VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_23-vv-02050 Package ID: USCOURTS-cofc-1_23-vv-02050 Petitioner: Donna Fogelstrom Filed: 2023-11-30 Decided: 2025-12-10 Vaccine: pneumococcal conjugate Vaccination date: 2022-09-07 Condition: left shoulder injury related to vaccine administration (SIRVA) Outcome: compensated Award amount USD: 45000 AI-assisted case summary: On November 30, 2023, Donna Fogelstrom filed a petition alleging that a pneumococcal conjugate vaccine administered on September 7, 2022 caused a left shoulder injury related to vaccine administration. Respondent denied that Ms. Fogelstrom sustained a Table SIRVA, denied vaccine causation, and denied vaccine-related sequelae. The public stipulation does not give a medical chronology of onset, treatment, imaging, therapy, injections, or residual symptoms. The parties resolved the case by stipulation. On December 10, 2025, Chief Special Master Brian H. Corcoran adopted the stipulation and awarded Ms. Fogelstrom $45,000.00 as a lump sum through counsel's IOLTA account. Theory of causation field: Pneumococcal conjugate vaccine September 7, 2022 allegedly causing left SIRVA; adult, exact age not stated. COMPENSATED by stipulation. Respondent denied Table SIRVA, causation, and sequelae; public stipulation lacks clinical details. Award $45,000 lump sum. Chief SM Brian H. Corcoran; petition November 30, 2023; decision December 10, 2025. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_23-vv-02050-0 Date issued/filed: 2026-01-09 Pages: 7 Docket text: PUBLIC DECISION (Originally filed: 12/10/2025) regarding 24 DECISION Stipulation/Proffer Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made. -------------------------------------------------------------------------------- Case 1:23-vv-02050-UNJ Document 25 Filed 01/09/26 Page 1 of 7 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-2050V DONNA FOGELSTROM, Chief Special Master Corcoran Petitioner, Filed: December 10, 2025 v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Jered Medlock, Medlock & Gramlich LLP, Fort Smith, AR, for Petitioner. Joseph Douglas Leavitt, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON JOINT STIPULATION1 On November 30, 2023, Donna Fogelstrom filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine Act”). Petitioner alleges that she suffered a Table shoulder injury related to vaccine administration (“SIRVA”) as a result of her September 7, 2022 pneumococcal conjugate vaccination. Petition at ¶¶ 2-3, 11; Stipulation at ¶¶ 2, 4. Petitioner further alleges that she received her vaccination in the United States, that she suffered the residual effects of her injury for more than six months, and that there has been no prior award or settlement of a civil action on her behalf as a result of her injury. Petition at ¶¶ 2, 7-8, 10; Stipulation at ¶¶ 3-5. “Respondent denies that [P]etitioner sustained a SIRVA Table Injury and denies that the vaccine caused her alleged shoulder injury, any other injury.” Stipulation at ¶ 6. Nevertheless, on December 8, 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. 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-02050-UNJ Document 25 Filed 01/09/26 Page 2 of 7 Pursuant to the terms stated in the attached Stipulation, I award the following compensation: A lump sum of $45,000.00, to be paid through an ACH deposit to Petitioner’s counsel’s IOLTA account for prompt disbursement to Petitioner. Stipulation at ¶ 8. This amount represents compensation for all items of damages that would be available under Section 15(a). Id. I approve the requested amount for Petitioner’s compensation. In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of Court is directed to enter judgment in accordance with this decision.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-02050-UNJ Document 25 Filed 01/09/26 Page 3 of 7 IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS DONNA FOGELSTROM, Petitioner, V. No. 23-2050V (ECF) Chief Special Master Corcoran SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. STIPULATION The parties hereby stipulate to the following matters: I. On November 30, 2023, petitioner filed a petition for vaccine compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-l Oto -34 (the "Program"). The petition seeks compensation for an injury allegedly related to petitioner's receipt of the pneumococcal conjugate ("Prevnar 20") vaccine, which vaccine is contained in the Vaccine Injury Table, 42 C.F.R. § I 00.3(a) (the "Table"). 2. Petitioner received a Prevnar 20 vaccine on September 7, 2022. 3. The vaccine was administered within the United States. 4. Petitioner alleges that she suffered a left-sided shoulder injury related to vaccine administration ("SIRVA") as a result of her vaccination. Petitioner further alleges that she experienced the residual effects of this injury for more than six months. 5. Petitioner represents that there has been no prior award or settlement of a civil action for damages as a result of her alleged injury. Case 1:23-vv-02050-UNJ Document 25 Filed 01/09/26 Page 4 of 7 6. Respondent denies that petitioner sustained a SIRVA Table injury and denies that the vaccine caused her alleged shoulder injury, or any other 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 eight 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-21 (a)(]), the Secretary of Health and Human Services will issue the following vaccine compensation payment: A lump sum payment of $45,000.00 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 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-2 l (a)(!), 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 her attorney represent that the compensation to be provided pursuant to this Stipulation is not for any items or services for which the Program is not primarily liable under42 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 (42 U.S.C. § 1396 et seq.)), or by entities that provide health services on a pre-paid basis. 