SAWYER v. SECRETARY OF HEALTH AND HUMAN SERVICES

In the United States Court of Federal Claims
OFFICE OF SPECIAL MASTERS
No. 22-489V
CAROLYN SAWYER,
Petitioner,
v.
SECRETARY OF HEALTH AND
HUMAN SERVICES,
Respondent.
Chief Special Master Corcoran
Filed: December 11, 2025
Jonathan Joseph Svitak, Shannon Law Group, P.C., Woodridge, IL, for Petitioner.
Alec Saxe, U.S. Department of Justice, Washington, DC, for Respondent.
RULING ON ENTITLEMENT1
On May 2, 2022, Carolyn Sawyer 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 left shoulder injury related to vaccine
administration (“SIRVA”) as a result of an influenza (“flu”) vaccine received on November
20, 2020. Petition at 1.
After review of the record and consideration of the parties’ arguments, I conclude
that Petitioner has provided preponderant evidence that she suffered the residual effects
or complications of her injury for more than six months after onset. Petitioner has also
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).
CORRECTED
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established all other requirements for a Table SIRVA, including onset of pain within 48
hours. Petitioner is therefore entitled to compensation.
I. 	Procedural History
On July 27, 2022, this case was assigned to the Special Processing Unit of the
Office of Special Masters. ECF No. 15. An initial status conference was held on January
30, 2023. ECF No. 20. After delay to Respondent’s medical review, Respondent filed a
status report stating his position that compensation would not be appropriate in this case,
setting forth those objections in his October 27, 2023 Rule 4(c) Report. ECF No. 29 (“Rule
4(c) Report”).
On July 30, 2024, I entered a scheduling order setting deadlines for briefing and
for Petitioner to file any additional evidence. ECF No. 32. Petitioner filed her brief in
support of her Table SIRVA claim on September 13, 2024. ECF No. 33 (“Pet’r Br.”).
Respondent filed a response brief on October 28, 2024. ECF No. 35 (“Resp’t Br.”).
Petitioner filed a reply brief on November 12, 2024. ECF No. 35 (“Pet’r Reply). This matter
is ripe for adjudication.
II. 	Relevant Evidence
I have reviewed all of the evidence filed to date. I will only summarize or discuss
evidence that directly pertains to the determinations herein, as informed by the parties’
respective citations to the record and their arguments.
A. 	Petitioner’s Vaccination and Initial Complaint of Left Shoulder Pain
On November 20, 2020, Petitioner received the flu vaccine in her left arm at a
routine wellness and medication refill appointment at her primary care provider (“PCP”),
the North Natchitoches Medical Clinic in Campti, LA (“Campti Clinic”). Ex. 2 at 36-39.
Petitioner was 67 years at the time of vaccination, and was employed as an accountant.
Id. at 36-38. She resided very close to her sister, Verna Edwards, and her brother, Lonnie
Bradley, and saw them frequently. Ex. 5 at 1-2; Ex. 6 at 1-2. Petitioner had a history of
hypertension, anxiety, and insomnia, but did not have any previous left shoulder pain or
injury. See Ex. 2 at 36-43.
In a declaration, Petitioner asserts that immediately after the vaccination, she
experienced an “unusual, intense” pain in her left shoulder and upper arm, which lead her
to call the Campti Clinic the next day, November 21, 2020. Ex. 1 at 2. Petitioner claims
that she spoke with a nurse, Peggy Byrd, and was told to use a heating pad for pain relief.
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Id. Due to the risk of COVID-19 exposure, Petitioner attempted to treat her pain at home.
Id. Petitioner’s medical records do not contain any documentation of a November 21,
2020 call to the nurse.
Petitioner further states that over the next two months, she called Campti Clinic
“numerous times to complain about the pain and inability to use [her] left arm normally,
and was always told that it would just take time to go away.” Ex. 1 at 2. According to
Petitioner, the Campti Clinic receptionist “recalls [her] many phone calls to the clinic
during this time,” although Petitioner did not provide any statement from this individual
that would corroborate such allegations. Id. Petitioner’s medical records also do not
contain any reference to these calls.
