VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-00775
Package ID: USCOURTS-cofc-1_23-vv-00775
Petitioner: Inessa Ivanyuk
Filed: 2023-05-30
Decided: 2024-12-30
Vaccine: MMR and Tdap
Vaccination date: 2021-04-15
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 13223

AI-assisted case summary:
Inessa Ivanyuk filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging she suffered a shoulder injury related to vaccine administration (SIRVA) after receiving the measles, mumps, rubella (MMR) and tetanus-diphtheria-acellular-pertussis (Tdap) vaccines on April 15, 2021. The petition stated that the vaccines were administered in the United States and that her SIRVA symptoms had persisted for more than six months. Respondent denied that Ms. Ivanyuk sustained a SIRVA Table injury or that the vaccines caused her condition. Despite these differing positions, the parties filed a joint stipulation agreeing to settle the issues and award compensation. The court adopted the stipulation as its decision. Ms. Ivanyuk was awarded a lump sum of $12,500.00 payable to her, and an additional $723.63 to reimburse a Medicaid lien for services rendered by the State of California. This compensation covers all items of damages available under the program. The decision was issued on December 30, 2024, following the petition filed on May 30, 2023.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_23-vv-00775-0
Date issued/filed: 2024-12-30
Pages: 8
Docket text: PUBLIC DECISION (Originally filed: 11/25/2024) regarding 30 DECISION Stipulation/Proffer, ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made.
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Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 1 of 8
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 23-0775V
INESSA IVANYUK, Chief Special Master Corcoran
Petitioner, Filed: November 25, 2024
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Jimmy A. Zgheib, Zgheib Sayad, P.C., White Plains, NY, for Petitioner.
Zoe Wade, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On May 30, 2023, Inessa Ivanyuk 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”) resulting from a measles, mumps, rubella (“MMR”) and/or
tetanusdiphtheria acellular pertussis (“Tdap”) vaccine received on April 15, 2021. Petition
at 1; Stipulation, filed November 25, 2024, at ¶¶ 2-4. Petitioner further alleges the MMR
and Tdap vaccines were administered in the United States, her SIRVA symptoms have
persisted for more than six months, and neither Petitioner, nor any other party, has ever
filed any action, or received or accepted compensation in the form of an award or
settlement, for her vaccine-related injury. Petition at ¶¶ 4, 18-20; Stipulation at ¶¶ 3-5.
“Respondent denies that petitioner sustained a SIRVA Table injury; denies that the MMR
and/or Tdap vaccine caused her alleged shoulder injury or any other injury or condition;
and denies that her current condition is a sequelae of a vaccine-related injury.” Stipulation
at ¶ 6.
1Because 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.
2National 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-00775-UNJ Document 36 Filed 12/30/24 Page 2 of 8
Nevertheless, on November 25, 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. A lump sum of $12,500.00 in the form of a check payable to Petitioner;
and
B. A lump sumof $723.63, representing reimbursement of a Medicaid lien
for services rendered to Petitioner by the State of California, in the
form of a check payable jointly to Petitioner and the California
Department of Health Care Services:
Department of Health Care Services, Personal Injury Program
MS4720, P.O. Box. 997421
Sacramento, CA 95899-7421
Acct. # C93807704A-001T
Petitioner agrees to endorse this check to the Department of Health Care
Services.
Stipulation at ¶ 8. These amounts represent 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-00775-UNJ Document 36 Filed 12/30/24 Page 3 of 8
IN THE UNITED ST AT ES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
!NESSA IV ANY UK,
Petitioner, No. 23-775V
Chief Special Master Corcoran
v. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
I. Inessa lvanyuk ("petitioner") filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 to 34 (the ·'Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of the measles, mumps, and rubella (''MMR") and tetanus-diphtheria-acellular-pertussis
(''Tdap") vaccines, which vaccines are contained in the Vaccine Injury Table (the "Table''), 42
C.F.R. § I 00.3(a)
2. Petitioner received MMR and Tdap vaccines on April I 5, 2021.
3. The vaccines were administered within the United States.
4. Petitioner alleges that she sustained a shoulder injury related to vaccine administration
("SIRVA'') within the time period set forth in the Table. She further alleges that she has
experienced residual effects of her 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 her behalf as a result of the alleged injury.

Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 4 of 8
6. Respondent denies that petitioner sustained a SIRVA Table injury; denies that the
MMR and/or Tdap vaccine caused her alleged shoulder injury or any other injury or condition;
and denies that her current condition is a sequelae 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-2l(a)(I), the Secretary of Health and Human Services will issue
the following vaccine compensation payments for all damages that would be available under 42
U.S.C. § 300aa-l 5(a):
A. A lump sum of $12,500.00 in the form of a check payable to petitioner; and
B. A lump sum of $723.63, 1 representing reimbursement of a Medicaid lien for
services rendered to petitioner by the State of California, in the form of a check
payable jointly to petitioner and the California Department of Health Care
Services:
Department of Health Care Services, Personal Injury Program
MS 4720, P.O. Box 997421
Sacramento, CA 95899-7421
Acct. # C93807704A-00 IT
Petitioner agrees to endorse this check to the Department of Health Care Services.
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
1 This amount represents full satisfaction of any right of subrogation, assignment, claim, lien, or
cause of action the State of California may have against any individual as a result of any
Medicaid payments the California Department of Health Care Services has made to or on behalf
of Inessa lvanyuk as a result of her alleged vaccine-related injury suffered on or about April 15,
2021, under Title XIX of the Social Security Act, see 42 U. S.C. § 300aa-l S(g), (h).
2

Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 5 of 8
U.S.C. § 300aa-2 I( a)( I), 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
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. Payments made pursuant to paragraph 8 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 attorney·s 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-l 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 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, judgments, claims, damages, loss of services, expenses and all
demands of whatever kind or nature) that have been brought, could have been brought, or could
3

Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 6 of 8
be timely brought in the Court of Federal Claims, under the National Vaccine Injury
Compensation Program, 42 U.S.C. § 300aa-10 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 MMR and Tdap vaccinations
administered on April 15, 2021, as alleged in a petition for vaccine compensation filed on or
about May 30, 2023, in the United States Court of Federal Claims as petition No. 23-775V.
14. If petitioner should die prior to entry of judgment, this agreement shall be voidable
upon proper notice to the Court on behalf of either or both of the parties.
15. If the special master fails to issue a decision in complete conformity with the terms
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 terms 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 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. This Stipulation shall not be construed as an admission by the United States or the
Secretary of Health and Human Services that the MMR and/or Tdap vaccines caused petitioner's
alleged injury or any other injury or petitioner's current disabilities.
4

Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 7 of 8
18. All rights and obi igations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
5

Case 1:23-vv-00775-UNJ Document 36 Filed 12/30/24 Page 8 of 8
Respectfully submitted,
PETITIONER:
INESSA IVANYUK
ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
PETITIONER: OF THE AT IORNEY GENERAL:
p ~
.,.4lt.~"ti
J I ~ HEATHER L. PEARLMAN
Zgheib Sayad, P.C. Deputy Director
75 South Broadway, 4th Floor Torts Branch
White Plains, New York 10601 Civil Division
(9 I 4) 729-1I 10 U.S. Department of Justice
Email: jim@vaccinelawyers.com P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR
OF THE SECRETARY OF HEALTH RESPONDENT:
AND HUMAN SERVICES:
ffrey$.
Je Digit.ally signed by
Jeffrey S. Beach -S
-5
Beach Date: 2024.11.20
______ , s-02:20 -os·oo· tor
CAPT. GEORGE REED GRIMES, MD, MPH ZOER. WADE
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) 616-4118
Rockville, MD 20857 Email: zoe.wade@usdoj.gov
21> t'f
Dated: t/1/1. t,~
6