VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-01114 Package ID: USCOURTS-cofc-1_23-vv-01114 Petitioner: Elena Borisevich Filed: 2023-07-19 Decided: 2024-11-07 Vaccine: influenza Vaccination date: 2021-10-28 Condition: Guillain-Barré syndrome Outcome: compensated Award amount USD: 125000 AI-assisted case summary: Elena Borisevich filed a petition for compensation under the National Vaccine Injury Compensation Program, alleging that she suffered from Guillain-Barré syndrome (GBS) as a result of an influenza vaccine she received on October 28, 2021. The respondent, the Secretary of Health and Human Services, conceded that Ms. Borisevich was entitled to compensation. The respondent agreed that her condition, GBS, is a Table injury and that she met the criteria for a presumption of causation, as the onset occurred within the Table-defined window following a seasonal flu vaccination and there was no apparent alternative cause. A Ruling on Entitlement was issued on July 10, 2024, finding her entitled to compensation. Subsequently, the parties filed a joint stipulation for damages. On November 7, 2024, a Decision on Damages was issued, adopting the stipulation. Ms. Borisevich was awarded a lump sum of $125,000.00, representing compensation for all damages available under the Vaccine Act. This award covers her GBS injury, which is a condition listed on the Vaccine Injury Table. Theory of causation field: Table Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_23-vv-01114-0 Date issued/filed: 2024-08-14 Pages: 2 Docket text: PUBLIC ORDER/RULING (Originally filed: 07/10/2024) regarding 27 Ruling on Entitlement ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made. -------------------------------------------------------------------------------- Case 1:23-vv-01114-UNJ Document 29 Filed 08/14/24 Page 1 of 2 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-1114V ELENA BORISEVICH, Chief Special Master Corcoran Petitioner, v. Filed: July 10, 2024 SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. David Gregory Rogers, Rogers, Hofrichter & Karrh, LLC, Fayetteville, GA, for Petitioner. Ryan Nelson, U.S. Department of Justice, Washington, DC, for Respondent. RULING ON ENTITLEMENT1 On July 19, 2023, Elena Borisevich 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 Guillain-Barré syndrome (“GBS”), a Table injury, as a result of an influenza (“flu”) vaccine received on October 28, 2021. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters. On July 3, 2024, 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. Specifically, Respondent agrees that Petitioner has satisfied the criteria set forth in the effective Vaccine Injury Table (“Table”) and the Qualifications and Aids to Interpretation (“QAI”), which afford Petitioner a presumption of causation if the onset of GBS occurs 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 1:23-vv-01114-UNJ Document 29 Filed 08/14/24 Page 2 of 2 between three and forty-two days after a seasonal flu vaccination, and there is no apparent alternative cause. Id. at 4 (citing 42 C.F.R. §§ 100.3(a)(XIV)(D), (c)(15)). 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_23-vv-01114-cl-extra-10734523 Date issued/filed: 2024-08-14 Pages: 1 Docket text: Supplementary opinion from CourtListener cluster 10267933 -------------------------------------------------------------------------------- In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-1114V ELENA BORISEVICH, Chief Special Master Corcoran Petitioner, v. Filed: July 10, 2024 SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. David Gregory Rogers, Rogers, Hofrichter & Karrh, LLC, Fayetteville, GA, for Petitioner. Ryan Nelson, U.S. Department of Justice, Washington, DC, for Respondent. RULING ON ENTITLEMENT1 On July 19, 2023, Elena Borisevich 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 Guillain-Barré syndrome (“GBS”), a Table injury, as a result of an influenza (“flu”) vaccine received on October 28, 2021. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters. On July 3, 2024, 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. Specifically, Respondent agrees that Petitioner has satisfied the criteria set forth in the effective Vaccine Injury Table (“Table”) and the Qualifications and Aids to Interpretation (“QAI”), which afford Petitioner a presumption of causation if the onset of GBS occurs 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). between three and forty-two days after a seasonal flu vaccination, and there is no apparent alternative cause. Id. at 4 (citing 42 C.F.R. §§ 100.3(a)(XIV)(D), (c)(15)). 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 3: USCOURTS-cofc-1_23-vv-01114-1 Date issued/filed: 2024-11-07 Pages: 8 Docket text: PUBLIC DECISION (Originally filed: 10/04/2024) regarding 32 DECISION Stipulation/Proffer (Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made. -------------------------------------------------------------------------------- Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 1 of 8 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-1114V ELENA BORISEVICH, Chief Special Master Corcoran Petitioner, v. Filed: October 4, 2024 SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. David Gregory Rogers, Rogers, Hofrichter & Karrh, LLC, Fayetteville, GA, for Petitioner. Ryan Nelson, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON DAMAGES1 On July 19, 2023, Elena Borisevich 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 allegesthat she suffered from Guillain-Barré syndrome (“GBS”) following her receipt of an influenza (“flu”) vaccine received on October 28, 2021. