Shoulder injury related to vaccine administration and NVICP

In 1986, the United States Congress passed the National Childhood Vaccine Injury Act, which among other things created the  National Vaccine Injury Compensation Program (NVICP). The act’s main goal was to protect vaccine manufacturers from vaccine injury claims and liability–but not for the reasons you might think. We are going to take a look at how shoulder injury related to vaccine administration (SIRVA) relates to NVICP claims

Congress was rightly concerned that the costs for these legal actions was going to drive most, if not all, manufacturers from the USA market. That would have been  a horrific problem for the country, with no ability to protect children from deadly and dangerous diseases.

The NVICP provides a no-fault program to resolve vaccine injury claims – “quickly, easily, with certainty and generosity.” The program was (and continues to be) funded by a tax on all vaccines sold in the country. Moreover, using a system of expert administrative “judges” (called Special Masters), a petitioner seeking to establish causation-in-fact must show, by a preponderance of the evidence, that but for the vaccination they would not have been injured, and that the vaccination was a substantial factor in bringing about their injury.

NVICP data

The NVICP works reasonably well to compensate any real victims of vaccine injury, though, like any system, it is not perfect. For example, a panel of three special masters began hearing the first cases of the historic Omnibus Autism Proceedings in June 2007. They decided that there was absolutely no evidence, confirmed by peer-reviewed clinical research, that there was a link between vaccines and autism spectrum disorders.

Despite some frequent claims that the “huge payouts” from NVICP are indicative of the dangers of vaccines, the data supports the extremely high safety profile of vaccines, and shows they are incredibly important in preventing pathogenic diseases. The facts about compensation are:

  • From 2006 to 2014, over 2.5 billion doses of covered vaccines were distributed in the USA. Of that, there were 3,169 claims adjudicated by the NVICP (sometimes known as the Vaccine Court)  for claims filed in this time period, or 0.000127% of all vaccines delivered;
  • or more importantly, 1,939 claims were compensated. This means for every 1 million doses of vaccine that were distributed, 1 individual was compensated. In the world of medicine, a procedure that has that tiny injury rate should be considered nearly perfect;
  • furthermore, most of these claims (1562) were settled – and settlements do not require showing causation, and do not mean the claim has merit. As the HRSA explains: What reasons might a claim result in a negotiated settlement? – Prior to a decision by the U.S. Court of Federal Claims, both parties decide to minimize risk of loss through settlement.
    –A desire to minimize the time and expense of litigating a case
    –The need to resolve a case quickly
  • Since 1988, approximately US$3.2 billion have been paid to 4,205 claims that were determined to be related to vaccines. Yes, it seems like a large number, but again, based on the billions of doses of vaccines delivered, the number of cases is extremely small. The amount isn’t as large as it seems either since one debilitating injury can cost millions, and since it includes about $150 millions in lawyer fees, including for losing claims.

We’ve complained about how some antivaccination groups are really awful at simple math. These numbers for vaccine injury claims are so small that we ought to take pride in the medical miracle of vaccines. Moreover, the NVICP is a fairly efficient system in taking care of those who are actually injured by vaccines. Furthermore, researchers watch over the claims, since they really work to show causality, to determine how to make next generation vaccines better and safer.

There are two ways a petitioner can show causation in NVICP. One way is to prove that your case is covered by the “table” that establishes what injuries have some relationship to a vaccine. The other is to prove an off-table injury by showing that more likely than not the vaccine caused the injury.

Even there, however, petitioners get a break. Petitioners don’t need to show that science supports a causal connection between the vaccine and the problem. If they provide an expert that suggests a plausible theory, that can be enough – though the other side may counter it with their own experts.

It’s a good system, maybe even a great one. It makes it relatively easy for the injured to get generous compensation, without forcing them to go through a difficult set of procedures to win a tort case. And it doesn’t allow for spurious claims based on bad science, anecdotes and nonsense. That’s also good.

New vaccine injury claims

Recently, a new set of vaccine injury claims have made the rounds in real news services. Several large payouts have been made to individuals after receiving a flu vaccine, including US$1 million to a nurse in Louisiana. Already, some antivaccination websites are trying to say “gotcha!” But, as I’ve said time and again it’s the nuanced information that is a “gotcha.”

