. Ex. 3 at 11. As noted above, on November 24, 2021 Petitioner had received a non-covered
Moderna COVID-19 vaccine in her non-injured left arm, and a covered flu vaccine in her subsequently
injured right arm. Ex. 20 at 2.
10 This January 4, 2022 orthopedics record provides that swimming had been paused by Petitioner’s PCP.
Ex. 4 at 5. As noted above, swimming had actually been paused by a sports medicine physician.
Additionally the January 4, 2022 orthopedics record provides that Petitioner was already “going to physical
therapy as part of her training” and would “continue” PT for her shoulder. Ex. 4 at 5, 6. But the available
evidence indicates that Petitioner only started PT for her shoulder two days later. See e.g., Ex. 5 at 51-54.
7

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(cid:120) At the January 6, 2022 PT initial evaluation for her right shoulder, Petitioner
reported a vaccine injury, specific onset date of “11/25/2021,” and pain ranging
from 6-10/10, particularly while holding objects and reaching overhead. Ex. 5 at
51. Her disability score was 55/100. Id. The physical exam found pain-protective
behavior (“holding shoulder close to body to avoid pain, decr[eased] rib cage and
arm motion in gait”); decreased ROM; decreased strength; positive impingement
signs; and pain on flexion, external rotation, and palpation of the shoulder. Id. at
51-53. Suspecting adhesive capsulitis, the therapist started formal treatment of the
right shoulder twice a week. Id. at 53.
(cid:120) A February 15, 2022 orthopedics record reflects improved, but ongoing right
shoulder pain and decreased ROM. Ex. 4 at 3. Petitioner reported ongoing use of
Voltaren topical gel, activity modification, and an anti-inflammatory diet (in addition
to her ongoing PT sessions). Id. Because Petitioner had “significant concerns
about maximizing her chances to return for her Ironman scheduled in April,” she
underwent another subacromial steroid injection. Id.
(cid:120) On March 29, 2022, Petitioner reported that the last injection had significantly
relieved her right shoulder pain. Ex. 4 at 2. Petitioner had “no intentions of slowing
her training routine and wishe[d] to push through” to the upcoming Ironman
competition. Id.
(cid:120) On April 14, 2022, Petitioner attended her 18th formal PT session. Ex. 6 at 7. Her
right shoulder pain ranged from 3-5/10 and was “ach[y].” Id. Her disability score
was 20.45/100. Id. at 8. Her strength and scapular motion were “improved with
soreness at end range of motion.” Id. She had unmet long-term goals relating to
lifting and carrying items weighing 10 pounds or more; reaching overhead; and
doffing her shirt. Id. Petitioner was encouraged to continue formal PT. Id. But on
that same date (April 14, 2022), the physical therapist reported that Petitioner had
been unable to use all of her authorized PT sessions before the expiration date,
and she needed a 30-day extension of coverage. Ex. 6 at 6. It is unclear whether
or not Petitioner’s health insurance plan approved this request.
(cid:120) An April 19, 2022 orthopedics record provides that since the last injection,
Petitioner’s right shoulder “pain and discomfort ha[d] returned.” Ex. 4 at 1. A
physical examination found pain with overhead ROM; positive Neers and Hawkins
signs; and pain at the acromioclavicular joint and on cross arm adduction. Id. The
orthopedist injected Toradol (ketorolac, an NSAID) to the right subacromial space,
as previously planned, to help Petitioner attempt the Ironman competition later that
week. Ex. 4 at 1, 2.
8

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(cid:120) The next evidence is from over four months later, on August 26, 2022, when
Petitioner attended a primary care appointment for concerns including contracting
“COVID-19 in April,” and possibly again in July. Ex. 3 at 6. Petitioner received a flu
vaccine in an unspecified arm. Id. at 8. This primary care record does not
specifically address the presence or absence of a shoulder injury.11 Neither does
the record document any knee or hip issues, e.g., iliotibial (“IT”) band syndrome –
but the primary care PA referred that apparent issue to PT on or by September 8,
2022, see Ex. 6 at 41-43.
(cid:120) On September 8, 2022, Petitioner began formal PT for iliotibial (“IT”) band
syndrome. Ex. 6 at 44-46. On September 30, 2022, the fourth PT session and
progress note focused on IT band syndrome, but also noted Petitioner’s report of
“remnants of R shoulder pain (SIRVA 12/21),”12 with the pain ranging from 3-5/10
and characterized as “dull/achy.” Id. at 19.
(cid:120) From October 2022 through at least June 2023, the physical therapist apparently
treated Petitioner’s alleged SIRVA as a “secondary issue,” without a full evaluation
or formal diagnosis (in contrast to the ongoing, primary issue of IT band syndrome).