2 Case 1:23-vv-02050-UNJ Document 25 Filed 01/09/26 Page 5 of 7 11. Payment made pursuant to paragraph eight and any amounts awarded pursuant to paragraph nine 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 attorneys' fees and litigation costs, 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-l 5(g) and (h). 13. In return for the compensation described in paragraphs eight and nine, petitioner, in her individual capacity, and on behalf of her heirs, executors, administrators, successors, or assigns, does forever and in-evocably 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 be timely brought in the Court of Federal Claims, under the National Vaccine Injury Compensation Program, 42 U .S.C. § 300aa-l 0 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 Prevnar20 vaccination administered on September 7, 2022, as alleged in a petition for vaccine compensation filed on or about November 30, 2023, in the United States Court of Federal Claims as petition No. 23-2050V. 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 Chief 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 3 Case 1:23-vv-02050-UNJ Document 25 Filed 01/09/26 Page 6 of 7 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, expect as otherwise noted in paragraph nine 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 as 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 Prevnar 20 vaccine caused petitioner's alleged shoulder injury or any other injury, or that she 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-02050-UNJ Document 25 Filed 01/09/26 Page 7 of 7 Respectfully submitted, PETITIONER: J -:cJ,,Jl ft.o/K.. ~Ol'Vle DONNA FOGELSTRO ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE PETITIONER: OF THE ATTORNEY GENERAL: /uah~~- ?0:v1l~ ~ h0 Vl-U:'h lo #, ~~ M. J D LOCK '-.....:...._ HEATHER L. PEARLMAN Mlock&Grarn lich~ Deputy Director 105 N. 14th Torts Branch Fort Smith, AR 72901 Civil Division Telephone: (479) 494-5614 U.S. Department of Justice jmedlock@fortsmithlawfirm.com P.O. Box 146 Benjamin Franklin Station Washington, D.C. 20044-0146 AUTHORIZED REPRESENTATIVE OF ATTORNEY OF RECORD FOR THE SECRET ARY OF HEALTH AND RESPONDENT: HUMAN SERVICES: Jeffrey 5. Digitally signed by Jeffreys. Beach -5 Be a h S Date: 2025.11.21 C - _ 11 :13:01 -os·oo· for CAPT GEORGE REED GRIMES, MD, MPH Director, Division of Injury Compensation Programs 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, D.C. 20044-0146 5600 Fishers Lane, I 4W-l 8 (202) 616-0515 Rockville, MD 20857 joseph.leavitt@usdoj.gov t; Dated: 'Dtt.ttv\'ae.r 1.01...<; 1 5 ================================================================================ DOCUMENT 2: USCOURTS-cofc-1_23-vv-02050-cl-extra-11239055 Date issued/filed: 2026-01-09 Pages: 1 Docket text: Supplementary opinion from CourtListener cluster 10772470 -------------------------------------------------------------------------------- In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 23-2050V DONNA FOGELSTROM, Chief Special Master Corcoran Petitioner, Filed: December 10, 2025 v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Jered Medlock, Medlock & Gramlich LLP, Fort Smith, AR, for Petitioner. Joseph Douglas Leavitt, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON JOINT STIPULATION1 On November 30, 2023, Donna Fogelstrom filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the “Vaccine Act”). Petitioner alleges that she suffered a Table shoulder injury related to vaccine administration (“SIRVA”) as a result of her September 7, 2022 pneumococcal conjugate vaccination. Petition at ¶¶ 2-3, 11; Stipulation at ¶¶ 2, 4. Petitioner further alleges that she received her vaccination in the United States, that she suffered the residual effects of her injury for more than six months, and that there has been no prior award or settlement of a civil action on her behalf as a result of her injury. Petition at ¶¶ 2, 7-8, 10; Stipulation at ¶¶ 3-5. “Respondent denies that [P]etitioner sustained a SIRVA Table Injury and denies that the vaccine caused her alleged shoulder injury, any other injury.” Stipulation at ¶ 6. Nevertheless, on December 8, 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. 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). Pursuant to the terms stated in the attached Stipulation, I award the following compensation: A lump sum of $45,000.00, to be paid through an ACH deposit to Petitioner’s counsel’s IOLTA account for prompt disbursement to Petitioner. Stipulation at ¶ 8. This amount represents compensation for all items of damages that would be available under Section 15(a). Id. I approve the requested amount for Petitioner’s compensation. In the absence of a motion for review filed pursuant to RCFC Appendix B, the Clerk of Court is directed to enter judgment in accordance with this decision.