Petitioner’s first documented appointment for her left shoulder pain occurred on
January 29, 2021, ten weeks after vaccination, at the Campti Clinic. Ex. 2 at 32. Petitioner
informed the nurse practitioner at the that she had this pain for “about 2 [months] and that
the pain “initially started after she got a flu vaccine[.]” Id. Nurse practitioner (“NP”) Tina
Johnson prescribed a short course of prednisone and methocarbamol. Id. at 34.
B. 	Petitioner Focuses on Another Medical Issue and Does Not Treat Her
Left Shoulder for Seven Months
After the January 29, 2021 appointment, the focus of Petitioner’s medical care
shifted away from her left shoulder. On May 7, 2021, Petitioner was seen at the Campti
Clinic for a different issue. See Ex. 2 at 28. Petitioner explained to NP Johnson that she
had made the appointment to discuss left breast pain, but this had since resolved and
she believed it had been caused by pulling a muscle while cleaning. Id. However,
Petitioner kept the appointment to discuss a mass on her right arm that had been present
for two years (and hence predated vaccination), but was now bothering her and seemed
to be getting larger. Id. On examination, Petitioner had “normal movement of all
extremities,” although NP Johnson noted a three-to-four centimeter mass on her right
arm. Id. at 30. NP Johnson gave Petitioner a referral for this issue. Id. NP Johnson also
followed-up on Petitioner’s hypertension and checked her blood pressure. Id.
On May 24, 2021, Petitioner saw Dr. William Ball, a general surgeon at the
Natchitoches Regional Medical Center. Ex. 3 at 29. Dr. Ball found a lipoma on Petitioner’s
right upper extremity and an atypical nevus on the same arm. Id. Dr. Ball also listed “left
shoulder pain” as one of Petitioner’s medical problems, along with hypertension, anxiety,
and insomnia. Id. However, Dr. Ball’s physical examination notes stated that Petitioner
had normal movement of all extremities without swelling or muscle tenderness. Id. at 31.
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Dr. Ball recommended an excision of the lipoma and the atypical nevus. Id. at 31.
Petitioner underwent this surgery on June 23, 2021. Id. at 34.
C. 	Petitioner Resumes Left Shoulder Treatment
On August 5, 2021, Petitioner saw NP Johnson at the Campti Clinic. Petitioner
complained of left shoulder pain “since last [N]ovember following a flu shot.” Ex. 2 at 54.
Petitioner felt that the pain was getting worse, and denied any additional injury to her left
shoulder. Id. Petitioner described the pain as “intermittent, but persistent,” and rated it an
8-9/10 when she raised her arm. Id. In terms of pain relief, Petitioner stated that she took
Ibuprofen as needed and had tried topical gels without significant improvement. Id. NP
Johnson ordered x-rays, referred Petitioner to physical therapy (“PT”), and recommended
that she take muscle relaxers consistently for the next 7-10 days. 3 Id. at 26.
Petitioner returned to the Campti Clinic on August 19, 2021 and stated that she
had not yet heard from the PT office after her referral. Ex. 2 at 20. Petitioner repeated the
same information about her left shoulder pain and its onset as at the August 5, 2021
appointment, and also again denied any additional injury, fall, or trauma. Id. The NP
indicated that she would check on the status of the referral and instructed Petitioner to
keep taking muscle relaxers as needed. Id. at 23.
On August 31, 2021, Petitioner had her initial PT evaluation. Ex. 4 at 13-15. On an
intake form, Petitioner wrote that her reason for seeking PT was a “flu shot injury” with an
onset of “11/2020.” Id. at 13. The physical therapist also wrote that Petitioner “received a
flu shot in November 2020 since then she has been having [left] lateral shoulder pain and
it’s gotten worse and worse” until she could no longer lift her left arm above shoulder
level. Id. at 14. Petitioner engaged in PT sessions approximately one to two times per
week thereafter.
While Petitioner was continuing with PT, she saw NP Jennifer Thornton at the
Campti Clinic on October 20, 2021 to discuss her hypertension. Ex. 2 at 17. At this
appointment, NP Thornton referenced Petitioner’s PT due to an “arm injury last year.” Id.
