VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00249
Package ID: USCOURTS-cofc-1_23-vv-00249
Petitioner: Don Chambers
Filed: 2023-02-21
Decided: 2025-08-25
Vaccine: influenza
Vaccination date: 2021-10-13
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 35000

AI-assisted case summary:
Don Chambers filed a petition for vaccine compensation on February 21, 2023, alleging injury from an influenza vaccine he received on October 13, 2021. He claimed a shoulder injury related to vaccine administration (SIRVA), which is a condition listed on the Vaccine Injury Table. The respondent, the Secretary of Health and Human Services, denied that Mr. Chambers sustained a SIRVA Table injury or that the vaccine caused his alleged injury. Despite these differing positions, the parties filed a joint stipulation agreeing to settle the case and award compensation. Chief Special Master Corcoran adopted the stipulation as the decision, awarding Mr. Chambers a lump sum of $35,000.00. This amount is intended to cover all items of damages available under the Vaccine Act. The stipulation also outlines the process for awarding attorneys' fees and costs. The settlement represents a compromise of the parties' respective positions on liability and damages, and the United States does not admit that the influenza vaccine caused Mr. Chambers' alleged injury.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_23-vv-00249-0
Date issued/filed: 2025-08-25
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 07/25/2025) regarding 30 DECISION Stipulation/Proffer, Signed by Chief Special Master Brian H. Corcoran. (ppa) Service on parties made.
--------------------------------------------------------------------------------
Case 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 23-249V
DON CHAMBERS, Chief Special Master Corcoran
Petitioner,
v. Filed: July 25, 2025
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jonathan Joseph Svitak, Shannon Law Group, P.C., Woodridge, IL, for Petitioner.
Naseem Kourosh, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On February 21, 2023, Don Chambers filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”). On October 13, 2021, Petitioner received an influenza (“flu”) vaccine, a
vaccine contained in the Vaccine Injury Table (the “Table”), 42 C.F.R. § 100.3(a).
Petitioner alleges that he sustained a shoulder injury related to vaccine administration
(“SIRVA”) as defined in the Table; he further alleges that the flu vaccine caused his
alleged shoulder injury, and that he suffered the residual effects of his alleged injury for
more than six months.
Respondent denies that Petitioner sustained a SIRVA Table injury; denies that the
vaccine caused Petitioner’s alleged shoulder injury, or any other injury; and denies that
her current condition is a sequela of a vaccine-related injury.
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-00249-UNJ Document 36 Filed 08/25/25 Page 2 of 7
Nevertheless, on July 25, 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, I award the following
compensation:
A lump sum of $35,000.00 to be paid through an ACH deposit to Petitioner’s
counsel’s IOLTA account for prompt disbursement to Petitioner. Stipulation
¶ 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 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 3 of 7
IN THE UNITED ST A TES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
DON CHAMBERS,
Petitioner,
No. 23-249V (ECF)
V. Chief Special Master Corcoran
SECRETARY OF HEALTH
AND HUMAN SERVICES,
Respondent.
STIPULATION
The pa1iies hereby stipulate to the following matters:
1. Don Chambers, petitioner, filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-10 et seq. (the "Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of the influenza vaccine, which vaccine is contained in the Vaccine Injury Table (the "Table"),
42 C.F.R. § 100.3(a).
2. Petitioner received an influenza vaccine on October 13, 2021, in the left arm.
3. The vaccination was administered within the United States.
4. Petitioner alleges that petitioner sustained a shoulder injury related to vaccine
administration ("SIRVA") as set forth in the Table. Petitioner further alleges that petitioner
experienced the residual effects of this condition 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 petitioner's condition.

Case 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 4 of 7
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the
vaccine caused petitioner's alleged shoulder injury, or any other injury; and denies that
petitioner's current condition is a sequela of a vaccine-related injury.
7. Maintaining their above-stated positions, the parties 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 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-21 (a)(l), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
$35,000.00,
A lump sum of to be paid through an ACH deposit to petitioner's
counsel's IOLTA account for prompt disbursement to petitioner.
This amount represents compensation for all damages that would be available under 42
U.S.C. § 300aa-15(a).
9. As soon as practicable after the enhy 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 incuITed in proceeding upon this
petition.
10. 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,
Federal or State health benefits programs ( other than Title XIX of the Social Security Act
2

Case 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 5 of 7
(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-
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 unreimbursable expenses, the money provided
pursuant to this Stipulation will be used solely for petitioner's benefit 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-15(g) and (h).
13. In return for the payments described in paragraphs 8 and 9, petitioner, in petitioner's
individual capacity, and on behalf 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, jud ents, claims, damages, loss of services, expenses and all
gm
demands of whatever kind or nature) that have been brought, could have been brought, or could
be timely brought in the Court of Federal Claims, under the Vaccine Program, 42 U.S.C.
§ 300aa-l O et seq., 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 alleged to
have resulted from, the influenza vaccination administered on October 13, 2021, as alleged by
petitioner in a petition for vaccine compensation filed on or about February 21, 2023, in the
United States Court of Federal Claims as petition No. 23-249V.
14. If petitioner should die prior to entry of jud ent, this agreement shall be voidable
gm
upon proper notice to the Com1 on behalf of either or both of the parties.
3

Case 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 6 of 7
15. If the special master fails to issue a decision in complete confon11ity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter jud ent in confo1mity with a
gm
decision that is in complete confom1ity with the terms of this Stipulation, then the parties'
settlement and this Stipulation shall be voidable at the sole discretion of either paity.
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 fu1iher, 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 construed as an admission by the United States or the
Secretary of Health and Human Service that the influenza vaccine caused petitioner's alleged
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.
END OF STIPULATION
4

Case 1:23-vv-00249-UNJ Document 36 Filed 08/25/25 Page 7 of 7
Respectfully submitted,
PETITIONER:
��
DON CHAMBERS
ATTORNEY OF RECORD AUTHORIZED REPRESENTATIVE
FOR PETITIONER: OF THE ATTORNEY GENERAL:
-M-t�� Pt�
HEATHER L. PEARLMAN
Sha non Law Group, P.C. Deputy Director
6825 Hobson Valley Drive, Suite 101 Torts Branch
Woodridge, IL 60517 Civil Division
(312) 578-950 I U.S. Department of Justice
jsvitak@shannonlawgroup.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRET ARY OF HEALT H RESPONDENT:
AND HUMAN SERVICES:
Jeffrey s. Digitally signed by
Jeffrey S. Beach -S
B ea h S Date: 2025.07.15
C - for
12:46:23 -04•00·
CAPT GEORGE REED GRIMES, MD, MPH
Director, Division of Injury Trial Attorney
Compensation Programs Torts Branch
Health Systems Bureau Civil Division
Health Resources and Services U.S. Department of Justice
Administration P.O. Box 146
U.S. Department of Health Benjamin Franklin Station
and Human Services Washington, DC 20044-0146
5600 Fishers Lane, 08W-25A (202) 305-1159
Rockville, MD 20857 Naseem.Kourosh@usdoj.gov
5