VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_24-vv-00491 Package ID: USCOURTS-cofc-1_24-vv-00491 Petitioner: Michael Koldobskiy Filed: 2024-11-14 Decided: 2025-04-28 Vaccine: influenza Vaccination date: 2022-11-03 Condition: shoulder injury related to vaccine administration (SIRVA) Outcome: compensated Award amount USD: 60000 AI-assisted case summary: Michael Koldobskiy filed a petition for compensation under the National Vaccine Injury Compensation Program on April 1, 2024, alleging a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccine he received on November 3, 2022. The petition stated that the vaccine was administered in the United States, that the injury lasted for more than six months, and that no other action had been filed for the vaccine-related injury. The respondent, the Secretary of Health and Human Services, filed a Rule 4(c) report on October 24, 2024, conceding that Mr. Koldobskiy's injury was consistent with a SIRVA as defined by the Vaccine Injury Table and that he met all legal prerequisites for compensation. On November 14, 2024, Chief Special Master Brian H. Corcoran issued a Ruling on Entitlement, finding Mr. Koldobskiy entitled to compensation based on the respondent's concession and the evidence of record. Subsequently, on March 19, 2025, the respondent filed a proffer on award of compensation, proposing a payment of $60,000.00 for pain and suffering, which Mr. Koldobskiy accepted. On April 28, 2025, Chief Special Master Corcoran issued a Decision Awarding Damages, awarding Mr. Koldobskiy a lump sum payment of $60,000.00, to be paid via ACH deposit to his counsel's IOLTA account for prompt disbursement. This award represents compensation for all damages available under Section 15(a) of the Vaccine Act. Petitioner counsel was Diana Lynn Stadelnikas, and respondent counsel was Sarah Black Rifkin. The public decision does not describe the specific onset of symptoms, medical tests, or treatments. Theory of causation field: Petitioner Michael Koldobskiy alleged a shoulder injury related to vaccine administration (SIRVA) following an influenza vaccine administered on November 3, 2022. The respondent conceded that the injury was consistent with a SIRVA as defined by the Vaccine Injury Table, satisfying the "Table" theory of causation. Petitioner met all legal prerequisites for compensation. The case was decided by Chief Special Master Brian H. Corcoran. An entitlement ruling was issued on November 14, 2024, finding Petitioner entitled to compensation. On March 19, 2025, Respondent filed a proffer on award of compensation, agreeing to a $60,000.00 payment for pain and suffering, which Petitioner accepted. A decision awarding damages was issued on April 28, 2025, granting a lump sum payment of $60,000.00 to Petitioner. Petitioner counsel was Diana Lynn Stadelnikas, and respondent counsel was Sarah Black Rifkin. The public text does not detail specific medical experts, clinical findings, or the mechanism of injury beyond its classification as a SIRVA under the Vaccine Injury Table. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_24-vv-00491-0 Date issued/filed: 2024-12-20 Pages: 2 Docket text: PUBLIC ORDER/RULING (Originally filed: 11/14/2024) regarding 18 Ruling on Entitlement. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made. -------------------------------------------------------------------------------- Case 1:24-vv-00491-UNJ Document 23 Filed 12/20/24 Page 1 of 2 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 24-491V MICHAEL KOLDOBSKIY, Chief Special Master Corcoran Petitioner, Filed: November 14, 2024 v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Diana Lynn Stadelnikas, Mctlaw, Sarasota, FL, for Petitioner. Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent. RULING ON ENTITLEMENT1 On April 1, 2024, Michael Koldobskiy 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 vaccine administered on November 3, 2022. Petition at 1. Petitioner further alleges that the vaccine was administered within the United States, that he suffered from his injury for more than six months, and that he has not filed any other action for his vaccine-related injury. Petition at 4. The case was assigned to the Special Processing Unit of the Office of Special Masters. 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 1:24-vv-00491-UNJ Document 23 Filed 12/20/24 Page 2 of 2 On October 24, 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 has concluded that Petitioner’s injury is consistent with a SIRVA as defined by the Vaccine Injury Table. Id. at 6. Respondent further agrees that Petitioner has satisfied all legal prerequisites for compensation under the Vaccine Act. Id. 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_24-vv-00491-1 Date issued/filed: 2025-04-28 Pages: 5 Docket text: PUBLIC DECISION (Originally filed: 03/28/2025) regarding 28 DECISION Stipulation/Proffer. Signed by Chief Special Master Brian H. Corcoran. (kle) Service on parties made. -------------------------------------------------------------------------------- Case 1:24-vv-00491-UNJ Document 32 Filed 04/28/25 Page 1 of 5 CORRECTED In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 24-491V MICHAEL KOLDOBSKIY, Chief Special Master Corcoran Petitioner, Filed: March 28, 2025 v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Diana Lynn Stadelnikas, Mctlaw, Sarasota, FL, for Petitioner. Sarah Black Rifkin, U.S. Department of Justice, Washington, DC, for Respondent. DECISION AWARDING DAMAGES1 On April 1, 2024, Michael Koldobskiy 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 vaccine administered on November 3, 2022. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters. On November 14, 2024, a ruling on entitlement was issued, finding Petitioner entitled to compensation for a SIRVA. On March 19, 2025, Respondent filed a proffer on award of compensation indicating Petitioner should be awarded $60,000.00 for pain and suffering. Respondent’s Proffer on Award of Compensation (“Proffer”) at 4-5. In the Proffer, Respondent represented that Petitioner agrees with the proffered award. Id. 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-00491-UNJ Document 32 Filed 04/28/25 Page 2 of 5 Based on the record as a whole, I find that Petitioner is entitled to an award as stated in the Proffer. Pursuant to the terms stated in the Proffer, I award Petitioner a lump sum payment of $60,000.00, 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 Section 15(a). 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 1:24-vv-00491-UNJ Document 32 Filed 04/28/25 Page 3 of 5 IN THE UNITED STATES COURT OF FEDERAL CLAIMS OFFICE OF SPECIAL MASTERS MICHAEL KOLDOBSKIY, Petitioner, No. 24-491V Chief Special Master Corcoran v. ECF SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. RESPONDENT’S PROFFER ON AWARD OF COMPENSATION On April 1, 2024, Michael Koldobskiy (“petitioner”) filed a petition for compensation under the National Childhood Vaccine Injury Act of 1986, 42 U.S.C. §§ 300aa-1 to -34 (“Vaccine Act” or “Act”), alleging that he suffered a shoulder injury related to vaccine administration (“SIRVA”), as the result of an influenza vaccination received on November 3, 2022.1 ECF No. 1. On October 24, 2024, respondent filed his Vaccine Rule 4(c) report, conceding that petitioner suffered SIRVA as defined by the Vaccine Injury Table. ECF No. 16. On November 14, 2024, the Court issued a ruling on entitlement, finding that petitioner was entitled to compensation for a SIRVA Table injury. ECF No. 18. I. Items of Compensation Respondent proffers that petitioner should be awarded $60,000.00 in pain and suffering 1 On November 3, 2022, petitioner also received a COVID-19 vaccine. 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 Countermeasures Injury Compensation Program (“CICP”). See 85 Fed. Reg. 15198, 15202 (March 17, 2020). Case 1:24-vv-00491-UNJ Document 32 Filed 04/28/25 Page 4 of 5 damages. See 42 U.S.C. § 300aa-15(a)(4). This amount represents all elements of compensation to which petitioner is entitled under 42 U.S.C. § 300aa-15(a). Petitioner agrees.2 II. Form of the Award Petitioner is a competent adult. Evidence of guardianship is not required in this case. Respondent recommends that the compensation provided to petitioner should be made through a lump sum payment, as described below, and requests that the Chief Special Master’s decision and the Court’s judgment3,4 award the following: A lump sum payment of $60,000.00, to be paid through an ACH deposit to petitioner’s counsel’s IOLTA account for prompt disbursement to petitioner, Michael Koldobskiy. Petitioner agrees. III. Summary of Recommended Payments Following Judgment Lump sum payable to petitioner, Michael Koldobskiy: $60,000.00 2 This Proffer does not include attorneys’ fees and costs, which the parties intend to address after the Damages Decision is issued. 3 Should petitioner die prior to entry of judgment, respondent would oppose any award for future medical expenses, future lost earnings, and future pain and suffering, and the parties reserve the right to move the Court for appropriate relief. 4 The entry of judgment awarding the compensation described herein and in a Decision of the Chief Special Master, resolves 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 against the United States and the Secretary of Health and Human Services in the Court of Federal Claims, under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10 et seq., (a) 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 that resulted from, or that may be alleged to have resulted from, the vaccinations identified herein, and (b) 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 in the United States Court of Federal Claims as petition No. 24-491V. 2 Case 1:24-vv-00491-UNJ Document 32 Filed 04/28/25 Page 5 of 5 Respectfully submitted, YAAKOV M. ROTH Acting Assistant Attorney General C. SALVATORE D’ALESSIO Director Torts Branch, Civil Division HEATHER L. PEARLMAN Deputy Director Torts Branch, Civil Division VORIS E. JOHNSON, JR. Assistant Director Torts Branch, Civil Division s/Sarah Black Rifkin SARAH BLACK RIFKIN Trial Attorney Torts Branch, Civil Division U.S. Department of Justice P.O. Box 146, Benjamin Franklin Station Washington, D.C. 20044-0146 Tel: (202) 305-5997 Email: Sarah.Rifkin@usdoj.gov Dated: March 19, 2025 3