VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_24-vv-00804
Package ID: USCOURTS-cofc-1_24-vv-00804
Petitioner: Isak Ladegaard
Filed: 2024-05-23
Decided: 2026-06-30
Vaccine: Tdap
Vaccination date: 2022-10-31
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: entitlement_granted_pending_damages
Award amount USD: 

AI-assisted case summary:
Isak Ladegaard filed a petition alleging a left shoulder injury related to vaccine administration (SIRVA) after receiving a Tdap vaccine on October 31, 2022. He also received an influenza vaccine on the same day. The injury was alleged to be a Table Injury, requiring residual effects lasting longer than six months. The respondent contested the duration of the injury. The court found that Mr. Ladegaard likely suffered residual effects of his SIRVA for more than six months, meeting the severity requirement. The court also found that he met the other criteria for a Table SIRVA, including no prior history of shoulder issues that would explain the symptoms, pain occurring within 48 hours of vaccination, and pain and limited range of motion confined to the left shoulder. He is entitled to compensation. The court noted that the compensation for past pain and suffering would likely not be significant due to minimal conservative treatment and good, though temporary, pain relief from a steroid injection.

Theory of causation field:
Table

Public staged source text:

================================================================================
DOCUMENT 1: USCOURTS-cofc-1_24-vv-00804-0
Date issued/filed: 2026-08-03
Pages: 13
Docket text: PUBLIC ORDER/RULING (Originally filed: 06/30/2026) regarding 33 Ruling on Entitlement Signed by Chief Special Master Brian H. Corcoran. (nh) Service on parties made.
--------------------------------------------------------------------------------
Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 1 of 13
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 24-0804V
ISAK LADEGAARD,
Chief Special Master Corcoran
Petitioner,
Filed: June 30, 2026
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Elizabeth Ellis Simek, Shannon Law Group, Woodridge, IL, for Petitioner.
Margaret Armstrong, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On May 23, 2024, Isak Ladegaard 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 alleged that he suffered a left shoulder injury related to vaccine
administration (“SIRVA”), a defined Table Injury, after receiving tetanus, diphtheria,
acellular pertussis (“Tdap”) vaccine3 on October 31, 2022. Petition at 1, ¶¶ 5, 26.
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).
3 Petitioner also received an influenza (“flu”) vaccine in his left deltoid but alleges that his SIRVA is due to
the Tdap vaccine only. See Ex. 3 at 5 (vaccine record). Both vaccines are covered by the Program, and
there is a Table SIRVA listed for the tetanus toxoid, pertussis component, and flu vaccine. 42 C.F. R. §
100.3(a)(I)(C), (II)(C) & (XIV)(B) (2017).

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 2 of 13
Petitioner further alleged that his “left shoulder SIRVA injury, which caused him pain and
impairment for a period lasting longer than six months.” Id. at ¶ 20; accord. Ex. 1 at ¶ 22
(Petitioner’s declaration).4
The parties dispute whether the “severity requirement” that all Program claims
must satisfy has been met. For the reasons set forth below, I find that Petitioner likely
suffered the residual effects of his SIRVA for more than six months,5 and he has met the
other requirements of a compensable Table SIRVA injury. Petitioner is thus entitled to
compensation under the Vaccine Act.
I. Finding of Fact Regarding Duration of Residual Effects/Severity
At issue is whether Mr. Ladegaard has provided the preponderant evidence
needed to establish that he suffered the residual effects of his alleged SIRVA for more
than six months. Section 11(c)(1)(D)(i).
A. Authority
Pursuant to Vaccine Act Section 13(a)(1)(A), a petitioner must prove, by a
preponderance of the evidence, the matters required in the petition by Vaccine Act
Section 11(c)(1). A special master must consider, but is not bound by, any diagnosis,
conclusion, judgment, test result, report, or summary concerning the nature, causation,
and aggravation of petitioner’s injury or illness that is contained in a medical record.
Section 13(b)(1). “Medical records, in general, warrant consideration as trustworthy
evidence. The records contain information supplied to or by health professionals to
facilitate diagnosis and treatment of medical conditions. With proper treatment hanging in
the balance, accuracy has an extra premium. These records are also generally
contemporaneous to the medical events.” Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993).
Accordingly, where medical records are clear, consistent, and complete, they
should be afforded substantial weight. Lowrie v. Sec’y of Health & Hum. Servs., No. 03-
1585V, 2005 WL 6117475, at *20 (Fed. Cl. Spec. Mstr. Dec. 12, 2005). However, this rule
does not always apply. “Written records which are, themselves, inconsistent, should be
4 This declaration was signed on June 11, 2024, under penalty of perjury as required by 28 U.S.C.A. §
1746. Ex. 1 at 7, ECF No. 7-2.
5 Petitioner does not allege, nor would the evidence support, either alternative to establishing the severity
requirement: that the alleged injury resulted in death, or “inpatient hospitalization and surgical intervention.”
Section 11(c)(1)(D)(ii), (iii). Rather, this case turns on Petitioner’s inability to prove six months of post-onset
sequelae. See Section 11(c)(1)(D)(i).
2