See, e.g., Ex. 6 at 13, 11; Ex. 10 at 52, 49, 40, 38, 32, 23, 20, 18, 13, 5, 8, 2; Ex.
13 at 19, 16, 13, 4, 1 (PT sessions with manual therapy addressing “shoulder mobs
and A/PROM x5’”) (organized chronologically).
(cid:120) On August 21, 2023, Petitioner attended a telehealth appointment with her primary
care practice. Ex. 14 at 5. Petitioner reported that her regular provider at the
practice (a physician’s assistant) was out on maternity leave. Id. Petitioner reported
that she was “pretty continuously in PT for SIRVA” and she needed a renewed
prescription for PT in advance of an appointment scheduled for that afternoon. Id.
The primary care provider recorded entering a referral to PT. Id.
(cid:120) Later that same day, Petitioner and her regular physical therapist met for a formal
“initial examination” of a current right shoulder complaint. Ex. 13 at 62. Petitioner
reported that the injury had began with her 2021 flu vaccination, and that “Over the
past few months, sx have been manageable but this month, symptoms and AROM
limitations have resurfaced…” Id. Petitioner reported pain ranging from 6-8/10,
particularly upon reaching overhead; donning/doffing clothing; and holding objects
11 Respondent notes that the August 26, 2022 primary care record’s “Social History” section states:
“Exercise – training for 70.3.” Response at 6, citing Ex. 3 at 7. However, the same notation appears in at
least two earlier primary care records. Ex. 3 at 29-31 (May 7, 2021); id. at 39-41 (January 10, 2020). It is
unclear whether this notation was merely carried forward, versus actually entered at the August 24, 2022
appointment.
12 As noted above, Petitioner alleges SIRVA from a flu vaccine received on November 24, 2021.
9

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heavier than ten pounds. Id.13 The shoulder’s disability score was 45.45/100. Id.
Petitioner displayed pain-protective behavior (“guarding”); limitations with active
ROM and strength; positive capsular pattern, painful arc, and Hornblower’s tests;
and tenderness to palpation; but no radicular or neurological symptoms. Id. at 62-
63. The physical therapist assessed her symptoms as “consistent with adhesive
capsulitis (SIRVA) diagnosis,” and planned a course of formal treatment. Id. at 63-
64.
(cid:120) Petitioner attended a total of eight PT sessions focused on her shoulder that fall,
concluding on October 2, 2023. Id. at 31-64. The final progress note reflects a
slightly decreased disability score of 38.64 and some objective improvements
(e.g., in active shoulder flexion and reaching overhead). Id. at 38. The therapist
recommended more formal sessions, id., but none are in evidence.
(cid:120) Finally, at a July 25, 2024 orthopedics follow-up appointment, Petitioner sought
reevaluation of a reportedly chronic right shoulder injury. Ex. 22 at 3. Petitioner
reported that she had been unable to compete in the April 2022 Ironman event
“secondary to a positive COVID diagnosis.” Id. Afterwards, she had been able to
participation in “half” Ironman events, but at her previous level of competition. Id.
She reported “notable,” “on and off” right shoulder pain, for which she obtained
formal PT when possible (while balancing insurance and financial limitations) in
addition to a home exercise program. Id. On exam, the right shoulder had painful
ROM, positive Neers and Hawkins signs, and tenderness. Id. The orthopedist
discussed his “experience with SIRVA” and current treatment options for
Petitioner, then administered a subacromial steroid injection. Id. at 4.
(cid:120) Witness Statements.14 Regarding onset, Petitioner recalled that after her
November 2021 vaccinations, she “immediately noticed discomfort and lack of
mobility in both arms,” which persisted on the right side (corresponding to the flu
vaccination). Ex. 9 at ¶ 4. She recalls “constant” right shoulder pain and decreased
ROM throughout a work trip occurring the first week of December 2021. Id. at ¶¶
6-8.
(cid:120) Petitioner’s mother recalls Petitioner’s multiple complaints of right shoulder pain
after the November 2021 flu vaccination, first in telephone conversations. Ex. 21
at ¶ 3. The mother personally observed Petitioner’s “tremendous” pain and
13 The August 21, 2023 PT record incorrectly states that an orthopedist had recently recommended
continuation of PT. Ex. 13 at 62. As noted supra, Petitioner had actually seen a primary care provider earlier
that day. Ex. 14 at 5.
14 The statements at Exs. 9, 11-12, 21, 23, 24 are improperly labeled as affidavits – because they are not
notarized. However, the statements are certified as true and correct subject to punishment. Ex. 21 at ¶ 12.