Although the injuries were caused by the flu vaccination, they were not caused by the vaccine itself.

Here’s what happens. A flu vaccine must be delivered intramuscularly, that is, directly into the muscle. Generally, a healthcare worker will pinch the muscle on the upper arm (the deltoid muscle) in an attempt to deliver the vaccine into the muscle. The upper arm tends to have less subcutaneous fat, so it is considered the best location for flu vaccines.

Most package inserts for flu vaccines recommend 1″ needles (although medicine is nearly 100% metric, for some obscure reason, needle length remains in inches for most of the world) for adults and ½” needles for children, so that the injection actually gets into the deltoid muscle.

Unfortunately, there are a lot of nerves, blood vessels, ligaments and other important physiological structures in this area. And if the injection is done improperly there can be painful and sometimes permanent damage to this area of the deltoid muscle. This muscle is incredibly important for the large range of motion of the arms around the shoulder. When it is in pain, usually even if it is in just one small part of the range of motion, it can be debilitating.

deltoid-injection-anatomy

Up until a few years ago, the NVICP only compensated for vaccine injury claims that involved the actual contents of the vaccine. Now they will compensate patients  that have been diagnosed with shoulder injury related to vaccine administration (SIRVA).

Now just to be clear, SIRVA could happen with any intramuscular injection (vaccine or otherwise) that uses a longer needle into the deltoid muscle. Diabetics, for example, use shorter needles and are taught to inject insulin into fatty areas of the arm, thigh and abdomen. But if a diabetic used the wrong size needle and went too high on the arm, they could cause a SIRVA-like issue.

SIRVA generally is caused by a vaccine injected improperly high on the arm. This can damage musculoskeletal structures of the shoulder, such as tendons, ligaments or bursa, causing sudden shoulder pain. There is simply no relationship to the contents of flu, or any other, vaccine.

Other recommendations to prevent SIRVA were suggested in a recent article, “How to give — and receive — a safe shot”:

  • An intramuscular vaccination in the arm should avoid the top third of the deltoid muscle and aim for the middle of the muscle, its thickest portion.
  • Both the patient and the provider should be on the same plane — that is, either both sitting or both standing, although sitting is preferred. This reduces the risk of inadvertently injecting the vaccine too high up into the shoulder. (When I received the injection that led to problems, I was sitting down and the nurse was standing up). It is also a good idea to hold the arm out a little from the side, a position that helps protect the bursa.
  • The injection should go into the muscle at a 90-degree angle to the skin.
  • The Centers for Disease Control and Prevention provides specific recommendations for needle size based on the patient’s weight, but generally “the needles get bigger as the patient gets bigger,’’ says JoEllen Wolicki, a nurse educator in CDC’s immunization services division.

For patients and practitioners, the CDC’s web site has illustrations and recommendations describing proper vaccine protocols.

The NVICP and SIRVA

As already mentioned, NVICP has already been compensated claims of SIRVA. What has changed – and the reason for the article – is that the Department of Health and Human Services (DHHS) included a proposal to add SIRVA to the Table of Injuries as part of a proposed rule. Two issues need clarifying: what does adding SIRVA to the Table mean, and what is a proposed rule.

The DHHS proposes adding SIRVA developing within 48 hours of injection as an injury to all  vaccines injected into the muscle. It also proposes adding the injury to MMR, Varicella and MMRV even though those vaccines are not currently injected into the muscle to avoid having to change the table if vaccines that need to be injected into the muscle are developed. A petitioner would not be compensated from injuries from these vaccines with the current version that is not injected into the muscle.

What is a proposed rule? Under our Administrative Procedures Act, to pass a binding rule an agency has to publish a notice about the rule in the Federal Register, provide an opportunity for comment, and then publish a statement about the rule. Our courts have demanded that agencies provide good reasons for the rules. Today, agencies most commonly publish the rule on Regulations.gov, an electronic portal where people can find rules and post comments.

DHHS has published a rule including various changes to the Table of Injuries on the site–there is now a comment period, when anyone can submit comments. These can be submitted until January 25, 2016 – a lengthy and generous period. Then the agency will consider the comments and issue a final rule, with explanation of its decisions.

This is a chance for those with opinions on the table to provide input and affect its contents. Until the rule is finalized, SIRVA is not part of the Table – though petitioners can still win cases as off-table injuries.