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 IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS DONNA FOGELSTROM, Petitioner, V. No. 23-2050V (ECF) Chief Special Master Corcoran SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. STIPULATION The parties hereby stipulate to the following matters: I. On November 30, 2023, petitioner filed a petition for vaccine compensation under the National Vaccine Injury Compensation Program , 42 U.S.C. § 300aa-l Oto -34 (the " Program "). The petition seeks compensation for an injury allegedly related to petitioner' s receipt of the pneumococcal conjugate (" Prevnar 20 ") vaccine, which vaccine is contained in the Vaccine Injury Table, 42 C.F.R. § I 00.3(a) (the "Table"). 2. Petitioner received a Prevnar 20 vaccine on September 7, 2022. 3. The vaccine was administered within the United States. 4. Petitioner alleges that she suffered a left-sided shoulder injury related to vaccine administration (" SIRVA") as a result of her vaccination. Petitioner further alleges that she experienced the residual effects of this injury for more than six months. 5. Petitioner represents that there has been no prior award or settlement of a civil action for damages as a result of her alleged injury. 6. Respondent denies that petitioner sustained a SIRVA Table injury and denies that the vaccine caused her alleged shoulder injury , or any other 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 eight 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)(]), the Secretary of Health and Human Services will issue the following vaccine compensation payment: A lump sum payment of $45,000.00 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 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-2 l (a)(!), 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 her attorney represent that the compensation to be provided pursuant to this Stipulation is not for any items or services for which the Program is not primarily liable under42 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 (42 U.S.C. § 1396 et seq.)), or by entities that provide health services on a pre-paid basis . 2 11. Payment made pursuant to paragraph eight and any amounts awarded pursuant to paragraph nine 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 attorneys' fees and litigation costs, 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-l 5(g) and (h). 13. In return for the compensation described in paragraphs eight and nine, petitioner, in her individual capacity, and on behalf of her heirs, executors, administrators, successors, or assigns, does forever and in-evocably 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 be timely brought in the Court of Federal Claims, under the National Vaccine Injury Compensation Program , 42 U .S.C. § 300aa-l 0 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 Prevnar20 vaccination administered on September 7, 2022 , as alleged in a petition for vaccine compensation filed on or about November 30, 2023 , in the United States Court of Federal Claims as petition No. 23-2050V. 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 Chief 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 3 with a decision that is in complete conformity with the terms of this Stipulation, then the parties ' settlement and this Stipulation shall be vo idable at the so le discretion of either party. 16. This Stipulation expresses a full and comp lete negotiated settlement of liabi lity and damages c laimed under the National Childhood Vaccine Injury Act of 1986, as amended , expect as otherwise noted in paragraph nine above. There is abso lutely no agreement on the part of the parties hereto to make any payment or to do any act or thing other than as herein expressly stated and clearly agreed to. The parties further agree and understand that the award described in this Stipu lation may reflect a comprom ise of the parties ' respective positions as to liability and/or amount of damages, and further, that a change in the nature of th e inju ry or condition or in the items of compensation sought, is not grounds to modify or revise this agreement. 17. This Stipu lation shall not be construed as an admission by the United States or the Secretary of Health and Human Serv ices that the Prevnar 20 vacc in e caused petitioner's a lleged shou ld er injury or any other injury , or that she suffered an injury contained in the Vaccine Injury Tab le. 18. Al l rights and ob ligations of petitioner hereunder sha ll apply equally to petitioner' s heirs, executors, admin istrators, successors, and /or assign s. END OF STIPULATION 4 Respectfully submitted, PETITIONER: ~Ol'Vle DONNA FOGELSTRO J -:cJ,,Jl ft.o/K.. ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE PETITIONER: OF THE ATTORNEY GENERAL: ~ /uah~~- ?0:v1l~ h0 Vl-U:' hlo #, ~~ M. J D LOCK '-.....:...._ HEATHER L. PEARLMAN Mlock&Grarn lich~ Deputy Director 105 N. 14th Torts Branch Fort Smith, AR 72901 Civil Division Telepho ne: (479) 494-56 14 U.S. Department of Justice jmedlock@fortsmithlawfirm.com P.O. Box 146 Benjam in Franklin Station Washington, D.C. 20044-0146 AUTHORIZED REPRESENTATIVE OF ATTORNEY OF RECORD FOR THE SECRET ARY OF HEALTH AND RESPONDENT: HUMAN SERVICES: Jeffrey 5. Digitally signed by Jeffreys. Beach -5 Date: 2025.11.21 Bea Ch - S _ 11 :13:01 -os·oo· for CAPT GEORGE REED GRIMES, MD, MPH Director, Division of Injury Compensation Programs Health Systems Bureau Civil Div ision Hea lth Reso urces and Services U.S. Department of Justice Adm inistration P.O. Box 146 U.S. Department of Health Benjam in Franklin Station and Human Services Washington, D.C. 20044-0 146 5600 Fishers Lane, I4W-l 8 (202) 616-0515 Rockville, MD 20857 joseph.leavitt@usdoj.gov Dated : 'Dtt.ttv\'ae.r t; 1 1.01...<; 5