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 3 of 13
accorded less deference than those which are internally consistent.” Murphy v. Sec’y of
Health & Hum. Servs., No. 90-882V, 1991 WL 74931, *4 (Fed. Cl. Spec. Mstr. April 25,
1991), quoted with approval in decision denying review, 23 Cl. Ct. 726, 733 (1991), aff'd
per curiam, 968 F.2d 1226 (Fed.Cir.1992)). And the Federal Circuit recently “reject[ed] as
incorrect the presumption that medical records are accurate and complete as to all the
patient’s physical conditions.” Kirby v. Sec’y of Health & Hum. Servs., 997 F.3d 1378,
1383 (Fed. Cir. 2021).
The United States Court of Federal Claims has outlined four possible explanations
for inconsistencies between contemporaneously created medical records and later
testimony: (1) a person’s failure to recount to the medical professional everything that
happened during the relevant time period; (2) the medical professional’s failure to
document everything reported to her or him; (3) a person’s faulty recollection of the events
when presenting testimony; or (4) a person’s purposeful recounting of symptoms that did
not exist. La Londe v. Sec’y of Health & Hum. Servs., 110 Fed. Cl. 184, 203-04 (2013),
aff’d, 746 F.3d 1335 (Fed. Cir. 2014).
The Court has also said that medical records may be outweighed by testimony that
is given later in time that is “consistent, clear, cogent, and compelling.” Camery v. Sec’y
of Health & Hum. Servs., 42 Fed. Cl. 381, 391 (1998) (citing Blutstein v. Sec’y of Health
& Hum. Servs., No. 90-2808, 1998 WL 408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998).
The credibility of the individual offering such fact testimony must also be determined.
Andreu v. Sec’y of Health & Hum. Servs., 569 F.3d 1367, 1379 (Fed. Cir. 2009); Bradley
v. Sec’y of Health & Hum. Servs., 991 F.2d 1570, 1575 (Fed. Cir. 1993).
A special master may find that the first symptom or manifestation of onset of an
injury occurred “within the time period described in the Vaccine Injury Table even though
the occurrence of such symptom or manifestation was not recorded or was incorrectly
recorded as having occurred outside such period.” Section 13(b)(2). “Such a finding may
be made only upon demonstration by a preponderance of the evidence that the onset [of
the injury] . . . did in fact occur within the time period described in the Vaccine Injury
Table.” Id.
The special master is obligated to fully consider and compare the medical records,
testimony, and all other “relevant and reliable evidence contained in the record.” La
Londe, 110 Fed. Cl. at 204 (citing Section 12(d)(3); Vaccine Rule 8); see also Burns v.
Sec’y of Health & Hum. Servs., 3 F.3d 415, 417 (Fed. Cir. 1993) (holding that it is within
the special master’s discretion to determine whether to afford greater weight to medical
records or to other evidence, such as oral testimony surrounding the events in question
that was given at a later date, provided that such determination is rational).
3