What adding the injury to the table means is that for people who develop SIRVA within 48 hours of vaccinating, there will be a presumption that the vaccination caused the harm. That should make getting compensation for these vaccine injury claims easier and quicker.

Editor’s note: This article was originally published in August 2015 by myself and Dorit Rubinstein Reiss. It has been revised and updated to include more comprehensive information, to improve readability, and fix broken links.

 
 
Dorit Rubinstein Reiss

This article is by Dorit Rubinstein Reiss, Professor of Law at the University of California Hastings College of the Law (San Francisco, CA), is a frequent contributor to this and many other blogs, providing in-depth, and intellectually stimulating, articles about vaccines, medical issues, social policy and the law. 


Professor Reiss writes extensively in law journals about the social and legal policies of vaccination. Additionally, Reiss is also member of the Parent Advisory Board of Voices for Vaccines, a parent-led organization that supports and advocates for on-time vaccination and the reduction of vaccine-preventable disease.


  • monkyfoot

    Thank you for writing this Dorit, I’ve been dealing with this injury and going through the process before I read this article today. It is nice to come across something rarely spoken about that gives a voice to the issue, especially one that doesn’t espouse people abandoning vaccinations.

  • Paula Ledbetter Graves

    Does anyone know if there is a statute of limitations for reporting an injury? Both my mother and aunt had a frozen shoulder after receiving the flu shot from the same nurse (at different times) a few years ago.

  • Andrew Lazarus

    Quite amazing, I had a sore shoulder for something like six months after my last DTaP booster. I figured the nurse had done a bad job, and I guess I was right. (My other shoulder has been sore for 7 months for no vaccine-related reason; I think I should look into shoulder transplants.)

    • Depending on your age and comorbidities, there are conditions that are similar to this. For example, a frozen shoulder can be quite painful, and is not linked to the vaccination needle, but to diabetes.

      • Andrew Lazarus

        The shot one seemed pretty clear: it was sore the next day, and the next few months, right at the site.

        So, yet another reason to get my blood sugar out of the borderline range is it will finish unfreezing the other shoulder. OK, off to the gym I guess.

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  • Diddly doo

    “In 1986, the United States Congress passed the National Childhood Vaccine Injury Act, which among other things created the National Vaccine Injury Compensation Program (NVICP).
    The act’s main goal was to protect vaccine manufacturers from vaccine
    injury claims and liability–but not for the reasons you might think.

    Congress was rightly concerned that the costs for these legal actions
    was going to drive most, if not all, manufacturers from the USA market.
    That would have been a horrific problem for the country, with no
    ability to protect children from deadly and dangerous diseases.” weasel words from the Septic rantor.

    this is outrageous to the extreme. The government has to pass a law to keep vaccination on line, even though the ‘evidence’ for vaccine efficacy is published by vested interests. The act should be balanced, to ensure honest data collection on efficacy, of which there is not.

    Congress was only concerned with profit damage limitation, this kind of law is obscene and brings both the law and medical practice seriously into disrepute on many levels. It is events like this that keep the questions of the need to vaccinate alive and kicking.

    On many levels you are all truly misaligned.

    • Dorit Reiss

      Starting from the top:
      A. The only way to say the evidence for vaccine efficacy is published by vested interests is to see governments everywhere and universities everywhere as vested interests. That kind of makes the term lose its meaning.

      B. You have provided nothing to support your claim that Congress was acting to protect profits. In a sense, that may be true – infectious diseases outbreaks cost a lot of money. But they also cost lives and have costs in suffering and harms. Congress acted to protect the vaccine supply and children and the public health. I don’t think protecting lives and preventing harm is obscene, personally.

      • Diddly doo

        The problem for vaccine ‘efficacy’ studies is that they don’t use the same kind of placebo that other drug studies use. This allows selective data to be used in studies where the ‘placebo’ is effectively the same vaccine minus the bit that is supposed to promote antigens. This means when both groups get serious adverse effects like brain swelling, the data can be left out because the ‘control’ and ‘vaccined’ groups had the same level of adverse reactions.

        It is a nice legal weasel argument Dorit, but we all know that lawyers come from ‘pools’ and their main training skill comes from the ability to waterdown the issues so that there is no real outcome. If lawyers piss the system off too much they don’t get asked to work for it.