Petitioner complained of increased left arm pain and an inability to sleep, although she
did report an improvement in her range of motion. Id. NP Thornton also recommended
muscle relaxers. Id. at 19.
On November 3, 2021, Petitioner saw NP Johnson to follow up on her left shoulder
pain and fatigue. Ex. 2 at 12. Petitioner again described her complaint as “left shoulder
pain following a flu vaccine last [year].” Id. Petitioner stated that the muscle relaxers
3 The x-ray results were unremarkable. Ex. 2 at 54.
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helped, but had not resolved her pain. Id. Additionally, Petitioner was feeling “down”
because the physical therapist had said that she may not get full range of motion back in
her arm and should have come sooner to PT. Id. NP Johnson advised Petitioner to keep
going with PT and prescribed prednisone and diclofenac topical gel. Id. at 15.
Petitioner attended 22 sessions of PT between August 31, 2021, and February 1,
2022. Ex. 2 at 14-37. In January 2022, Petitioner began to report that she was feeling
good and did not have pain. Ex. 4 at 33-37. Petitioner was discharged from PT on
February 1, 2022 with the comment “doing very well” and a pain rating of 0-2/10. Id. at
36-37. Petitioner did not file any additional treatment records.
D. 	Declaration Evidence
Petitioner filed her first declaration on May 6, 2022. 4 As stated above, Petitioner
described contacts with the Campti Clinic between November 21, 2020, and January 29,
2021 that are not documented in her medical records. See Ex. 1 at 1-2. In terms of the
treatment gap, Petitioner explained that after her January 29, 2021 appointment, she
“continued to experience significant pain” in her left shoulder and “increasing loss of range
of motion,” but due to the potential for COVID-19 exposure decided to “prioritize [her]
needs for medical attention to minimize [her] trips to the doctor.” Id. at 2. Petitioner felt
that the removal of a potential skin cancer on her right arm trumped the need to address
left shoulder pain that "though debilitating, was not potentially fatal.” Id. at 2-3. Petitioner
stated that “[a]s the spring/summer COVID surge was abating,” she was “finally able to
secure an appointment” in August 2021 to see NP Johnson. Id. at 3. Petitioner also denied
that PT had been as helpful as suggested by the PT notes, stating that her left shoulder
“is nowhere near 100% back to normal.” Id. at 4.
Petitioner’s younger sister, Verna Edwards, also provided a declaration dated May
6, 2022. Ex. 5 at 1-2. Ms. Edwards resides next door to Petitioner. Id. at 1. Ms. Edwards
stated that she and Petitioner spoke on the phone on November 20, 2020, just after she
had received the flu vaccine, and Petitioner said that she was in intense pain. Id. at 1.
Petitioner also went to Ms. Edward’s house on November 21, 2020 and complained of
left shoulder pain. Ms. Edwards stated that since the vaccination, Petitioner has
complained to her daily about the pain. Id. at 1-2. Ms. Edwards has also observed
Petitioner having difficulty performing household chores and other daily tasks due to the
pain and limited range of motion in her left shoulder. Id. at 2.
4 The declarations filed in this matter were signed under penalty of perjury pursuant to 28 U.S.C. § 1746.
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Petitioner’s younger brother, Lonnie Bradly, submitted a very similar declaration.
Mr. Bradlely also lives near Petitioner. Ex. 6 at 1. Mr. Bradley stated that he spoke with
Petitioner on November 20, 2020, about her intense pain from the flu vaccine. Id. Like
Ms. Edwards, he also saw her on November 21, 2020, and heard her complaints of left
shoulder pain on that day and continuing thereafter. Id. Mr. Bradley declared that “[o]ver
the next few months,” he observed Petitioner keeping her left arm folded to avoid
movements. Id. at 1-2. Mr. Bradley “checked in on Petitioner almost daily out of concern
for her left arm and shoulder pain.” Id. at 2.
On July 12, 2023, Petitioner filed a second declaration. Ex. 7 at 1. Although her
first declaration only stated that she contacted the Campti Clinic numerous times before
the January 29, 2021 appointment, Petitioner now added that after this time, she
continued to call and speak with a receptionist or nurse about her symptoms. Id. at 2.