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 4 of 13
B. Analysis
I make this finding after a complete review of the record, which includes all medical
records, affidavits or declarations, and additional evidence filed. Specifically, I highlight
the following:
• During the three years prior to vaccination, Mr. Ladegaard (a college
professor in Chicago, Illinois)6 sought medical care from his primary care
provider (“PCP”) on several occasions, for a gym injury sustained in 2019,
affecting his neck, back, and left trapezius; and several unrelated and
common medical conditions. Ex. 2 at 3-18; Ex. 13 at 26-31.
• In his initial declaration, Petitioner addressed a gap in his prior medical
records, explaining that “[f]rom August 2020 until August 2021, [he] worked
remotely from Melbourne, Australia.” Ex. 1 at ¶ 3. In her declaration,7
Petitioner’s spouse (a college professor in Hong Kong) provided a detailed
explanation how the couple met in South Korea in 2008; married in 2013;
and lived together in Boston from 2013 through 2019, in Chicago during the
Fall of 2022 (when Petitioner sustained his alleged SIRVA), and since
December 2023. Ex. 11 at ¶¶ 2-6, 9, 11.
• While attending graduate school in Boston on March 7, 2019, Petitioner
sought treatment for “persistent left shoulder/upper back pain for about 6
weeks” that started after he failed to “put weights down with good control”
when doing a shoulder press at the gym. Ex. 13 at 26. Describing “bad [pain]
for 3-5 days” in his neck, followed by more moderate pain in his left
trapezius, he reported a lack of further improvement, despite rest. Id.
• Assessing Petitioner with “[s]prains and strains of [the] thoracic, the PCP
provided him with Ibuprofen and a home exercise program (“HEP”) and
instructed him to modify his activity and return if the symptoms continued or
worsened. Ex. 13 at 30.
6 Petitioner is a citizen of Norway. Ex. 13 at 13.
7 Like Petitioner’s declaration, his spouse’s declaration was signed under penalty of perjury as required by
28 U.S.C.A. § 1746. Ex. 11 at 5, ECF No. 18-2. It was dated March 20, 2025. Id.
4

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 5 of 13
• On December 10, 2021, Petitioner received a COVID-19 vaccine,
administered intramuscularly in his left deltoid. Ex. 17 at 2-3. He reported
no problems associated with this vaccination.
• On September 28, 2022, approximately one month before receiving the
Tdap vaccine alleged as causal, Petitioner again sought care for the pain
he experienced after the gym incident in 2019. Ex. 5 at 17-23, 28-31. He
attended physical therapy (“PT”) for neck pain that “started hurting in 2019[8]
after dropping a weight too quickly at the gym.” Ex. 5 at 17. He reported that
the accident “pulled traction on his L UE” (Id.), that his symptoms worsened
when “putting his head forward” (id. at 30), and that a simultaneous wrist
injury had resolved (id. at 31). Estimating his current pain level as one and
five at its worst (id. at 22), Petitioner listed the steps he had taken to reduce
his symptoms, for example, exercises, stretching, and sleeping on his back
(id. at 21, 30) but “ha[d] hit a plateau” (id. at 21).
• The therapist assessed Petitioner as suffering the “the signs and symptoms
of L cervical strain, . . . poor shoulder/neck posture, limited cervical flexion/R
SB/R[9] rot[ation], and increased TTP[10] in L UT.” Ex. 5 at 19. Opining that
Petitioner “ha[d] excellent rehab potential” (id.), the therapist recommended
twice weekly PT sessions for six weeks (id. at 20).
• At his subsequent two PT sessions on October 11 and 13, 2022, Petitioner
reported feeling about the same and not too sore after PT. Ex. 5 at 13, 15.
In the records from both sessions and on the discharge summary completed
December 16, 2022, it was noted that he had met both his long-term and
short-term goals. Id. at 11, 14, 16.
• On October 12, 2022, Petitioner received a second COVID-19 vaccine,
administered intramuscularly in his left deltoid. Ex. 17 at 2-3. He reported
no problems associated with this vaccination.
• On October 31, 2022, Petitioner (then 36 years old) received Tdap and flu
vaccines at his PCP’s clinic, both administered intramuscularly in his left
deltoid. Ex. 3 at 4-5. In his declaration, Petitioner recalled feeling “the usual
8 In this record, Petitioner provided a slightly later onset date of September 1, 2019. Compare Ex. 5 at 21
with Ex. 13 at 29 (identifying a pain onset in mid-January 2019).
9 Although the exact meaning of this abbreviation is unclear, it undoubtedly refers to some type of shoulder
movement.
10 TTP stands for tender to palpitation. MEDICAL ABBREVIATIONS at 604 (16th ed. 2020).
5