        And you are doing rather nicely.

        The recent swine flu mythdemic was totally protected by politicians, when Roche lost all the Tamiflu data after millions of taxpayers money was spent on it, even the BMJ pointed out this was not acceptable. The establishment made losts of money from it, no conspiracy there, it happened – same with ebola – the WHO withdrew its annual hemorrhagic fever budget the year before it kicked off and the CDC own the patent on ebola too. It is in every politicians interest to create ‘external’ events like wars and flu outbreaks to take the focus of what a crap job they are doing.

        We are sick of ‘experts’ making policy. The world banking crisis is an extension of that.

        You are a system cat, full of crap and good at writing nothing

        • Dorit Reiss

          I’m afraid that is incorrect.
          A. Your comment about efficacy only applies to clinical trial data – and even there, you could (incorrectly) try and argue using the ingredients without the active vaccine can hide some of the safety data, but it won’t affect the effectiveness finding: either the active ingredient works, or it doesn’t, and a solution without the active ingredient is a correct control.

          For retrospective studies it’s really irrelevant – the comparison there is between those with the exposure (got the relevant vaccine) and those without. Yes, you do have a comparison.

          B. Even for clinical trials – to remind you, vaccine ingredients haven’t changed that much over the last 70 years or more. For example, aluminum adjuvants have been in use since the 1930s. Their safety profile is known – and they don’t cause brain inflammation. Comparing the active ingredients in vaccine v. a control without it – a known control – is completely valid.

          C. Citation needed for your claims about the swine flu pandemic and ebola. And to remind you, both killed people. No myth or lie. I think politicians should act to respond to diseases that can kill people, personally. Lives matter.

          D. Personally, I think expert input into highly technical areas that affect human safety is important. I would not like the uninformed making decisions about nuclear safety – or health.

          • Diddly doo

            Nice try Dorit
            A – the trials only test for production of vaccine associated antibodies and assume that his means the vaccine works. There are no studies that show a correlation between antibody levels and protection against any disease. Vaccine trials are flawed because they are not about proving the vaccine prevents disease. The insert on Flulaval vaccine demonstrates this perfectly. It says in plain English ‘There are no adequate trials that demonstrate a decrease in influenza disease after vaccination with flulaval”

            To make this clear, ‘efficacy in vaccine clinical trials is only directed at vaccine associated antibody production, it has nothing to do with the vaccines ‘efficacy’ in preventing any disease.

            This means that the idea that vaccine trials are in someway contributing to a body of evidence that shows they prevent disease is a total lie.

            B http://www.ncbi.nlm.nih.gov/pubmed/22235057

            Mechanisms of aluminum adjuncts toxicity and autoimmunity in pediatric populations.

            You cannot claim that vaccine adjuncts do not cause brain inflammation because the studies on toxicity have not been done. Your anecdotal opinion is not a fact, however much you might like it to be.

            C Poland was the only country in Western Europe who refused to accept that there was a swine flu pandemic. Look that up yourself, I’d love to be up in court against you one day – it would be a ball.

            “In the UK the game was up, the swine flu pandemic was complete bullshit, yes people died but how many – 100!
            http://www.dailymail.co.uk/news/article-1263975/Swine-flu–300m-squandered-jabs-didnt-need.html

            Scientists and pharmaceutical companies that profited
            from the swine flu scare stand accused of grossly exaggerating the risks of the outbreak.

            In Britain it was predicted up to 65,000 would die from the
            virus. The Government sprang into action and spent £1billion
            stockpiling anti-virals such as Tamiflu and ordering enough vaccines to give two doses to every man, woman and child.

            But the Doomsday scenario never unfolded. Just 457 people died
            of swine flu, but as 80 per cent of these had underlying health
            problems, only around 100 died of swine flu alone.

            Lost Tamiflu data BMJ, Christ you are a lazy arse:

            http://www.bmj.com/tamiflu

            Nice appeal to emotion there, politicians have a duty not to use disease outbreaks as a lever to change laws that don’t need changing. Popularist terrorism isn’t on. It is significant that the countries that had outbreaks had piss poor infrastructures, 3 hospital beds per 10,000 as opposed to 50 in OECD countries, the lack of general sanitation and clean water were also like nothing found in OECD countries.