Petitioner stated that the Campti Clinic personnel told her to continue using the same
remedies. Id. Petitioner also explained that at the May 7, 2021 appointment regarding her
right arm, she was still experiencing left shoulder pain, but she was not asked any
questions about it and her left shoulder was not examined. Id.
III. 	Ruling on Entitlement
A. 	Legal Standards
To receive compensation under the Vaccine Program, a petitioner must prove
either (1) that he suffered an injury falling within the Vaccine Injury Table, or (2) that he
suffered an injury that was actually caused by his vaccine. See Sections 13(a)(1)(A),
11(c)(1). Under either method, however, a petitioner must demonstrate that the injured
person has “suffered the residual effects or complications of his illness, disability, injury,
or condition for more than six months after the administration of the vaccine.” 5 Section
11(c)(1)(D)(i). Cases may appropriately be dismissed for failure to substantiate the
severity requirement. See, e.g., Hinnefeld v. Sec'y of Health & Hum. Servs., No. 11-328V,
2012 WL 1608839, at *4–5 (Fed. Cl. Spec. Mstr. Mar. 30, 2012) (dismissing case where
medical history revealed that petitioner’s Guillain-Barré Syndrome resolved less than two
months after onset).
The petitioner carries the burden of establishing the matters required in the
petition, including the severity requirement, by a preponderance of the evidence. Section
13(a)(1)(A); see Song v. Sec'y of Health & Hum. Servs., 31 Fed. Cl. 61, 65-66 (1994),
5 Petitioner does not allege, nor would the evidence support, either alternative for establishing the severity
requirement: that the alleged injury resulted in death, or “inpatient hospitalization and surgical intervention.”
Section 11(c)(1)(D)(ii), (iii).
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aff'd, 41 F.3d 1520 (Fed. Cir. 2014). Congress has stated that the severity requirement
was designed “to limit the availability of the compensation system to those individuals
who are seriously injured from taking a vaccine.” H.R. REP. 100-391(I), at 699 (1987),
reprinted in 1987 U.S.C.C.A.N. 2313–1, 2313–373, cited in Cloer v. Sec’y of Health &
Hum. Servs., 654 F.3d 1322, 1335 (Fed. Cir. 2011), cert. denied, 132 S.Ct. 1908 (2012);
Wright v. Sec’y of Health & Hum. Servs., 22 F.4th 999, 1002 (Fed. Cir. 2022).
The Vaccine Act prohibits finding that a petitioner has met this burden “based on
the claims of a petitioner alone, unsubstantiated by medical records or by medical
opinion.” Section 13(a). Medical records must be considered, see Section 13(b)(1), and
are generally afforded substantial weight. Cucuras v. Sec’y of Health & Hum. Servs., 993
F.2d 1525, 1528 (Fed. Cir. 1993). However, the Federal Circuit has “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 factual matters required to prove elements of a Vaccine Act claim may be
established by a mix of witness statements and record proof, with the special master
required to fully consider and compare the medical records, testimony, and all other
“relevant and reliable evidence contained in the record.” La Londe v. Sec’y of Health &
Hum. Servs., 110 Fed. Cl. 184 (2013) (citing Section 12(d)(3); Vaccine R. 8), aff’d, 746
F.3d 1335 (Fed. Cir. 2014).
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 Table, a SIRVA is compensable if it manifests within 48 hours of the
administration of a flu vaccine. 42 C.F. R. § 100.3(a)(XIV)(B). The criteria establishing a
SIRVA under the accompanying Qualifications and Aids to Interpretation (“QAI”) are as
follows:
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
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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).
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.
B. 	Petitioner 	Has 	Established 	Severity 	by 	a 	Preponderance 	of 	the
Evidence
In order to meet the statutory six-month severity requirement, Petitioner must
demonstrate, by a preponderance of the evidence, that she suffered the “residual effects
or complications” of her claimed injury beyond May 20, 2021. See Section 11(c)(1)(D)(i).