See 28 U.S.C.A. § 1746 (providing that such a statement may be given like force and effect as an affidavit).
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limitations upon handing off her dog, just before her departure for the December
2021 work trip. Id. at ¶¶ 5-6.
(cid:120) Petitioner also maintains that her right shoulder injury persisted for over six
months. She acknowledges being a “serious and competitive athlete” and wanting
to push through competing in the April 2022 Ironman event. Ex. 9 at ¶ 17. In pursuit
of that goal, she received formal PT; home therapies; and “slowly, painfully,
push[ed] [her]self back into the pool… about two months before [her] scheduled
full Ironman.” Id. at ¶¶ 17-18 (describing being unable to extend her right arm while
swimming; using her left arm as much as possible; and wearing fins on her feet).
Petitioner does not address whether she actually attempted or completed the April
2022 Ironman, but she describes “revamp[ing] her overall approach to
competitions, instead selecting “run, bike, run” races throughout 2022. Id. at ¶ 20.
By 2023, Petitioner was working out in the pool 3-4 times a week, with pain
medication in advance and hat applied to the shoulder afterwards. Ex. 16 at ¶ 3.
She initially returned to races featuring “easier swims (down rive or non-ocean),”
but reported ongoing shoulder pain and reduced ROM. Id. at ¶ 4. As of September
2024, Petitioner alleges chronic shoulder pain and limitations which continue to
significantly disrupt her competitions (e.g., 70.3, or “Half Ironman” events) and
other aspects of her life. See e.g., Ex. 16 at ¶¶ 24-30.
(cid:120) Regarding her treatment gap after April 2022, Petitioner contends that her health
insurance coverage for PT addressing her shoulder ran out. Ex. 23 at ¶ 5. She
could not afford to pay out of pocket for formal PT, opting instead for home
exercises. Id. Petitioner also states that the orthopedist’s injections, including on
April 19, 2022, temporarily relieved her shoulder pain but only for a few weeks’
time. Id. at ¶ 16. She did not return to the orthopedist after April 19, 2022, because
he did not offer any further treatment options, other than PT and non-prescription
pain medications. Id. at ¶ 17.Petitioner avers that she resumed formal PT for knee
problems in September 2022, and she took that opportunity to mention her
continued right shoulder pain even before getting insurance authorization
specifically to address the shoulder in August 2023. Id. at ¶¶ 19-20.
(cid:120) In a May 29, 2024 letter “to whom it may concern,” physical therapist Samantha
Jacobsen describes caring for Petitioner “since she was diagnosed with SIRVA…
a condition that raised following vaccine administration, leading to pain and
impaired range of motion in the affected shoulder.” Ex. 24. The therapist stresses
that Petitioner had not suffered any pre-vaccination shoulder injury, or any
apparent “sports-related or separate shoulder injury that occurred after the vaccine
injury.” Id. The therapist writes that “despite our diligent work,” Petitioner continues
to suffer considerable pain and reduced ROM. Id.
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A. Severity
The record preponderantly supports a finding that Petitioner’s right shoulder injury
(allegedly stemming from her November 24, 2021 vaccination, and undisputedly present
by her December 14, 2021 primary care evaluation) lasted for at least six months, under
the meaning of Section 11(c)(1)(D)(i).
Respondent’s severity objection is not unreasonable, considering Petitioner’s well-
documented desire to return to strenuous competitions, and her discontinuation of formal
treatment for an extended period after April 19, 2022. Response at 8-9. However, at that
point the injury had already been present for four to five months (depending on onset,
which is assessed further below), which speaks to some degree of initial severity.
Moreover, the medical records never predict or state that the shoulder injury
resolved, but instead indicate that Petitioner wished to “push through” the pain and
attempt the Ironman (Ex. 4 at 2). On April 19, 2022, the orthopedist administered a
Toradol injection to Petitioner’s shoulder to that end (Ex. 4 at 1). The available evidence
also suggests that Petitioner had been returning to her workouts gradually, and with
modifications (see e.g., Ex. 9 at ¶¶ 17-18).
Petitioner later claimed that she was unable to attempt the Ironman because of an
intervening COVID-19 infection (Ex. 3 at 6; Ex. 22 at 3). Finally, Petitioner’s
discontinuation of formal PT for her shoulder after April 14, 2022, was more likely than
not explained by insurance limits (see e.g., Ex. 6 at 6-8 (April 2022 records reflecting that
Petitioner had not achieved her goals, and the PT coverage period had expired); Ex. 6 at
13 (October 2022 start of PT sessions featuring “shoulder mobs and A/PROM”); Ex. 13
at 62-64 (August 2023 PT formal evaluation for shoulder injury since the vaccination
nearly two years earlier); Ex. 24 (therapist’s letter endorsing a continuous shoulder
injury)).