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 6 of 13
amount of minimal discomfort” when receiving the flu vaccine but extreme
pain during the administration of the Tdap vaccine. Ex. 1 at ¶ 7.
• Twelve days post-vaccination on November 12, 2022, Petitioner messaged
his PCP, asking if it was normal to experience continued shoulder pain in
response to the Tdap shot he received on October 31, 2022. Ex. 4 at 1. He
replied in the negative when asked if his arm was swollen or red, adding
that his pain had decreased from “5/5” to “3/5 or 2.5/5.” Id. The nurse
addressing Petitioner’s concerns instructed him to let someone at the clinic
know if “the pain doesn’t resolve completely or if [he] notice[d] it increasing.”
Id.
• On December 18, 2022, Petitioner again messaged his PCP, stating that
his pain continued and any improvement he had gained ceased two weeks
ago. Ex. 4 at 2. The nurse responding to his message instructed him to
make an appointment with the PCP or go to urgent care. Id.
• When seen by the PCP four days later (on December 21, 2022), Petitioner
reported that his Tdap vaccine “hurt more than usual, “that the shoulder pain
“ha[d] improved but not resolved completely,” and that his pain intensity was
three out of ten. Ex. 2 at 19. Observing “mild tenderness on palpitation of
the left deltoid” and reduced range of motion (“ROM”), the PCP provided
Petitioner with an orthopedic surgery referral, prescribed cyclobenzaprine11
and meloxicam12 and instructed him to apply Voltaren gel as needed. Ex. 2
at 19, 21.
• On that same day, Petitioner underwent a PT evaluation at the same clinic
where he received treatment for his neck and back pain. Ex. 5 at 4-7. He
again linked his left shoulder to the vaccine he received. Id. at 4, 6.
• Noting that Petitioner “present[ed] with pain, decreased motion, impaired
strength which limit[ed] him functionally” (id. at 6), the therapist assessed
his rehabilitation potential to be excellent and recommended twice weekly
PT sessions for four weeks. Id. at 6-7. In a letter to Petitioner’s PCP, the
therapist stated that Petitioner “would follow up once he feels ready.” Id. at
10.
11 Cyclobenzaprine hydrochloride is “a compound structurally related to the tricyclic antidepressants; used
as a skeletal muscle relaxant for relief of painful muscle spasms; administered orally.” DORLAND’S
ILLUSTRATED MEDICAL DICTIONARY (“DORLAND’S”) at 455 (32th ed. 2012).
12 Meloxicam is “a nonsteroidal anti-inflammatory drug used in the treatment of osteoarthritis; administered
orally. DORLAND’S at 1126.
6

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 7 of 13
• After attending only the initial PT evaluation, Petitioner self-discharged on
January 25, 2023. Ex. 5 at 3. It was noted that he declined further treatment
and was provided a HEP. Id.
• Less than three weeks later on February 14th, Petitioner messaged his
PCP’s clinic, reporting continued left shoulder pain from the Tdap vaccine
he received on October 31, 2022, and requesting a referral to an orthopedist
covered by his insurance. Ex. 4 at 3. The responding nurse asked that he
confirm coverage of the orthopedic surgeons in the Chicago area with his
medical insurance carrier, adding that a referral then could be provided. Id.
• On March 3, 2023, Petitioner attended an orthopedic visit for evaluation for
left shoulder pain after receiving a Tdap vaccine in October 2022. Ex. 7 at
20. Reporting taking anti-inflammatories and engaging in PT “in the past
prior to this vaccination but no recent physical therapy in the setting of the
symptoms,” he described significant pain for approximately four to five days
that subsided but continued to cause “difficulty with overhead movements
and activities secondary to pain in the shoulder.” Id.
• Assessing Petitioner as suffering from “[l]eft subacromial bursitis secondary
to previous vaccination into potentially the bursa which is still lingering and
. . . caus[ing] relative weakness,” the orthopedist administered an
ultrasound-guided subacromial injection, recommended PT, and instructed
Petitioner to return to the clinic and possibly undergo an MRI if no
improvement was gained. Ex. 7 at 21; see id. at 22-31 (for additional details
related to the steroid injection).
• On March 7, 2022, it appears Petitioner sent his spouse (now living and
working in Hong Kong) a text message, informing her that his shoulder was
“much better now” after receipt of a steroid injection last week. Ex. 12 at 1.
He added that he was “exercising every day again.” Id.
• On April 15, 2023, Petitioner scheduled another appointment with his
orthopedist, seeking a second cortisol shot because his shoulder pain had
returned. Ex. 7 at 5. He reported that his pain was “better than it was before
[his] first visit . . . [that he] exercised a lot, [and that he was] not sure what
to do next.” Id. In his supplemental declaration,13 Petitioner stated that the
appointment was scheduled for April 21, 2023. Ex. 15 at 7.
13 Petitioner’s supplemental declaration was signed on July 18, 2025, under penalty of perjury as required
by 28 U.S.C.A. § 1746. Ex. 15 at 3, ECF No. 18-2.
7

