UNPUBLISHED

DECISION AWARDING DAMAGES1

NORA BETH DORSEY, Chief Special Master.

On March 30, 2018, petitioner filed a petition for compensation under the National Vaccine Injury Compensation Program, 42 U.S.C. § 300aa-10, et seq.,2 (the "Vaccine Act"). Petitioner alleges that she suffered a shoulder injury related to vaccine administration ("SIRVA") as a result of an influenza ("flu") vaccination administered on September 13, 2016. Petition at 1. The case was assigned to the Special Processing Unit of the Office of Special Masters.

On March 21, 2019, a ruling on entitlement was issued, finding petitioner entitled to compensation for a SIRVA. On April 30, 2019, respondent filed a proffer on award of compensation ("Proffer") indicating petitioner should be awarded $112,500.00 and $11,569.44 to satisfy a New Jersey Medicaid lien. Proffer at 1. In the Proffer, respondent represented that petitioner agrees with the proffered award. Id. Based on the record as a whole, the undersigned finds that petitioner is entitled to an award as stated in the Proffer.

Pursuant to the terms stated in the attached Proffer, the undersigned awards

The clerk of the court is directed to enter judgment in accordance with this decision.4

IT IS SO ORDERED.

RESPONDENT'S PROFFER ON AWARD OF COMPENSATION

On March 21, 2019, respondent conceded that entitlement to compensation was appropriate under the terms of the Vaccine Act. Thereafter, on March 21, 2019, Chief Special Master Dorsey issued a Ruling on Entitlement, finding that petitioner was entitled to vaccine compensation for his Shoulder Injury Related to Vaccine Administration ("SIRVA").

I. Compensation for Vaccine Injury-Related Items

Based on the evidence of record, respondent proffers that petitioner should be awarded $112,500.00. This amount represents all elements of compensation to which petitioner would be entitled under 42 U.S.C. § 300aa-15(a), with the exception of the reimbursement of the Medicaid lien, below. Petitioner agrees.

Respondent further proffers that petitioner should be awarded funds to satisfy a State of New Jersey Medicaid lien in the amount of $11,569.44, which represents full satisfaction of any right of subrogation, assignment, claim, lien, or cause of action the State of New Jersey may have against any individual as a result of any Medicaid payments that the State of New Jersey has made to or on behalf of Rita Czyzewski from the date of her eligibility for benefits through the date of judgment in this case as a result of his vaccine-related injury suffered on or about September 13, 2016, under Title XIX of the Social Security Act. Petitioner agrees.

II. Summary of Recommended Payments

Respondent recommends that the compensation provided to petitioner be made through two lump sum payments as described below:

Petitioner agrees to endorse this payment to Treasurer, State of New Jersey.

Petitioner is a competent adult. Evidence of guardianship is not required in this case.