Respondent contends that this case strongly resembles a matter in which I
concluded that a different petitioner had not established severity. Response at 9-10, citing
Han v. Sec’y of Health & Hum. Servs., No. 20-0817V, 2024 WL 1235405 (Fed. Cl. Spec.
Mstr. Feb. 21, 2024). Respondent is correct that both cases feature generally healthy,
physically active individuals with gaps in shoulder treatment. However, as Petitioner notes
(Reply at 2), Han reflected an earlier stop to treatment (just two months and 11 days post-
vaccination, compared to nearly five months post-vaccination in this case);
documentation of normal ROM and strength (compared to ongoing limitations here); no
steroids or NSAID injections; and greater intervening medical care for other concerns.
Han, 2024 WL 1235405 at *2-11. Accordingly, Han is distinguishable. Reply at 2.
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For all of those reasons, Petitioner has managed to establish that her post-
vaccination shoulder injury persisted for over six months. (At the same time, Petitioner’s
treatment gaps – and her resumption of physical exercise and competitions, even if
involving modifications for her shoulder injury, will be relevant to any assessment of an
appropriate damages award.)
B. Onset
Respondent argues that the earliest medical record histories of Petitioner’s
shoulder injury are too vague to establish onset within 48 hours after the November 24,
2021 vaccination. Response at 12. But the December 14, 2021 record describes post-
vaccination “arm pain bilaterally for 1 week,” after which the “LEFT arm pain resolved” but
“RIGHT arm pain has persisted.” Ex. 3 at 16 (emphasizing that the right arm received the
flu vaccine at issue). This record supports a finding of right shoulder pain beginning shortly
after the vaccination and persisting for several weeks, even if it does not pinpoint the
onset date.
Respondent also emphasizes the December 15, 2021 sports medicine notation
that Petitioner “didn’t notice pain in Rt arm at first” during her December 2021 Response
at 12, citing Ex. 3 at 14. But this same record reflects that the pain had “persisted” since
the vaccination. Id.
Many other medical records support onset as occurring within the Table timeframe.
See e.g., Ex. 4 at 5 (“right shoulder pain since receiving the flu shot on 11/24/2021”); Ex.
5 at 51 (onset date of “11/25/2021”). Finally, Petitioner’s mother personally observed her
shoulder injury as being present before the work trip – which evidence further supports
Petitioner’s onset allegation, and which Respondent has not acknowledged. See
Response at 7-8, 12-13 (not addressing the mother’s sworn statement). Through this
evidence and Petitioner’s own supplemental statements, she has preponderantly
established a Table SIRVA onset.
IV. Remaining Table SIRVA QAI Criteria and Statutory Requirements
Petitioner’s success in meeting the remaining QAI requirements is not disputed,
and I also find that they have been preponderantly satisfied. The record does not reflect
any history of right shoulder pain or dysfunction (see supra 5 and n. 6), symptoms
extending beyond the right shoulder; or potential alternative explanations for the alleged
SIRVA. Petitioner was also documented to have reduced ROM (see e.g., Ex. 3 at 14-15;
Ex. 5 at 51-53).
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The statutory requirements applicable to all claims are also preponderantly
established. Petitioner received a covered vaccine in the United States (Ex. 20 at 2). And
she states that she has not pursued or received any other compensation for this injury
(Ex. 9 at ¶ 23). Thus, she is entitled to Vaccine Program compensation.
Conclusion and Damages Order
For the foregoing reasons, Petitioner is entitled to compensation for a right-sided
SIRVA. Thus, this case is now in the damages phase.
As stated above (in Section III.A), Petitioner has established that her SIRVA is
sufficiently severe to warrant Vaccine Program compensation. But at the same time, any
damages award will need to consider her return to physical exercise and competitive
events even with modifications to her shoulder; as well as her treatment gaps, and fairly
conservative treatment overall. The parties should attempt to agree on an appropriate
damages award – which will likely center on pain and suffering, and potentially out-of-
pocket medical expenses. The case does not appear to involve a lost earnings claim,
workers’ compensation, or a Medicaid lien.
Within 60 days, by no later than Friday, May 1, 2026, Petitioner shall file a
Status Report updating me on the parties’ progress toward informally resolving the
issue of damages. The Status Report shall specifically state the date by which Petitioner
provided or intends to provide a demand for damages to Respondent. Additionally,
Petitioner shall confirm whether any Medicaid lien exists, and if so, state the date by which
Petitioner anticipates providing Respondent a letter from the appropriate state agency
verifying the amount of the lien. As always, Petitioner should continue to file any updated
medical records as they become available.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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