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 8 of 13
• On April 18, 2023, a nurse from the clinic contacted Petitioner, stating that
she saw his scheduled appointment and wanted to inform him that he could
not receive another cortisone injection for three months. Ex. 8 at 1. The
nurse suggested the orthopedist could order an MRI and Petitioner could
“follow up afterward to discuss the results.” Id. She also asked if he had
started PT. Id.
• In his April 19, 2023 response, Petitioner confirmed that he would like to
proceed with the MRI, but wanted to ensure it would be “covered by [his]
insurance.” Ex. 8 at 1. He added that he “ha[d] gone to physical therapy
once, and have followed exercise tips on a near-daily basis since [his] last
visit.” Id.
• The next day, the nurse replied that the orthopedist would enter the order
for an MRI at some time that day. Ex. 8 at 1. She instructed Petitioner to
share his medical insurance information when scheduling the MRI, noting
he then would be told if the procedure would be covered. Id.
• On April 21, 2023, Petitioner asked if he needed to cancel the appointment
he made on April 15, 2023. Ex. 8 at 1-2. The nurse informed him she would
cancel the appointment for him. Id. Id. at 2.
• In their declarations, Petitioner and his wife described the symptoms
Petitioner experienced and their effects. Ex. 1 at ¶¶ 7-9, 18-20; Ex. 11 at ¶¶
8, 10, 12; Ex. 15 at ¶ 8. Noting that they reconciled and began living together
in December 2023, Petitioner and his spouse insisted that he continued to
suffer symptoms - described as a pain level of four out of ten, but
acknowledged to be manageable. Ex. 1 at ¶ 20; Ex. 11 at ¶¶ 11-12; Ex. 15
at ¶¶ 8-9.
• Petitioner also provided reasons why he failed to pursue additional PT, the
ordered MRI, and a second steroid injection. Ex. 1 at ¶¶ 14, 16-18; Ex. 15
at ¶¶ 6, 8. He stressed his preference to rely on a HEP instead of formal
PT, his recollection that the orthopedist did not believe an MRI would be
helpful, the difficulties he encountered determining if the cost of the MRI
would be covered by insurance, his marital difficulties, and the more
manageable levels of the pain he experienced in late summer 2023, and
later. Id.
8