Respondent’s challenge to severity is based on Petitioner’s lack of treatment for her left
shoulder between January 29 and August 5, 2021. Rule 4(c) Report at 5-6; Resp’t Br. at
5-9. Respondent emphasizes that in the first six months after the November 20, 2020
vaccination, Petitioner was treated for left shoulder pain just once. See Rule 4(c) Report
at 5; Resp’t Br. at 6. Respondent also notes that Petitioner did not mention any left
shoulder pain and had normal physical examinations at her May 2021 appointments
addressing her right arm mass and atypical nevus. See id.
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To rebut this argument, Petitioner cites several cases in which the severity
requirement was satisfied despite significant treatment gaps. Pet’r Br. at 12-13 (citing
Loughren v. Sec’y of Health & Hum. Servs., No. 19-1463V, 2023 WL 6536210 (Fed. Cl.
Spec. Mstr. Sept. 6, 2023); Lamine v. Sec’y of Health & Hum. Servs., No. 20-1560V, 2023
WL 4881504 (Fed. Cl. Spec. Mstr. June 30, 2023); Mullen v. Sec’y of Health & Hum.
Servs., No. 20-1743V, 2023 WL 7161745 (Fed. Cl. Spec. Mstr. Sept. 28, 2023); Fey v.
Sec’y of Health & Hum. Servs., No. 20-1832V, 2023 WL 5606239 (Fed. Cl. Spec. Mstr.
July 26, 2023)); Pet’r Reply at 2-3 (citing Nielsen v. Sec’y of Health & Hum. Servs., No.
21-0590V, 2024 WL 4328583 (Fed. Cl. Spec. Mstr. Aug. 23, 2024); Ferguson v. Sec’y of
Health & Hum. Servs., No. 21-0046V, 2024 WL 1675051 (Fed. Cl. Spec. Mstr. Mar. 18,
2024)). In response, Respondent argues that these cases are distinguishable because
they involved more treatment before the start of the gap, such as multiple PCP visits and
PT sessions; here, by contrast, Petitioner only had a single appointment. Resp’t Br. at 7-
8. Petitioner acknowledges in her reply that she underwent less treatment following
vaccination, but maintains that her medical evidence is otherwise similar to what has been
accepted to meet the burden of proof. Pet’r Reply at 2-4.
Although Petitioner’s cases are not particularly factually analogous, they support
the well-established principle that a seven-month treatment gap does not automatically
preclude a favorable severity finding. See Law v. Sec’y of Health & Hum. Servs., No. 21-
0699V, 2023 WL 2641502, at *5 (Fed. Cl. Spec. Mstr. Mar. 27, 2023). Respondent
conflates the quantity of formal treatment (especially pre-gap) with the duration of the
residual effects of the claimed injury. Evidence that a petitioner underwent extensive
treatment shortly after vaccination may assist in proving severity by demonstrating that
her symptoms would not be expected to resolve within six months. See, e.g., Fey, 2023
WL 5606239, at *5. However, there is no specific level of treatment that must be reached
during the six-month window, or prior to the start of a treatment pause. See Resp’t Br. at
8-9. Respondent’s argument ultimately speaks to the severity of the injury, and thus is
relevant to damages, but does not end the analysis on this aspect of entitlement.
Respondent further ignores that at the August 5, 2021 appointment, NP Johnson
recorded that Petitioner was still experiencing left shoulder pain, that she felt it was getting
worse, and that she had tried over-the-counter remedies without success. Ex. 2 at 24.
Petitioner continued to link her pain and limited range of motion to the November 20, 2020
flu vaccine at her August 19, 2021 follow-up appointment, her PT evaluation, and her later
appointments at the Campti Clinic (on October 20, 2021 and November 3, 2021). See Ex.
2 at 12, 17, 20; Ex. 4 at 13. Petitioner’s seemingly-normal musculoskeletal examinations
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in May 2021 are admittedly not supportive of her claim. 6 However, the overall impression
from the record is that Petitioner’s left shoulder symptoms had not resolved by that point.