            We never were at risk outside these countries, even nurses who worked there said that, most recover with basic hydration and above all not attempting to reduce the fever with meds, it makes them bleed more.

            D Expert input unfortunately isn’t what we would like it to be. All domestic houses for example could be offgrid with no utility bills but the experts who de nationalised the utilities wouldn’t like it. If we sorted this we wouldn’t need stupid tech like nuclear so it wouldn’t be an issue.

            Ask the Japanese about experts running nuclear power stations.

            • Dorit Reiss

              A. Trials do test for antibodies, but they also test for rates of infection. Here is an example: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(08)60524-3/abstract. Note that it examined rates of infection.

              Can’t do that with influenza vaccines, because they’re annual and change. So you have to do that after the fact. But you do it for vaccines generally. It’s not just antibodies, and yes, it measures effectiveness.

              B. You provide an opinion piece by two anti-vaccine scientists, Shaw and Tomljenovic, discredited by WHO: http://www.theglobeandmail.com/life/health-and-fitness/health/ubc-stands-behind-vaccine-studies-discredited-by-who/article23302328/. Aluminum adjuvants have been in use for a long time. And studies have been done. See, for example:

              Cochrane Review: http://www.thelancet.com/journals/laninf/article/PIIS1473-3099(04)00927-2/fulltext

              While highlighting that data was limited, review concluded: “We found no evidence that aluminium salts in vaccines cause any serious or long-lasting adverse events.”

              C. The fact that we acted quickly and prevented the Swine Flu from being worse doesn’t make it less of a real danger. It killed enough. http://www.skepticalraptor.com/skepticalraptorblog.php/pandemic-flu-vaccine-narcolepsy-an-analysis/

              D. The fact that experts aren’t infallible doesn’t negate the fact that they’re way better than non-experts at running things.

            • Diddly doo

              A One problem here Dorit, what is the point of testing for antibody production? The other problem is:

              Funding
              GlaxoSmithKline.
              That is the kind of PR study that the BMJ editor meant when he called 50% of medical peer review published nonsense. Is that the best you can do!

              B is for bull. Labeling someone as anti vaccine is not scientific. They did a systematic review of available vaccine evidence and found vaccine efficacy and related subjects seriously wanting. That is responsible and scientific. Just because you have the “we all know vaccines save lives pseudosciencememevirus” it doesn’t make you anecdote science.

              C The quick action was for the media and vaccine industry and politicians to make a buck. There was no more threat from pandemic flu as from normal flu – it was total crap.

              D I assume you must be a self appointed expert, I hope they pay you well for lying.

            • Dorit, it pains me to see you wasting your time on an antivaxx zealot like diddly. I can only commend you for your continued patience, and measured responses.

  • Maxwell Killion

    I read about SIRVA but I am pointing out it’s extremely hard to establish if a child or non-verbal child/adult is in pain and even harder to PROVE (easier to deny) injury in someone who can not articulate effectively for themselves. If this sort of condition is happening I appreciate you WARNING the public about it. It is one more concern to take into account when considering vaccination. You trying to take the focus off of one subject (the vaccine) and shift it to another. I am not really understanding your point other than you were upset that some people were publicizing large payouts for the flu vaccine and wanted to try and explain it away with another theory, which I am not seeing any proof other than your explanation of SHIRVA and YOU
    saying that is what happened. Just because you think it was SHIRVA doesn’t mean it was, you saying “Here’s what happens” Who gives you the authority to say it was SHIRVA instead of the flu vaccine they were compensated for?

    • Dorit Reiss

      This comment is somewhat incoherent and hard to understand, so I will respond as best I can to what can be understood from it.

      This is not an injury that relies only on expressing pain – nor are most vaccine injuries. It has external manifestations. As to one more concern when considering vaccination – most people probably realize an injection can lead to pain, especially if not done well.

      As to what people were compensated for – the cases say it was SIRVA. Not that hard. As does the news story linked to in the post. Are you saying the program, which compensated these people for SIRVA, doesn’t have the authority to do that?

      How exactly does this shift focus from anything? It certainly doesn’t negate how rare vaccine injuries are – even with this. It just highlights that this can happen and that the system is acting to make it easy to sue. If it negates anything, it negates the claim that NVICP is rigged against petitioners. If there is evidence a vaccine caused a harm, there’s compensation, and the government even acts to make it easy.