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters. On July 10, 2024, a Ruling on Entitlement was issued, finding Petitioner entitled to compensation for GBS corresponding to a listing on the Vaccine Injury Table, 42 C.F.R. §§ 100.3(a)(XIV)(D), (c)(15)). 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-01114-UNJ Document 33 Filed 11/07/24 Page 2 of 8 On October 2, 2024, Respondent filed the attached joint stipulation.3,4 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 a lump sum of $125,000.00 in the form of a check payable to Petitioner. Stipulation at ¶ 8. This amount represents compensation for all damages that would be available under Section 15(a). Id. The Clerk of Court is directed to enter judgment in accordance with this decision.5 IT IS SO ORDERED. s/Brian H. Corcoran Brian H. Corcoran Chief Special Master 3Usually, a proffer is filed by Respondent if the parties have reached an informal agreement regarding the appropriate amount of compensation to be awarded after an entitlement determination. However, in a minority of cases, the parties may choose to file a joint stipulation instead, reflecting more of a compromise regarding the compensation to be awarded. 4 In attaching the parties’ joint stipulation, I have omitted the last page – a Docusign form that includes personal information regarding Petitioner. 5 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-01114-UNJ Document 33 Filed 11/07/24 Page 3 of 8 IN THE UNITED STAT ES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS ) ELENA BORISEVICH, ) ) Petitioner, ) ) No. 23-l l 14V v. ) Chief Special Master Corcoran ) ECF SECRETARY OF HEALTH AND ) HUMAN SERVICES, ) ) Respondent. ) STIPULATION The parties hereby stipulate to the following matters: l. Elena Borisevich, 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 an influenza ("flu") vaccine, which is a vaccine contained in the Vaccine Injury Table (the "Table"), 42 C.F.R. § l 00.3 (a). 2. Petitioner received the flu vaccine on October 28, 2021. 1 3. The vaccination was administered within the United States. 4. Petitioner suffered from Guillain-Barre syndrome ("GBS") within the time period set forth in the Table following receipt of the flu vaccine, and experienced the residual effects of 1 On September 30, 202 l and October 28, 2021, petitioner received COVID-19 vaccines. Vaccines against COVID-19 are not contained in the Vaccine Injury Table. See 42 U.S.C. § 300aa-14 and 42 C.F.R. § 100.3(a). Pursuant to the declaration issued by the Secretary of Health and Human Services under the Public Readiness and Emergency Preparedness Act (42 U.S.C. §§ 247d-6d, 247d-6e), claims for alleged injuries from COVID-19 countermeasures, including vaccines, may be compensable under the Countenneasures Injury Compensation Program ("CICP"). See 85 Fed. Reg. 15198, 15202 (March 17, 2020). Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 4 of 8 OBS for more than six months. 5. There is not a preponderance of evidence demonstrating that petitioner's injury is due to a factor unrelated to vaccination. 6. 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. 7. Accordingly, petitioner is entitled to compensation under the terms of the Vaccine Act for her OBS Table injury. Therefore, a decision should be entered awarding the compensation described in paragraph 8 of this Stipulation. 8. As soon as practicable after an entry ofj udgment 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-2 l(a)(l), the Secretary of Health and Human Services will issue the following vaccine compensation payment: A lump sum of $125,000.00 in the form of a check payable 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 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-2l(a)(l), 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. 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, 2 Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 5 of 8 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. 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 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-15(a) and (d), and subject to the conditions of 42 U.S.C. § 300aa-l 5(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, (a) 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 hereafter could be timely brought in the Court of Federal Claims, under the Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 et seq., (i) 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 that may be alleged to have resulted from, the vaccinations administered on September 30, 2021 and October 28, 2021, and (ii) that petitioner has had, now has, or hereafter may have with respect to the injury that gave rise to the petition for vaccine compensation filed on or about July 19, 2023, in the United States Court of Federal Claims as 3 Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 6 of 8 petition No. 23-l l 14V; and (b) waives any and all rights to any compensation that may be available under the Countermeasures Injury Compensation Program (CICP), 42 U.S.C. § 247d- 6e (or an action under 42 U.S.C. § 247d-6d(d)}, for a claim alleging that a covered countermeasure, including the COVID-19 vaccinations administered on September 30, 2021 and October 28, 2021, on their own or in combination with the flu vaccination administered on October 28, 2021, caused or seriously aggravated the injuries that were the subject of the petition for vaccine compensation filed on or about July 19, 2023, in the United States Court of Federal Claims as petition No. 23-l l 