In addition, Petitioner’s description of worsening pain at her August-November
2021 appointments, particularly her description of her lack of success self-treating with
Ibuprofen and topical gels, overcomes any suggestion that her left shoulder symptoms
did not continue beyond May 2021. 7 Petitioner reported her symptoms status for the
purpose of obtaining medical treatment, and I give those statements significant weight on
that basis. There is not a lack of “objective record evidence,” as Respondent asserts, and
I do not rely solely on her declaration testimony. See Rule 4(c) Report at 5. Petitioner was
also not required to obtain “orthopedic treatment or radiographic findings connecting her
vaccination to her left shoulder complaints” when she resumed treatment. See id. There
is sufficient evidence in this record that Petitioner’s symptoms from August 2021 onward
represented a continuation of the original injury to deem severity established.
Respondent’s attack on Petitioner’s stated rationale for the treatment gap is not
persuasive. Respondent questions Petitioner’s explanation that she delayed treatment
due to the COVID-19 Pandemic, noting that she was fully vaccinated against the virus by
March 9, 2021 (and hence in the midst of the gap). Resp’t Br. at 6. However, Petitioner
does not just rely on the COVID-19 Pandemic in general, but makes clear that to minimize
COVID-19 exposure, she chose to prioritize treating her right arm mass, which she feared
could be cancerous, over her left shoulder pain. Ex. 1 at 2; Ex. 7 at 2. Again, this choice
to forego treatment is relevant to damages – but based on her medical records, I cannot
conclude that she did not likely have any left shoulder symptoms during this time.
I also do not find that there was an intervening cause that would explain Petitioner’s
symptoms. Respondent argues that a new injury was more likely than not the source of
Petitioner’s left shoulder pain after the treatment gap, because she mentioned left breast
pain at her May 7, 2021 appointment. Resp’t Br. at 6 (citing Ex. 2 at 28). However (and
separate from the fact that the left breast and left shoulder are distinct parts of the body),
Petitioner attributed this pain to pulling a muscle while cleaning, and stated that it had
already resolved. Ex. 2 at 28. Further, Petitioner repeatedly denied any new injury at her
August 2021 appointments. Id. at 20, 54. I also do not perceive any credibility concerns
in Petitioner’s characterization that she prioritized her right arm even though she
6 Petitioner’s left shoulder pain was listed as a medical problem at her May 24, 2021 appointment with Dr.
Ball, despite the finding of normal movement of extremities and no swelling or muscle tenderness. See Ex.
3 at 29, 31.
7 In making this finding, I give little weight to Petitioner’s declaration statements that she called the Campti
Clinic to complain of left shoulder pain both before and after the January 29, 2021 appointment. Although I
have no reason to disbelieve Petitioner, these contacts were not documented.
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admittedly made the May 7, 2021 appointment to discuss her left breast pain, and the
right arm mass had been present for some time. See Resp’t Br. at 6. Petitioner has
preponderantly demonstrated that she suffered the residual effects of her injury for more
than six months post-vaccination.
C. 	Petitioner Has Established the Onset of Left Shoulder Symptoms
Within 48 Hours Post-Vaccination by Preponderant Evidence
In addition to severity, Respondent also challenges onset, arguing that Petitioner
did not complain of left shoulder pain until seventy days after vaccination, and then
described it vaguely, as occurring “after” or “following” vaccination. Rule 4(c) Report at 7;
Resp’t Br. at 9-10. According to Respondent, there is no “independent evidence” to
support onset and Petitioner only offers “anecdotal evidence” to support her claim. Resp’t
Br. at 9-10.
Respondent analogizes the facts of this case to three decisions in which I found a
lack of preponderant evidence for a 48-hour onset. Resp’t Br. at 9 (citing Rose v. Sec’y
of Health & Hum. Servs., No. 20-0056V, 2022 WL 4128908 (Fed. Cl. Spec. Mstr. Aug.