  • Maxwell Killion

    This also does not cover the fact that the vaccination of babies who can not talk or express they had pain at the injection site, how would you know if they were injected improperly, they can’t tell you if they have pain. Also many autistic children are non-verbal. How would they be able to tell you? The parent is the expert on the child. You do not think that, you think that all parents (who question vaccines or the people giving them) are misguided and you write articles like this to explain everything about vaccines, because you want everyone to be vaccinated against their will. The vaccines are not perfect, and the compensation is not generous. The truth is that if there are flaws (any flaws) in a vaccine, a provider administering a vaccine and or the compensation if you are injured from a mandated vaccine (even for school because a forced choice is not really a choice, let’s get real) there should always be an opt out option, you are a legal professional, you should know that.

    • Dorit Reiss

      SIRVA does have outside manifestations. Again, I suggest you try reading the article and understanding it.

  • Maxwell Killion

    This article shows that there not only are vaccine injuries and they are real, because you have stated that people go through the “not perfect” NVICP program and are “generously” compensated (if you consider 250,000.00 for your life generous) if their injuries are deemed legitimate by a panel of experts that are hired by the NVICP program. There is no judge, no jury. So to me that seems not “easy” to prove anything. Almost like trying to get a claim approved by an insurance company. They will try to deny anything they can, so you do have to prove it, you make it sound like you don’t have the burden of proof that you would if you took it to a court of justice. If you did file a malpractice suit it would be heard by an unbiased (as possible as that is) judge and the statute of limitations on the injury could be longer. Especially in case of SHIRVA. I think that you would have more control of your case and the outcome of your case if you filed independently in a court of justice. I think that’s why they call it a court of JUSTICE not a compensation program.

    • Dorit Reiss

      Nobody denies serious harms from vaccines can happen. As the article highlights, they are extremely rare.

      As it also highlights, winning your case in NVICP is much easier than in the courts – you only have to prove causation and damages, and the causation science is easier.

      I’m not sure why the commentator deduced showing SIRVA is harder – the article shows if anything the opposite, and putting it on the table would make ti easier yet.

      I suggest the commentator makes an effort to get a better understanding of the program, to avoid such errors.

  • Maxwell Killion

    I don’t need to understand anything. It’s clear that you produced and article that was supposed to take the focus off of the vaccine, and highlight that when people have a reaction after they get a vaccine that it may not have actually been the vaccine, but the person who administered the vaccine not doing it right. I get that, and now that brings up two things that people should be alerted to when receiving a vaccine, the potential adverse effects from the vaccine and the potential adverse effects of someone not doing it right. The later would not be a vaccine injury claim because the vaccine did not cause the vaccine injury. You put these two subjects in this article also about the NVICP to reassure people that if they do happen to have an adverse reaction, they will “easily” be compensated. Which is false, there is nothing easy about the NVICP. This article fails to even state that the NVICP has flaws, which you admit it does. And no someone would have a much easier time suing a doctor or nurse for administering a vaccine improperly resulting in injury that going through the NVICP when it had nothing to do with the vaccine in the first place.

    • Dorit Reiss

      Most people probably realize the difference between problems with the content of the vaccine and problems with not injecting something properly – which could apply to vaccines or to other things.

      The article focuses on a specific issue – it’s not a comprehensive overview of NVICP’s strengths and weaknesses. I’ve done it elsewhere – and the links are in the article, including explaining why it’s an easier process than the regular courts. So far, you have in no way contradicted it.

      Your last comment is a little unclear. Why would it be easier to have to sue a doctor or nurse and prove negligence than go through a no-fault program where you don’t have to prove that and where causation is easier to show – and will become easier yet if this is added to the table?

      • Maxwell Killion

        You are wrong to say it’s easy, quick or generous . The system is extremely flawed and you fail to provide that information. I provided a report from the government proving what I have stated. I think you may want to read it.