14V, including Guillain Barre Syndrome ("GBS"), for which petitioner will receive compensation pursuant to this Stipulation. If petitioner has such a claim currently pending with the CICP, petitioner hereby withdraws such claim for compensation in the CICP.2 If no claim for compensation has been filed in the CICP as of the date this Stipulation is filed, petitioner waives the right to file a claim as described in this paragraph for compensation in the CICP. 14. If petitioner should die prior to entry ofj udgment, 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 2 After entry ofj udgment reflecting a decision consistent with the terms of this Stipulation, petitioner agrees that respondent will send this Stipulation to the CICP as evidence of petitioner's withdrawal of their CICP claim and waiver of any potential compensation under the CICP. 4 Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 7 of 8 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 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. The Stipulation shall not be construed as an admission by the United States or the Secretary of Health and Human Services that the flu vaccine caused petitioner's OBS or any other injury or her current condition; however, petitioner has satisfied the Table criteria to establish entitlement to compensation. 18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's heirs, executors, administrators, successors, and/or assigns. END OF STIPULATION 5 Case 1:23-vv-01114-UNJ Document 33 Filed 11/07/24 Page 8 of 8 Docusign Envelope ID: 86AFA0B0-FF01-48CC-A1 D 5-6032D680155C Respectfully submitted, PETITIONER: GOocuSigned by: ~606/7/FF ELENA BORISEVICH ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE OF THE ATTORNEY GENERAL: P~ER: _ ~~~~ GREGROGE~ Counsel for Petitioner Deputy Director Rogers, Hofrichter and Karrh LLC Torts Branch, Civil Division 225 S. Glynn St. U.S. Department of Justice Fayetteville, GA 30214 P.O. Box 146 grogers@rhkpc.com Benjamin Franklin Station Washington, DC 20044-0146 AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR OF THE SECRETARY OF HEALTH RESPONDENT: AND HUMAN SERVICES: Jeffreys. Digitally signed by Jeffrey S. Beach -5 Be ac h -S. Date: 2024.09.25 10:1s:23 .04•00· tor CAPT GEORGE REED GRIMES, MD, MPH Director, Division of Injury Trial Attorney Compensation Programs Torts Branch, Civil Division Health Systems Bureau U.S. Department of Justice Health Resources and Services 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 202-616-4027 Rockville, Md 20857 ryan.nelson3@usdoj.gov /11-l - lo2V Dated: 6 ================================================================================ DOCUMENT 4: USCOURTS-cofc-1_23-vv-01114-cl-extra-10733787 Date issued/filed: 2024-11-07 Pages: 1 Docket text: Supplementary opinion from CourtListener cluster 10267197 -------------------------------------------------------------------------------- In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-1114V ELENA BORISEVICH, Chief Special Master Corcoran Petitioner, v. Filed: October 4, 2024 SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. David Gregory Rogers, Rogers, Hofrichter & Karrh, LLC, Fayetteville, GA, for Petitioner. Ryan Nelson, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON DAMAGES1 On July 19, 2023, Elena Borisevich 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 Guillain-Barré syndrome (“GBS”) following her receipt of an influenza (“flu”) vaccine received on October 28, 2021. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters. On July 10, 2024, a Ruling on Entitlement was issued, finding Petitioner entitled to compensation for GBS corresponding to a listing on the Vaccine Injury Table, 42 C.F.R. §§ 100.3(a)(XIV)(D), (c)(15)). 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). On October 2, 2024, Respondent filed the attached joint stipulation.3, 4 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 a lump sum of $125,000.00 in the form of a check payable to Petitioner. Stipulation at ¶ 8. This amount represents compensation for all damages that would be available under Section 15(a). Id. The Clerk of Court is directed to enter judgment in accordance with this decision.5 IT IS SO ORDERED. s/Brian H. Corcoran Brian H. Corcoran Chief Special Master 3 Usually, a proffer is filed by Respondent if the parties have reached an informal agreement regarding the appropriate amount of compensation to be awarded after an entitlement determination. However, in a minority of cases, the parties may choose to file a joint stipulation instead, reflecting more of a compromise regarding the compensation to be awarded. 4 In attaching the parties’ joint stipulation, I have omitted the last page – a Docusign form that includes personal information regarding Petitioner. 5 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 IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS ) ELENA BORISEVICH, ) ) Petitioner, ) ) No. 23-l l 14V v. ) Chief Special Master Corcoran ) ECF SECRETARY OF HEALTH AND ) HUMAN SERVICES, ) ) Respondent. ) STIPULATION The parties hereby stipulate to the following matters: l . Elena Borisevich, 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 an influenza ("flu") vaccine, which is a vaccine contained in the Vaccine Injury Table (the "Table"), 42 C.F.R. § l 00.3 (a). 2. Petitioner received the flu vaccine on October 28, 2021 . 1 3. The vaccination was administered within the United States. 