VICP Registry Case Source Bundle Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_24-vv-00737 Package ID: USCOURTS-cofc-1_24-vv-00737 Petitioner: Donna Kostuch Filed: 2024-05-10 Decided: 2025-08-12 Vaccine: influenza Vaccination date: 2022-10-04 Condition: shoulder injury related to vaccine administration (SIRVA) Outcome: compensated Award amount USD: 15000 AI-assisted case summary: On May 10, 2024, Donna Kostuch filed a petition alleging that an influenza vaccination administered on October 4, 2022 caused a shoulder injury related to vaccine administration. She alleged residual effects lasting more than six months. The public decision is a joint stipulation and does not describe onset, treatment, imaging, or expert opinions. Respondent denied that Ms. Kostuch sustained a Table SIRVA, denied that the vaccine caused her alleged shoulder injury or any other injury, and denied that her current condition was vaccine-related. The parties nevertheless agreed to settle. On August 12, 2025, Chief Special Master Brian H. Corcoran adopted the stipulation and awarded Ms. Kostuch $15,000 for all damages available under Section 15(a), payable through counsel's IOLTA account. She was represented by Kathleen Margaret Loucks of Lommen Abdo Law Firm. Theory of causation field: Influenza vaccine on October 4, 2022, adult exact age not stated, alleged SIRVA. COMPENSATED by joint stipulation. Respondent denied Table SIRVA, causation, and sequela, but stipulated to $15,000 for all damages. Public stipulation gives no detailed clinical timeline or expert analysis. Chief Special Master Corcoran, August 12, 2025. Attorney: Kathleen Margaret Loucks, Lommen Abdo Law Firm. Public staged source text: ================================================================================ DOCUMENT 1: USCOURTS-cofc-1_24-vv-00737-0 Date issued/filed: 2025-09-17 Pages: 7 Docket text: PUBLIC DECISION (Originally filed: 08/12/2025) regarding 29 DECISION Stipulation/Proffer ( Signed by Chief Special Master Brian H. Corcoran. )(mpj) Service on parties made. -------------------------------------------------------------------------------- Case 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 1 of 7 In the United States Court of Federal Claims OFFICE OF SPECIAL MASTERS No. 24-0737V DONNA KOSTUCH, Chief Special Master Corcoran Petitioner, Filed: August 12, 2025 v. SECRETARY OF HEALTH AND HUMAN SERVICES, Respondent. Kathleen Margaret Loucks, Lommen Abdo Law Firm, Minneapolis, MN, for Petitioner. Mark Kim Hellie, U.S. Department of Justice, Washington, DC, for Respondent. DECISION ON JOINT STIPULATION1 On May 10, 2024, Donna Kostuch 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”) following an influenza vaccination she received on October 4, 2022. Petition at ¶¶ 2-3; Stipulation, filed at August 11, 2025, ¶¶ 2, 4. Petitioner further alleges that she suffered the residual effects of her injury for more than six months. Petition at ¶ 4; Stipulation at ¶ 4. “Respondent denies that Petitioner sustained a Table SIRVA injury, and further denies that the flu vaccine Petitioner’s alleged left shoulder injury, or any other injury, or her current condition.” Stipulation at ¶ 6. Nevertheless, on August 11, 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 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 2 of 7 Pursuant to the terms stated in the attached Stipulation, I award the following compensation: A lump sum of $15,000.00, 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 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 3 of 7 (cid:1)(cid:13)(cid:23)(cid:19)(cid:5)(cid:7)(cid:23)(cid:3)(cid:14)(cid:9)(cid:19)(cid:7)(cid:6)(cid:23)(cid:22)(cid:19)(cid:4)(cid:19)(cid:7)(cid:18)(cid:23)(cid:16)(cid:15)(cid:21)(cid:17)(cid:19)(cid:23)(cid:15)(cid:8)(cid:23)(cid:10)(cid:7)(cid:23)(cid:6)(cid:7)(cid:17)(cid:4)(cid:2)(cid:23)(cid:16)(cid:11)(cid:4)(cid:20)(cid:12)(cid:18)(cid:23) (cid:10)(cid:5)(cid:5)(cid:7)(cid:2)(cid:3)(cid:18)(cid:11)(cid:6)(cid:18)(cid:14)(cid:12)(cid:4)(cid:2)(cid:7)(cid:1)(cid:8)(cid:18)(cid:9)(cid:1)(cid:15)(cid:17)(cid:4)(cid:13)(cid:16)(cid:18) (cid:56)(cid:85)(cid:83)(cid:84)(cid:49)(cid:227)(cid:75)(cid:85)(cid:92)(cid:93)(cid:99)(cid:51)(cid:66)(cid:19)(cid:227) 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(cid:107)(cid:114)(cid:206)(cid:156)(cid:180)(cid:177)(cid:227)(cid:144)(cid:190)(cid:227)(cid:116)(cid:107)(cid:172)(cid:107)(cid:148)(cid:120)(cid:195)(cid:227)(cid:180)(cid:177)(cid:227)(cid:151)(cid:120)(cid:187)(cid:227)(cid:113)(cid:128)(cid:152)(cid:107)(cid:166)(cid:133)(cid:227)(cid:107)(cid:195)(cid:227)(cid:107)(cid:227)(cid:187)(cid:117)(cid:195)(cid:211)(cid:166)(cid:204)(cid:227)(cid:180)(cid:134)(cid:227)(cid:151)(cid:120)(cid:187)(cid:227)(cid:107)(cid:166)(cid:166)(cid:120)(cid:147)(cid:120)(cid:116)(cid:227)(cid:156)(cid:177)(cid:163)(cid:213)(cid:187)(cid:153)(cid:120)(cid:195)(cid:31)(cid:227) Case 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 4 of 7 6. Respondent denies that petitioner sustained a Table SIRVA injury, and further denies that the flu vaccine caused petitioner's alleged left shoulder injmy, any other injwy, or her current condition. 7. Maintaining their above-stated positions, the parties nevertheless now agree that the issues between them shall be settled and 1hat 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-21 (a)( 1), the Secretary of Health and Human Services will issue the following vaccine compensation payment: A lump sum of $15,000.00 to be paid through an ACH deposit to petitioner's counsel's IOLTA accowlt for prompt disbursement to petitioner. This amount represents compensation for all damages that would be available under 42 U .S.C. § 300aa-l 5(a). 9. As soon as practicable after the entry of judgment 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)( 1) , and an application, the patties 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 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. 2 Case 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 5 of 7 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-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 her individual capacity, and on behalf of her 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 be timely brought in the Court of Federal Claims, under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-IO et seq., on accoW1t of, or in any way growing out of, any and all known or unknown, suspected or unsuspected personal injuries to or death ofpctitioncr resulting from, or alleged to have resulted from, the flu vaccination administered on October 4, 2022, as alleged by petitioner in a petition for vaccine compensation filed on or about May l 0, 2024, in the United States Cou1i of Federal Claims as petition No. 24-0737Y. 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. 3 Case 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 6 of 7 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 confonnity 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 flu vaccine caused petitioner's alleged left shoulder injury or any other injury or her current condition, or that petitioner suffered an injury contained in the Vaccine lnjmy 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 1:24-vv-00737-UNJ Document 33 Filed 09/17/25 Page 7 of 7 Respectfully submitted, PETITIONER: I , <~.• ~ ~~ r,.:__\ ·t ' I , ?_, (- • i C,\ -~ DONNA KOSTUCH ATTORNEY OF AUTHORIED REPRESENTATIVE PETITIONER: OF THE ATTORNEY GENERAL: ~(~A~R-