VICP Registry Case Source Bundle
Canonical URL: https://vicp-registry.org/case/USCOURTS-cofc-1_25-vv-00108
Package ID: USCOURTS-cofc-1_25-vv-00108
Petitioner: Elizabeth Flores
Filed: 2025-01-21
Decided: 2026-05-07
Vaccine: influenza
Vaccination date: 2023-11-17
Condition: left shoulder injury related to vaccine administration (SIRVA)
Outcome: entitlement_granted_pending_damages
Award amount USD: 

AI-assisted case summary:
Elizabeth Flores filed a petition alleging that she suffered a left shoulder injury related to vaccine administration (SIRVA) as a result of an influenza vaccine administered on November 17, 2023. The respondent argued that the petitioner's medical records did not establish that the injury began within 48 hours of vaccination, as required for a Table SIRVA claim. The petitioner's medical records consistently indicated that her shoulder pain began shortly after the vaccination. Although she delayed seeking treatment for over two months, the court found that this delay did not preclude establishing Table-consistent onset, citing precedent where longer delays were accepted. The court found that the petitioner provided preponderant evidence that the onset of her shoulder pain occurred within 48 hours of vaccination. The case is proceeding to determine damages.

Theory of causation field:
Table

Public staged source text:

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DOCUMENT 1: USCOURTS-cofc-1_25-vv-00108-0
Date issued/filed: 2026-06-17
Pages: 7
Docket text: PUBLIC ORDER/RULING (Originally filed: 05/07/2026) regarding 21 Findings of Fact & Conclusions of Law, Signed by Chief Special Master Brian H. Corcoran. (ppa) Service on parties made.
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Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 1 of 7
In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 25-108V
ELIZABETH FLORES, Chief Special Master Corcoran
Petitioner,
v. Filed: May 7, 2026
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Maximillian J. Muller, Muller Brazil, LLP, Dresher, PA, for Petitioner.
Dorian Hurley, U.S. Department of Justice, Washington, DC, for Respondent.
FACT RULING ON ONSET1
On January 21, 2025, Elizabeth Flores filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.2 (the
“Vaccine Act”), alleging that she suffered a left shoulder injury related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine administered to her on
November 17, 2023. See Pet. at 1, ECF No. 1. The case was assigned to the Special
Processing Unit of the Office of Special Masters.
For the reasons set forth below, I find it more likely than not that the onset of
Petitioner’s shoulder pain occurred within 48 hours of vaccination, as alleged.
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 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 2 of 7
I. Relevant Procedural History
Though the parties made a tentative effort to settle this claim, they were ultimately
unsuccessful. ECF Nos. 13-15, 17-18. Respondent filed his Rule 4(c) Report on
December 22, 2025, arguing that Petitioner’s medical records do not preponderantly
establish the alleged injury began within 48 hours of the subject vaccination, as required
for a Table SIRVA claim. ECF No. 19 at 6 (internal citations omitted). Petitioner has not
filed any documents in response. The issue of onset is ripe for resolution.
II. 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). “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. In Lowrie, the special master wrote that “written records which
are, themselves, inconsistent, should be accorded less deference than those which are
internally consistent.” Lowrie, 2005 WL 6117475, at *19.
The United States Court of Federal Claims has recognized that “medical records
may be incomplete or inaccurate.” Camery v. Sec’y of Health & Hum. Servs., 42 Fed. Cl.
381, 391 (1998). The Court later 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, 42
Fed. Cl. at 391 (citing Blutstein v. Sec’y of Health & Hum. Servs., No. 90-2808, 1998 WL
408611, at *5 (Fed. Cl. Spec. Mstr. June 30, 1998)).
2

Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 3 of 7
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 § 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).
III. Relevant Factual Evidence
I make this finding of fact after a complete review of the record, including all
medical records, declarations, and additional evidence filed, and in particular the
following:3
• Petitioner received the subject flu vaccine in her left deltoid on November
17, 2023, at her local pharmacy. Ex. 1 at 3.
• Approximately 75 days post-vaccination (January 31, 2024), Petitioner saw
an orthopedist reporting left shoulder pain. Ex. 3 at 25. In her intake
questionnaire, Petitioner noted that she “[r]ecently received a flu vaccine on
November 17 to [her] left shoulder and ever since then [she has] had pain
and limited range of motion [(“ROM”)].” Id. at 43. She also reported that she
had no problems with her shoulder “until November 2023 when she
received the vaccine in the left upper arm.” Id. at 25. Following an
examination (showing positive impingement signs and some painful ROM),
Petitioner was diagnosed with impingement syndrome and subacromial
bursitis that “may be related to the vaccine as she had no problems with her
shoulder prior to the vaccine administration.” Id. at 26.
• During Petitioner’s annual physical with her primary care provider (“PCP”)
that same day (January 31, 2024), Petitioner noted she had “L shoulder
3 While I have reviewed all the evidence filed to-date in this case, only evidence related to onset will be
discussed herein, though other facts may be provided as necessary.
3

Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 4 of 7
limited ROM since getting vaccine in November.” Ex. 2 at 30. Petitioner
continued that she saw an orthopedist that morning for “L shoulder pain post
vaccine into [the] bursa in [the] Fall.” Id. at 31.
• On April 1, 2024, Petitioner had an initial PT evaluation. Ex. 4 at 26.
Petitioner complained of “L shoulder pain that started after receiving [a] flu
shot in November.”4 Id. She also noted that “a month later she was still
having pain.” Id. Petitioner described the pain as being the worst during the
first month and a half and rated it currently as a 3/10. Id. Despite findings
on physical examination (including “[m]ild winging” of her left scapula,
impingement signs, and mildly reduced ROM), Petitioner did not return to
PT thereafter; she canceled all future appointments and was discharged
from PT per her request on May 1, 2024. Id. at 17.
• While Petitioner had one orthopedic follow-up visit for left shoulder
symptoms on May 16, 2024 (during which she received a steroid injection
in the left shoulder, Ex. 3 at 11-12), Petitioner did not return to care
thereafter for approximately six months – despite attending several visits for
various unrelated ailments during that time. See, e.g., Ex. 2 at 8-10, 17-18;
Ex. 7 at 8-10, 12, 17.
• Following a six-month gap in care for left shoulder symptoms, Petitioner
returned to her orthopedist’s office in mid-November 2024 to follow up on
left shoulder pain. Ex. 6 at 11. Petitioner reiterated that her left shoulder
pain “initially started following a flu shot.” Id. She endorsed “good pain relief”
following the last steroid injection but stated that the pain had not fully
resolved. Id. A physical examination revealed equal ROM in both shoulders.
Id. The treater thought that clinically, Petitioner did not have a major rotator
cuff pathology and assessed Petitioner with shoulder impingement and
pain, plus rotator cuff tendinitis. Id. at 12. Petitioner received a second
steroid injection and was given an order for an at-home transcutaneous
electrical nerve stimulation (“TENS”) unit. Id.
• Petitioner filed a declaration (authored in January 2025), and explained in it
that on the day she received the subject flu vaccine, “[a]s usual, that night[,]
[her] arm was sore from the injection.” Ex. 5 ¶ 3. Petitioner noted that as a
nurse, she was aware that there may be soreness following vaccination for
up to two weeks. Id. However, she recalled that after three to four weeks,
4 I will note that on her PT intake form, when asked if this injury was related to occurrences at work or a car
accident, for example, Petitioner noted that her injury was related to “Other Liability/Potential Lawsuit.” See
Ex. 4 at 34.
4

Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 5 of 7
she was having difficulty sleeping on her side and had limited ROM in her
left shoulder. Id. ¶ 4. By one-and-a-half months post vaccination, Petitioner
stated that she still had “significant” pain and thus decided to make an
appointment for care. Id. ¶ 5.
• No other medical record or declaration evidence regarding the onset of
Petitioner’s post-vaccination shoulder injury has been filed.
IV. Finding of Fact Regarding Onset
A petitioner alleging a SIRVA claim must show that she experienced the first
symptom or onset of pain within 48 hours of vaccination. 42 C.F.R. § 100.3(a)(XIV)(B);
42 C.F.R. § 100.3(c)(10)(ii) (QAI criteria). As noted, Respondent contends that Petitioner
cannot satisfy this Table criterion because she waited two and a half months post-
vaccination to report pain. Rule 4(c) Report at 6 (internal citations omitted). More so,
according to Respondent, Petitioner never placed the onset of her pain within forty-eight
hours of vaccination when seeking care for her shoulder – instead only vaguely stating
that her pain began after vaccination. Id. And, Respondent asserts that even in her
declaration, Petitioner describes only typical post-vaccination soreness the night of her
vaccination, and then significant pain arising between three and six weeks after
vaccination. Id.
The totality of the evidence favors Petitioner’s onset contentions. The
aforementioned medical records establish that Petitioner consistently reported to treaters
onset close-in-time to vaccination, that she sought treatment within just over two months
of the vaccination, and that she indeed was experiencing symptoms in the relevant
timeframe.
The fact that Petitioner delayed treatment for two to three months does not
preclude Petitioner from establishing Table-consistent onset. In other cases, even much
greater delays have not undermined an otherwise-preponderantly-established onset
showing consistent with the Table. See, e.g., Tenneson v. Sec’y of Health & Hum. Servs.,
No. 16-1664V, 2018 WL 3083140, at *5 (Fed. Cl. Spec. Mstr. Mar. 30, 2018), mot. for rev.
denied, 142 Fed. Cl. 329 (2019) (finding a 48-hour onset of shoulder pain despite a nearly
six-month delay in seeking treatment); Williams v. Sec’y of Health & Hum. Servs., No. 17-
830V, 2019 WL 1040410, at *9 (Fed. Cl. Spec. Mstr. Jan. 31, 2019) (noting a delay in
seeking treatment for five-and-a-half months because a petitioner underestimated the
severity of her shoulder injury). The delay here is not nearly as long.
In fact, some delay in seeking treatment itself is never per se evidence of a non-
conforming onset. As I have previously noted, SIRVA petitioners often put off seeking
5

Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 6 of 7
shoulder-related care based on the reasonable assumption that the pain is normal and
will resolve on its own over time, especially since patients are often told by medical
providers at the time of vaccination to expect some soreness and pain. This appears to
have been (at least partially) the case here, with Petitioner explaining that she expected
some soreness for a period of time post vaccination but that the pain did not subside, thus
prompting her to seek care. Ex. 5 ¶¶ 3-5.
In addition, Petitioner affirmatively and repeatedly linked her shoulder pain to the
subject flu vaccine – beginning with the January 31, 2024 treatment encounter, at which
time she reported that she “[r]ecently received a flu vaccine on November 17 to [her] left
shoulder and ever since then [she has] had pain and limited range of motion [(“ROM”)].”
Ex. 3 at 43. Although this entry does not preponderantly support Table onset on its own,
other subsequent medical records consistently corroborate this entry with similar detail
and thus provide support for a two-day onset showing. See, e.g., id. at 25 (another entry
from the same encounter explaining that her pain did not start “until November 2023 when
she received the vaccine in the left upper arm.”); Ex. 2 at 30 (an entry from Petitioner’s
PCP visit the same day describing “L shoulder limited ROM since getting vaccine in
November.”); Ex. 4 at 26 (an April 1, 2024 PT report of “L shoulder pain that started after
receiving [a] flu shot in November.”). The filed record fails to contain any contrary entries
regarding onset. The contemporaneous medical records corroborate Petitioner’s
assertions and thus establish that the onset of her injury occurred within the timeframe
required by the Table.
Conclusion
Petitioner has provided preponderant evidence that the onset of her shoulder pain
occurred within 48 hours of vaccination.
I encourage the parties to make a final re-attempt at informal resolution (of
settlement or damages). Respondent shall file, by no later than Monday, June 08,
2026, a status report concerning how he intends to proceed, including, if appropriate,
whether he would like to file an amended Rule 4(c) Report or whether he is otherwise
willing to entertain a renewed settlement demand from Petitioner.
In the event Respondent is open to informal resolution of either settlement or
damages, and to aid in those discussions, the parties should keep in mind that the record
supports a mild injury overall, requiring fairly conservative treatment for a limited duration.
Petitioner participated in only one PT session, received two steroid injections, did not
undergo surgery; and by November 2024 (just one year post vaccination), she had “equal
ROM” (to the right shoulder) and had mostly ceased receiving formal treatment for her
6

Case 1:25-vv-00108-UNJ Document 24 Filed 06/17/26 Page 7 of 7
left shoulder symptoms (with the exception of a February 2025 MRI and at-home care
thereafter). See, e.g., Ex. 3 at 11-12; Ex. 4 at 17; Ex. 5 at 1-2. Petitioner should thus not
expect more than a modest award, even at full value of this case.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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