VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_24-vv-00052
Package ID: USCOURTS-cofc-1_24-vv-00052
Petitioner: Roberto Rivera
Filed: 2024-01-12
Decided: 2025-10-30
Vaccine: influenza
Vaccination date: 2022-10-11
Condition: shoulder injury related to vaccine administration (SIRVA)
Outcome: compensated
Award amount USD: 67500

AI-assisted case summary:
On January 12, 2024, Roberto Rivera filed a petition alleging that an influenza vaccination administered on October 11, 2022 caused a shoulder injury related to vaccine administration. He alleged that residual effects lasted more than six months.

Respondent denied that Mr. Rivera sustained a Table SIRVA, denied that the vaccine caused his alleged shoulder injury or any other injury, and denied that his current condition was a sequela of a vaccine-related injury. The public stipulation does not describe onset, treatment, imaging, injections, therapy, or functional effects.

On October 29, 2025, the parties filed a joint stipulation. Chief Special Master Brian H. Corcoran adopted it on October 30, 2025 and awarded Mr. Rivera $67,500.00 as a lump sum for all damages available under the Vaccine Act. The decision text describes payment through counsel's IOLTA account, while the attached stipulation describes a check payable to Mr. Rivera. Mr. Rivera was represented by John Beaulieu of Siri & Glimstad, LLP.

Theory of causation field:
Adult petitioner; influenza vaccine October 11, 2022; alleged Table SIRVA/off-Table shoulder injury. COMPENSATED by stipulation. Respondent denied Table SIRVA and causation; public text lacks clinical chronology. SM Corcoran October 30, 2025. Award $67,500.00 lump sum. Petition filed January 12, 2024. Attorney: John Beaulieu.

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_24-vv-00052-0
Date issued/filed: 2025-12-15
Pages: 7
Docket text: PUBLIC DECISION (Originally filed: 10/30/2025) regarding 35 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (cr) Service on parties made.
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Case 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 24-0052V
ROBERTO RIVERA, Chief Special Master Corcoran
Petitioner, Filed: October 30, 2025
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
John Beaulieu, Siri & Glimstad, LLP, Louisville, KY, for Petitioner.
Camille Michelle Collett, U.S. Department of Justice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION1
On January 12, 2024, Roberto Rivera 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 he suffered a shoulder injury related to vaccine
administration (“SIRVA”) following an influenza vaccination he received on October 11,
2022. Petition at 1; Stipulation, filed at October 29, 2025, ¶¶ 2, 4. Petitioner further alleges
that he has suffered the residual effects of his vaccine-related injury for more than six
months. Petition at ¶ 22; Stipulation at ¶ 4. “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 his current condition is a sequela of a vaccine-related
injury.” Stipulation at ¶ 6.
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 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 2 of 7
Nevertheless, on October 29, 2025, the parties filed the attached joint stipulation,3
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 $67,500.00, 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.4
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
3 The filed Stipulation included an electronic signature page that has been removed from the attachment
to protect the confidential information of the signers.
4 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 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 3 of 7
IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS
ROBERTO RIVERA,
Petitioner, No. 24-52V
Chief Special Master Corcoran
V. ECF
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
STIPULATION
The parties hereby stipulate to the following matters:
I. Roberto Rivera ("petitioner"), filed a petition for vaccine compensation under the
National Vaccine Injury Compensation Program, 42 U .S.C. § 300aa-l O to 34 (the ''Vaccine
Program"). The petition seeks compensation for injuries allegedly related to petitioner's receipt
of an influenza ("flu'') vaccine, which vaccine is contained in the Vaccine Injury Table (the
"Table"), 42 C.F.R. § I 00.3(a).
2. Petitioner received a flu vaccine on October 11, 2022.
3. The vaccine was administered within the United States.
4. Petitioner alleges that he sustained a shoulder injury related to vaccine administration
("SIRVA'') within the time period set forth in the Table. He further alleges that he 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 his behalf as a result of his alleged injury.
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Case 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 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 his
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 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-2I (a)(I ), the Secretary of Health and Human Services will issue
the following vaccine compensation payment:
A lump sum of $67,500.00 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-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.
10. Petitioner and his 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.
2
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Case 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 5 of 7
§ 1396 et seq.)), or by entities that provide health services on a pre-paid basis.
11. Payment 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 attorneys' fees and litigation costs, and past unreimbursable 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 subjectto 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 his
ind iv id ual capacity, and on behalf of his 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
(includingagreements,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 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 flu vaccination administered on October 11, 2022, as
alleged in a petition for vaccine compensation filed on or about January 12, 2024, in the United
States Court of Federal Claims as petition No. 24-52V.
14. If petitioner should die prior to entry of judgment, this agreement shall be voidable
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Case 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 6 of 7
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 confonnity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in confonnity 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 th is
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 thatthe flu vaccine caused petitioner's alleged injury or
any other injury or his current disabilities, or that petitioner suffered an injury contained in the
Vaccine Injury Table.
t 8. All rights and obligations of petitioner hereunder shall apply equally to petitioner's
heirs, executors, administrators, successors, and/or assigns.
END OF STIPULATION
4
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Case 1:24-vv-00052-UNJ Document 42 Filed 12/15/25 Page 7 of 7
Respectfully submitted,
PETITIONER:
ROBERTO RIVERA
ATTORNEY OF RECORD FOR AUTHORIZED REPRESENTATIVE
PETITIONER: OF THE ATTORNEY GENERAL:
BEAULIEU HEATHER L. PEARLMAN
I & GLIMSTAD LLP Deputy Director
745 Fifth Avenue Suite 500 Torts Branch
NewYork,NY 10151 Civil Division
(212) 532-1091 U.S. Department of Justice
E-mail: jbeau lieu@sirillp.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:
s.
Jeffrey ~ -
~!~:I'.~ signed by Jeffrey S.
Beach -5 Date: 2025.10.22 14:26:29 f
-04•00· or
CAPT GEORGE REED GRIMES, MD, MPH CAMILLE M. COLL
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 20044-0 t 46
5600 Fishers Lane, 14 W-I 8 Tel: (202) 616-4098
Rockville, MD 20857 E-mail: Camille.M.Collett(a),usdoj.gov
_to_,~_q""'--ll,-m- _.2S=-/-
Dated:
5
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