GOLB v. SECRETARY OF HEALTH AND HUMAN SERVICES

OCR transcription for search; preserved printed pages are authoritative

Case 1:24-vv-01616-UNJ Document 33 Filed 01/30/26 Page1of7

In the Gnited States Court of Federal Claims

OFFICE OF SPECIAL MASTERS
No. 24-1616V

RAPHAEL GOLB, Chief Special Master Corcoran

Petitioner, Filed: December 30, 2025
V.
SECRETARY OF HEALTH AND
HUMAN SERVICES,

Respondent.

Jonathan J oseph Svitak, Shannon Law Group, P.C., Woodndge, IL, for Petitioner.
Dima Atiya, U.S. Department of J ustice, Washington, DC, for Respondent.
DECISION ON JOINT STIPULATION!

On October 9, 2024, Raphael Golb filed a petition for compensation under the
National Vaccine Injury Compensation Program, 42 U.S.C. §300aa-10, et seq.’ (the
“Vaccine Act”). Petitioner alleges that he suffered a shoulder injury related to vaccine
administration (“SIRVA”) resulting from an influenza (“flu”) vaccine received on August
31, 2023. Petition at 1; Stipulation, filed December 30, 2025, at {1 2-4. Petitioner further
alleges that the vaccine was administered in the United States, he suffered residual
effects of his injury for more than six months, and there has been no prior award or
settlement of a civil action for damages on his behalf as a result of his condition. Petition
at 7 12, 15, 16; Stipulation at {4 3-5. “Respondent denies that the flu vaccine caused
petitioner to suffer a left shoulder injury or any other injury or his current condition and
denies that petitioner sustained a SIRVA Table injury.” Stipulation at {| 6.

Nevertheless, on December 30, 2025, the parties filed the attached joint
stipulation, stating that a decision should be entered awarding compensation. I find the

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 httos:/Awww.govinfo.gov/app/collection/uscourts/national/cofc, in accordance with the E-Govemment
Act of 2002. 44 U.S.C. § 3501 note (2018) (Federal Management and Promotion of Electronic Govemment
Services). This means the Decision will be available to anyone with access to the intemet. 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 matenal 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).

AUTHENTICATED
U.S. GOVERNMENT
INFORMATION

GPO

2
stipulation reasonable and adopt it as my decision awarding damages, on the terms set
forth therein.
Pursuant to the terms stated in the attached Stipulation, I award the following
compensation:
A lump sum of $35,000.00, 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.
Case 1:24-vv-01616-UNJ Document 33 Filed 01/30/26 Page 2 of 7

Case 1:24-vv-01616-UNJ Document 33 _ Filed 01/30/26 Page 3of7

IN THE UNITED STATES COURT OF FEDERAL CLAIMS
OFFICE OF SPECIAL MASTERS

)
RAPHAEL GOLB, )
)
Petitioner, )
) No. 24-1616V
v. ) Chief Special Master Corcoran (SPU)

) ECF
SECRETARY OF HEALTH AND )
HUMAN SERVICES, )
)
Respondent. )

)
STIPULATION

The parties hereby stipulate to the following matters:

1. Raphael Golb, petitioner, filed a petition for vaccine compensation under the

National Vaccine Injury Compensation Program, 42 U.S.C. §§ 300aa-10 to -34 (the “Vaccine

Program”). The petition seeks compensation for injuries allegedly related to petitioner’s receipt

of an influenza (“flu”) vaccine, which is a vaccine contained in the Vaccine Injury Table (the

“Table”), 42 C.F.R. § 100.3 (a).
2. Petitioner received the flu vaccine on August 31, 2023.
3. The vaccination was administered within the United States.

4. Petitioner alleges that he sustained a Shoulder Injury Related to Vaccine

Administration (“SIRVA”) as defined in the Table; he further alleges that the flu vaccine caused

his alleged shoulder injury, and that he suffered the residual effects of his alleged injury for more

than six months.

5. Petitioner represents that there has been no prior award or settlement of a civil action

for damages on his behalf as a result of his condition.

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6. Respondent denies that the flu vaccine caused petitioner to suffer a left shoulder injury
or any other injury or his current condition and denies that petitioner sustained a SIRVA Table
injury.

7. Maintaining their above-stated positions, the parties nevertheless now agree that the
issues between them shall be settled and that 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 $35,000.00 to be paid through an ACH deposit to petitioner’s

counsel’s IOLTA account for prompt disbursement to petitioner. This amount

represents compensation for all damages that would be available under 42 U.S.C.

§ 300aa-1 5{a).

9. As soon as practicable after the entry of judgment on entitlement in this case, and after
petitioner has filed both a proper and timely election to receive compensation pursuant to
42 U.S.C. § 300aa-21(a)(1), and an application, the parties 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 his attoney 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-15(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.

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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-15(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 his
individual capacity, and on behalf of his 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-10 et seq., on account of, or in any way growing out of, any and all
known or unknown, suspected or unsuspected personal injuries to or death of petitioner resulting
from, or alleged to have resulted from, the flu vaccination administered on August 31, 2023, as
alleged by petitioner in a petition for vaccine compensation filed on or about October 9, 2024, in
the United States Court of Federal Claims as petition No. 24-1616V.

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.

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15. If the special master fails to issue a decision in complete conformity with the terms
of this Stipulation or if the Court of Federal Claims fails to enter judgment in conformity with a
decision that is in complete conformity 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 or significantly aggravated
petitioner’s alleged shoulder injury, or any other injury or his current condition, or that petitioner
suffered an injury contained in the Vaccine Injury Table.

18. Allrights and obligations of petitioner hereunder shall apply equally to petitioner’s
heirs, executors, administrators, successors, and/or assigns.

END OF STIPULATION

“a SS SL SR SS

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Case 1:24-vv-01616-UNJ

Respectfully submitted,

PETITIONER:

Raphacl Hatt

RAPHAEL GOLB

ATTORNEY OF RECORD FOR
PETITIONER:

<A —
JONA ITAK )
Shannofi Law Group, P.C.
6825 Hobson Valley Drive

Woodbridge, IL 60517

AUTHORIZED REPRESENTATIVE
OF THE SECRETARY OF HEALTH

AND HUMAN SERVICES:
Digitally signed by
Jeffrey a Jeffrey S. Beach -S
Date: 2025.12.11
Beach -S 12:31:47 -05'00' for

CAPT GEORGE REED GRIMES, MD, MPH
Director, Division of Injury
Compensation Programs
Health Systems Bureau
Health Resources and Services
Administration
U.S. Department of Health
and Human Services
5600 Fishers Lane, 14W-18
Rockville, MD 20857

Dated: Wa / oy, Df 2025

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Document 33

Filed 01/30/26 Page 7 of 7

AUTHORIZED REPRESENTATIVE
OF THE ATTORNEY GENERAL:

HEATHER L. PEARLMAN
Deputy Director

Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146

Benjamin Franklin Station
Washington, DC 20044-0146

ATTORNEY OF RECORD FOR
RESPONDENT:

rom

MA JAWAD ATI
Trial Attorney
Torts Branch, Civil Division
U.S. Department of Justice
P.O. Box 146
Benjamin Franklin Station
Washington, DC 20044-0146
(202) 880-0182
Dima.Atiya@usdoj.gov