        • Dorit Reiss

          If you look below, I have not only read the GAO report but I wrote about it. Here is the link again: http://shotofprevention.com/2014/12/09/government-accountability-office-report-on-vaccine-injury-compensation/

          • Maxwell Killion

            What you wrote about in the shot of prevention contradicts what you wrote in this article about the NVICP (I realize this isn’t an article solely on the NVICP). Adding SIRVA to the table of injuries could only cloud the lines of whether it was the vaccine or the administration of the vaccine, and I would like to know the difference if any in the compensation amounts for an adverse reaction from the vaccine, and an adverse reaction from the administration of the vaccine SHIRVA. If SHIRVA payouts are less and they can claim it not be the fault of the vaccine, then sure the NVICP and the vaccine companies would benefit from that.

            • Maxwell Killion

              “It’s a good system, maybe even a great one. It makes it relatively easy for the injured to get generous compensation”

            • Maxwell Killion

              It highlights a program that is not perfect, but is mostly working. And it indicates that the department in charge – HHS – is aware of the challenges and is working on areas that need improvement. If anyone hoped that examination by the GAO would lead to aggressive condemnation of VICP, they are going to be disappointed. There is no evidence of corruption in the report; there is no evidence of systematic mistreatment of petitioners; problems – like delays – are addressed and explained, and generally, the report does not suggest that VICP requires a dramatic overhaul.

            • Maxwell Killion

              Those two statements are not consistent. “Not perfect” and “maybe even a great one” are two are not the same sentiment.

            • Dorit Reiss

              Great =/= perfect. No contradiction.

            • Maxwell Killion

              you said in one article the system was “not perfect” and in another article you said it’s “maybe even a great one”. And actually said both, in this article that it’s not perfect but maybe even a great one. Which one is it? Not perfect or maybe even a great one?

            • Sia

              Parachutes aren’t perfect, either. They’re still a great idea.

            • Dorit Reiss

              Nothing here contradicts my previous work about NVICP.

              The last comment is somewhat unclear. Compensation is generally related to the level of damage, not the type of injury.

          • Maxwell Killion

            Also you may have just opened an entirely different can of worms. People who have no issue with the vaccine itself and are completely willing to vaccinate to schedule all the vaccines, at all the proper times, may read this and say, I am afraid now that the person who is administering it is going to do it wrong.

            • Dorit Reiss

              Because without writing this, people would not be aware that someone giving an injection can do a bad job and cause hurt?

  • Maxwell Killion

    My point is she says the system works, “easily”. The government clearly even admits it’s flawed. How would Dorit know how the VICP works easily or not, she wouldn’t know an adverse reaction to a vaccine if it happened to her. She would just blame it on the the injection OF the vaccine not the vaccine. She would find something else to blame it on. I guess you think it’s fine that the government thinks your life is worth 250,000.00 TOPS, I personally have a problem with that. Dorit even admitted it should be more. Also if there aren’t any deaths, there wouldn’t be a specific amount to pay in event of a death.

    • I don’t believe that $250,000 is “tops.” And since there are no deaths, it’s kind of a specious claim.

    • Dorit Reiss

      Why do you need to understand what an adverse reaction is to understand whether an administrative adjudication system is easy to win through? NVICP is not perfect; it’s still much easier to be compensated there than in the court, and even easier when claiming a Table Injury.

      You seem to find the distinction between the content of the vaccine and the way it’s administered confusing or troubling. Would you like to explain what exactly isn’t clear to you?

      I agree that the 250,000 cap on death should be raised – but VICP can’t change that: that’s up to Congress. I would point out that caps on damages are pretty common in state law, in torts and also in workers compensation – which is the closest comparison. As in workers’ compensation, it’s part of the compromise – petitioners have an easier time winning a case, but damages are limited.

  • Maxwell Killion

    What GAO Found

    Most of more than 9,800 claims filed with the National Vaccine Injury
    Compensation Program (VICP) since fiscal year 1999 have taken multiple years
    to adjudicate (see fig.). More than 1,000 (11 percent) of claims filed since fiscal
    year 1999 were still in process (pending) as of March 31, 2014; most of these
    were pending for 2 years or less. A greater percentage of the claims filed since
    fiscal year 2009 were resolved within 1 or 2 years. In all but 1 year since fiscal
    year 2009, the program has met the target for the average time to adjudicate
    claims (about 3.5 years) tracked by the Department of Health and Human
    Services (HHS), which administers the program. Officials from the U.S. Court of
    Federal Claims (USCFC), where VICP claims are adjudicated, report that delays
    may occur while petitioners gather evidence for their claims. Since 2006, about
    80 percent of compensated claims have been resolved through a negotiated
    settlement.