4. Petitioner suffered from Guillain-Barre syndrome ("GBS") within the time period set forth in the Table following receipt of the flu vaccine, and experienced the residual effects of 1 On September 30, 202 l and October 28, 2021 , petitioner received COVID-19 vaccines. Vaccines against COVID-19 are not contained in the Vaccine Injury Table. See 42 U.S.C. § 300aa-14 and 42 C.F.R. § 100.3(a). Pursuant to the declaration issued by the Secretary of Health and Human Services under the Public Readiness and Emergency Preparedness Act (42 U.S.C. §§ 247d-6d, 247d-6e), claims for alleged injuries from COVID-19 countermeasures, including vaccines, may be compensable under the Countenneasures Injury Compensation Program ("CICP"). See 85 Fed. Reg. 15198, 15202 (March 17, 2020). OBS for more than six months. 5. There is not a preponderance of evidence demonstrating that petitioner's injury is due to a factor unrelated to vaccination. 6. 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. 7. Accordingly, petitioner is entitled to compensation under the terms of the Vaccine Act for her OBS Table injury. Therefore, a decision should be entered awarding the compensation described in paragraph 8 of this Stipulation. 8. As soon as practicable after an entry ofjudgment 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-2 l(a)(l), the Secretary of Health and Human Services will issue the following vaccine compensation payment: A lump sum of $125,000.00 in the form of a check payable 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 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 U.S.C. § 300aa-2l(a)(l), 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. 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, 2 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. 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 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-15(a) and (d), and subject to the conditions of 42 U.S.C. § 300aa-l 5(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, (a) 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 hereafter could be timely brought in the Court of Federal Claims, under the Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 et seq., (i) 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 that may be alleged to have resulted from, the vaccinations administered on September 30, 2021 and October 28, 2021, and (ii) that petitioner has had, now has, or hereafter may have with respect to the injury that gave rise to the petition for vaccine compensation filed on or about July 19, 2023, in the United States Court of Federal Claims as 3 petition No. 23-l l 14V; and (b) waives any and all rights to any compensation that may be available under the Countermeasures Injury Compensation Program (CICP), 42 U.S.C. § 247d- 6e (or an action under 42 U.S.C. § 247d-6d(d)}, for a claim alleging that a covered countermeasure, including the COVID-19 vaccinations administered on September 30, 2021 and October 28, 2021, on their own or in combination with the flu vaccination administered on October 28, 2021, caused or seriously aggravated the injuries that were the subject of the petition for vaccine compensation filed on or about July 19, 2023, in the United States Court of Federal Claims as petition No. 23-l l 14V, including Guillain Barre Syndrome ("GBS"), for which petitioner will receive compensation pursuant to this Stipulation. If petitioner has such a claim currently pending with the CICP, petitioner hereby withdraws such claim for compensation in the CICP.2 If no claim for compensation has been filed in the CICP as of the date this Stipulation is filed, petitioner waives the right to file a claim as described in this paragraph for compensation in the CICP. 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 2 After entry of judgment reflecting a decision consistent with the terms of this Stipulation, petitioner agrees that respondent will send this Stipulation to the CICP as evidence of petitioner's withdrawal of their CICP claim and waiver of any potential compensation under the CICP. 4 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 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. The Stipulation shall not be construed as an admission by the United States or the Secretary of Health and Human Services that the flu vaccine caused petitioner's OBS or any other injury or her current condition; however, petitioner has satisfied the Table criteria to establish entitlement to compensation. 18. All rights and obligations of petitioner hereunder shall apply equally to petitioner's heirs, executors, administrators, successors, and/or assigns. END OF STIPULATION 5 Docusign Envelope ID: 86AFA0B0-FF01 -48CC-A1D5-6032D680155C Respectfully submitted, PETITIONER: GOocuSigned by: ~ 6 0 6 /7/FF ELENA BORISEVICH ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE OF THE ATTORNEY GENERAL: P~ER: _ GREGROGE~ Counsel for Petitioner ~~~~ Deputy Director Rogers, Hofrichter and Karrh LLC Torts Branch, Civil Division 225 S. Glynn St. U.S. Department of Justice Fayetteville, GA 30214 P.O. Box 146 grogers@rhkpc.com Benjamin Franklin Station Washington, DC 20044-0146 AUTHORIZED REPRESENTATIVE ATTORNEY OF RECORD FOR OF THE SECRETARY OF HEALTH RESPONDENT: AND HUMAN SERVICES: Jeffreys. Digitally signed by Jeffrey S. Beach -5 Date: 2024.09.25 Beac h -S. 10:1s:23 .04•00· tor CAPT GEORGE REED GRIMES, MD, MPH Director, Division of Injury Trial Attorney Compensation Programs Torts Branch, Civil Division Health Systems Bureau U.S. Department of Justice Health Resources and Services 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 202-616-4027 Rockville, Md 20857 ryan.nelson3@usdoj.gov Dated: /11-l - lo2V 6