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 9 of 13
To satisfy the Vaccine Act’s severity requirement in this case, Petitioner must show
that he suffered symptoms of his alleged SIRVA beyond April 30, 2023 (assuming a same
day onset which the record preponderantly supports). Although the residual effects of his
SIRVA may be intermittent or mild, he must show they continued to some extent through
at least that date.
Emphasizing Petitioner’s lack of treatment after March 2023 and decision not to
undergo an MRI, Respondent argues that “Petitioner has not established that he suffered
from his alleged SIRVA injury for more than six months post-vaccination.” Rule 4(c)
Report at 8. He maintains Petitioner’s affidavit should be afforded little weight because it
represents Petitioner’s claims alone and is “inconsistent with the medical records”. Id.
Specifically, he insists that Petitioner’s claim that his orthopedist agreed an MRI was not
needed runs counter to the orthopedist’s statement, made on March 3, 2023, that an MRI
would be helpful if Petitioner’s pain did not improve. Id. at 9.
Although Petitioner last visited his orthopedist on March 3, 2023, he continued to
seek additional treatment and report ongoing symptoms during communications with his
orthopedist’s clinic through at least April 20, 2023 - 10 days prior to the six-month mark.
On April 15, 2023, he scheduled a follow-up appointment because his shoulder pain had
returned following temporary relief gained from a steroid injection administered on March
7, 2023. Ex. 8 at 1. After being informed he could not yet receive another steroid injection
as requested, Petitioner agreed to undergo an MRI. Id. And he asked that his appointment
(scheduled for April 21, 2023) be canceled, only after this treatment change. Id. at 2.
These communications show Petitioner’s left shoulder pain continued at least through
April 19, 2023, when he agreed to undergo an MRI.
Even though Petitioner’s symptoms throughout his injury course were relatively
mild, it is unlikely that his SIRVA would have resolved completely before the end of the
April 2023 – especially given the absence of treatment which would have provided quick
relief, such as a second steroid injection. At most, because Petitioner would have been
eligible for another injection in late summer 2023, it can be surmised that his symptoms
ended, or at least greatly diminished prior to that time (but after the end of April). Although
his failure to pursue the planned MRI signals an earlier symptom reduction, it also could
be attributed to problems with his medical insurance coverage - clearly a concern for
Petitioner14 - or the mild nature of the symptoms he was experiencing.
14 When requesting an orthopedic referral in February 2023, and an order for an MRI in April 2023, Petitioner
requested assurances that the treatment would be covered by his medical insurance. Ex. 4 at 3; Ex. 8 at 1.
In his supplemental declaration, he stated that he “found it overwhelming to navigate the insurance process
to confirm whether an MRI would be covered”, due to his marital problems at the time, unfamiliarity with the
American healthcare system, and attention deficit disorder. Ex. 15 at ¶ 8.
9

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 10 of 13
Undergoing an MRI, which unlike a steroid injection is designed to diagnosis, not
treat, Petitioner’s pain, requires more significant follow-through. As his decision to forego
further PT in January 2023 illustrates, Petitioner did not always follow his medical
provider’s guidance, often selecting his preferred treatment, such as a HEP rather than
formal PT. And he clearly contacted his orthopedist in April, not to obtain the earlier
mentioned MRI, but to obtain a second steroid injection. Therefore, Petitioner’s failure to
undergo the planned MRI is not as significant as Respondent portends – although it does
signify a lack of symptom severity.
Overall, the record in this case supports the conclusion that Petitioner’s SIRVA-
related symptoms, even though mild enough to warrant only conservative treatment for
less than six months, likely continued through at least the end of April 2023 if not a bit
beyond. Accordingly, I find there is preponderant evidence to establish Petitioner suffered
the residual effects of his alleged SIRVA for more than six months (although as noted
above the same evidence supports the view that Petitioner’s injury was not notably severe
for purposes of calculating damages).
II. Additional Requirements for Entitlement
A. Legal Standards
In addition to requirements concerning the vaccination received, the duration of
petitioner’s injury (discussed above in Section I), and the lack of other award or
settlement,15 a petitioner must establish that she suffered an injury meeting the Table
criteria, in which case causation is presumed, or an injury shown to be caused-in-fact by
the vaccination she received. Section 11(c)(1)(C).
The most recent version of the Table, which can be found at 42 C.F.R. § 100.3,
identifies the vaccines covered under the Program, the corresponding injuries, and the
time period in which the particular injuries must occur after vaccination. Section 14(a).
Pursuant to the Vaccine Injury Table, a SIRVA is compensable if it manifests within 48
hours of the administration of a Tdap vaccine. 42 C.F. R. § 100.3(a)(I)(C) & (II)(C). The
criteria establishing a SIRVA under the accompanying Qualifications and Aids to
Interpretation (“QAI”) are as follows:
15 In summary, a petitioner must establish that she received a vaccine covered by the Program,
administered either in the United States and its territories or in another geographical area but qualifying for
a limited exception; suffered the residual effects of her injury for more than six months, died from her injury,
or underwent a surgical intervention during an inpatient hospitalization; and has not filed a civil suit or
collected an award or settlement for her injury. See Section 11(c)(1)(A)(B)(D)(E).
10