10, 2022), Bulman v. Sec’y of Health & Hum. Servs., No. 19-1217V, 2021 WL 4165349
(Fed. Cl. Spec. Mstr. Aug. 12, 2021), and Pitts v. Sec’y of Health & Hum. Servs., No. 18-
1512V, 2020 WL 2959421 (Fed. Cl. Spec. Mstr. Apr. 29, 2020)). However, these cases
are distinguishable, because they all involved longer delays in seeking treatment as well
as intervening examinations that would have been likely to detect the alleged shoulder
pain if it had been present. Rose, 2022 WL 4128908, at *4; Bulman, 2021 WL 4165349,
at *3-4; Pitts, 	2020 WL 2959421, at *5. Further, in Pitts, the petitioner specified to one
treater that his pain began a week after vaccination. 2020 WL 2959421, at *4. In those
circumstances, 	the 	combination 	of 	vague 	descriptions 	of 	onset 	(or 	contradictory
descriptions), extended time since vaccination, and intervening appointments lead me to
conclude that even though the “standard applied to SIRVA claims on the onset issue is
fairly liberal,” the “sequential and contemporaneous record does not lend overall support
to the [p]etitioner’s allegations.” Rose, 2022 WL 4128908, at *4; Bulman, 2021 WL
4165349, at *5; Pitts, 2020 WL 2959421, at *6.
Here, the facts fall on the other side of this line. Although Petitioner did not directly
state that her pain began within 48 hours of vaccination, “petitioners are not required to
point to records setting forth with chronographic specificity the precise day and hour that
their onset manifested.” Flores v. Sec’y of Health & Hum. Servs., No. 20-1858V, 2023 WL
4248571, at *5 (Fed. Cl. May 24, 2023). Within the Vaccine Program, terms like “since,”
“shortly after,” and “following” the vaccination are typically understood to “mean very close
in time – immediately, or at most within a day or two” after vaccination. Flowers v. Sec’y
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of Health & Hum. Servs., No. 20-285V, 2024 WL 2828211, at *11 (Fed. Cl. Spec. Mstr.
May 8, 2024), mot. for rev. den’d, 173 Fed. Cl. 613 (2024). Petitioner also did not have
any intervening appointments and never suggested an alternate onset.
Nor is her delay of two and a half months before first seeking treatment wholly
attenuated or untimely. See Flores, 2023 WL 4248571, at *5. I have often stated that it is
common for SIRVA petitioners to delay seeking treatment, thinking the injury will resolve
on its own. Petitioner’s declarations and those of her siblings, who saw her frequently,
corroborate her medical records and reduce their vagueness.
Respondent’s demand for “independent evidence” of onset is thus uncompelling.
See Resp’t Br. at 10. I reject Respondent’s argument that Section 13(a) of the Vaccine
Act, which prohibits a finding of entitlement “based on the claims of a petitioner alone,
unsubstantiated by medical records or medical opinion,” precludes me from relying on
medical records that contain a petitioner’s reported history of onset. See id. If this were
correct, no petitioner would be able to make out a claim, given that most SIRVA cases
begin with a subjective report of shoulder pain to a medical provider.
Petitioner has demonstrated that the onset of shoulder pain more likely than not
began within 48 hours of vaccination. However (and consistent with the aforementioned
severity issues), Petitioner’s delay and decision to forego treatment suggest that she
suffered a milder SIRVA injury. Any award in this case for pain and suffering should be
modest.
Conclusion and Scheduling Order
Respondent does not raise any other objections to entitlement. See generally id.
Based on my independent review, I find that Petitioner has preponderantly established all
requirements for a Table SIRVA claim. 42 C.F.R. § 100.3(c)(10). Accordingly, she need
not prove causation-in-fact. Section 11(c)(1)(C). I also find that Petitioner has satisfied all
other statutory requirements. Section 11(c)(A), (B), and (D).
For the foregoing reasons, I find that Petitioner has established entitlement
and is thus entitled to compensation for a Table SIRVA following the November 20,
2020 flu vaccination.
The case is now formally in the damages phase. The parties are encouraged to
pursue informal resolution of an appropriate damages award. If the parties determine that
informal resolution is not possible, they should be prepared to promptly brief the
appropriate award of damages.
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By no later than Monday, January 12, 2026, Petitioner shall file a Status
Report updating me on the parties’ efforts towards informally resolving damages.
IT IS SO ORDERED.
s/Brian H. Corcoran
Brian H. Corcoran
Chief Special Master
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