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 11 of 13
Shoulder injury related to vaccine administration (SIRVA). SIRVA manifests
as shoulder pain and limited range of motion occurring after the
administration of a vaccine intended for intramuscular administration in the
upper arm. These symptoms are thought to occur as a result of unintended
injection of vaccine antigen or trauma from the needle into and around the
underlying bursa of the shoulder resulting in an inflammatory reaction.
SIRVA is caused by an injury to the musculoskeletal structures of the
shoulder (e.g. tendons, ligaments, bursae, etc.). SIRVA is not a neurological
injury and abnormalities on neurological examination or nerve conduction
studies (NCS) and/or electromyographic (EMG) studies would not support
SIRVA as a diagnosis (even if the condition causing the neurological
abnormality is not known). A vaccine recipient shall be considered to have
suffered SIRVA if such recipient manifests all of the following:
(i) No history of pain, inflammation or dysfunction of the affected shoulder
prior to intramuscular vaccine administration that would explain the alleged
signs, symptoms, examination findings, and/or diagnostic studies occurring
after vaccine injection;
(ii) Pain occurs within the specified time frame;
(iii) Pain and reduced range of motion are limited to the shoulder in which
the intramuscular vaccine was administered; and
(iv) No other condition or abnormality is present that would explain the
patient’s symptoms (e.g. NCS/EMG or clinical evidence of radiculopathy,
brachial neuritis, mononeuropathies, or any other neuropathy).
42 C.F.R. § 100.3(c)(10).
B. Analysis
Respondent has identified no further objections to compensation,16 and I find
Petitioner has otherwise satisfied all criteria for a Table SIRVA injury following receipt of
the Tdap vaccine. Although Petitioner sustained a prior gym injury which resulted in pain
located in his neck, back, and left trapezius, there is no evidence of prior left shoulder
16 Following a call in early May 2026, Respondent was given the opportunity to confirm, as illustrated by his
Rule 4(c) Report, that he had no other objection to compensation, other than his belief Petitioner had failed
to establish the required six-month severity. In a status report filed on May 22, 2026, Respondent stated he
“does not have any other objections to entitlement at this time.” ECF No. 32.
11

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 12 of 13
pain, inflammation, or dysfunction or an alternative cause that would explain Petitioner’s
post-vaccination left shoulder pain. Ex. 5 at 17-23, 28-31; Ex. 13 at 26-31; see 42 C.F.R.
§ 100.3(c)(10)(i), (iv) (first and fourth QAI criteria). And Petitioner experienced pain within
48 hours of vaccination and exhibited pain and limitations in ROM solely in his left, injured
shoulder. E.g., Ex. 2 at 19-21; Ex. 5 at 4-6; see 42 C.F.R. § 100.3(c)(10)(ii) & (iii) (second
and third QAI criteria).
As I have determined in this ruling, the record supports a finding that Petitioner
suffered the residual effects of his SIRVA for more than six months. See Section
11(c)(1)(D)(i) (the Vaccine Act’s six-month severity requirement). Additionally, the vaccine
record shows Petitioner received the Tdap vaccine administered at his PCP’s clinic in
Illinois. Ex. 3 at 4-5; see Section 11(c)(1)(A) (requiring receipt of a covered vaccine);
Section 11(c)(1)(B)(i) (requiring administration within the United States or its territories).
Additionally, there is no evidence that Petitioner has collected a civil award for his injury.
See Section 11(c)(1)(E) (lack of prior civil award). Thus, Petitioner has satisfied all
requirements for entitlement under the Vaccine Act.
III. Appropriate Amount of Compensation
Although I have found Petitioner entitled to compensation, I do not expect the
amount awarded for Petitioner’s past pain and suffering to be significant in magnitude.
The record shows Petitioner required only minimal conservative treatment and obtained
good (if temporary) pain relief from the steroid injection administered in early March 2023,
only four months post-vaccination. Despite Petitioner’s assertion that his symptoms
continued well beyond June 2023, there is no evidence, other than the assertions of
Petitioner and his wife, to support the alleged ongoing sequela.
Conclusion
Based on the entire record in this case, I find that Petitioner has provided
preponderant evidence satisfying all requirements for a Table SIRVA and the
Vaccine Act’s severity requirement needed for both Table and non-Table claims.
Petitioner is entitled to compensation in this case.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
12

Case 1:24-vv-00804-UNJ Document 36 Filed 08/03/26 Page 13 of 13
13