    • And your point is?

    • Dorit Reiss

      Thank you for highlighting that since 2009, the program worked hard to overcome its backlog and improved dramatically. And that many of the delays are because it takes petitioners time to prepare their case.

      The post above did not claim the program is perfect; it’s still much better for petitioners than having to prove their case in the court of justice.

  • Maxwell Killion

    This is the link to how “easily” the Vaccine Injury Compensation program is, assessed from the US Government Accountability Office in 2014. http://www.gao.gov/assets/670/667136.pdf

    • And your point is what?

    • Dorit Reiss

      Here is my analysis of this report. It actually does show the system mostly works. http://shotofprevention.com/2014/12/09/government-accountability-office-report-on-vaccine-injury-compensation/

      “The report’s conclusion highlights changes in the program. For example, most claims now are off-table injuries, and it’s not clear how adding injuries to the table will mean that more claims settle. The report highlights that addressing one criticism – the statute of limitations – requires statutory change and points out the importance of increasing awareness.

      But while the GAO report suggests areas where change is either in progress or needed, it’s hardly a condemnation of the program. It highlights a program that is not perfect, but is mostly working. And it indicates that the department in charge – HHS – is aware of the challenges and is working on areas that need improvement. If anyone hoped that examination by the GAO would lead to aggressive condemnation of VICP, they are going to be disappointed. There is no evidence of corruption in the report; there is no evidence of systematic mistreatment of petitioners; problems – like delays – are addressed and explained, and generally, the report does not suggest that VICP requires a dramatic overhaul.”

  • Maxwell Killion

    United States Government Accountability Office

    Report to the Chairman, Committee on
    Oversight and Government Reform,
    House of Representatives

    VACCINE INJURY
    COMPENSATION

    Most Claims Took
    Multiple Years and
    Many Were Settled
    through Negotiation

  • Maxwell Killion

    Also it isn’t about “getting” anything if a child dies, nothing can compensate you for the loss of a child, it’s that your wonderful vaccine compensation program is INSULTING. The fact that you lost a child and they give you 250,000.00 for it is INSULTING.

    • There is no evidence whatsoever that any child has ever died from vaccines as far back as 1990.

      Bring one single piece of evidence that ANY child has died, as published in a real peer-reviewed journal, and you may have a point. But good luck with that spamming spammer who spams.

    • Dorit Reiss

      It’s true that if your child dies there is no way to bring the child back. That’s why we vaccinate: to protect children’s health and life. The very, very rare vaccine injury is a very small risk compared to the risk of the disease.

      Further, I’m not sure why you think that’s a point against VICP. I’m not sure why the fact that nothing can bring a child back means that we shouldn’t compensate the parents for their loss. Our whole tort system is built on compensating for, among other things, unfixable losses. Money won’t bring back your arm lost in an accident, but it can help your life. The parents who lost a child are better compensated than not compensated. That’s another difference: parents who can suggest a connection to the vaccine – even if their evidence is flawed and limited – get compensated. Parents who lost their child because they didn’t vaccinate and the child got influenza, a pneumococcal infection, Hib, measles get nothing.

  • Maxwell Killion

    “Although the injuries were caused by the flu vaccination, they were not caused by the vaccine itself.” You said the injuries were not caused by the vaccine itself. You are trying to dismiss any claims that vaccines can cause adverse reactions by pointing out that it could actually be the injection and in that case, you wouldn’t report the “vaccine” to VAERS to start the claim process. Not sure if you read the link I provided but it actually is the government assessing the program and coming to the conclusion and admitting their own program is very very flawed. I think you bring up a very good point (so to speak) and that is to stop blaming the vaccines and going through this compensation program, and go after the doctors themselves who vaccinate irresponsibly (children with jaundice and underlying conditions in which they should have been concerned and cautious about) and file malpractice suits because they aren’t protected when it wasn’t the actual vaccine that caused the harm or reaction but the irresponsibility of the doctor. I think that is a great point. Honestly the vaccines are only proven safe for healthy people and if a doctor has any question as to the health of a child, they probably shouldn’t be vaccinating them anyway and if they do, they should be sued.

    • We don’t say that. The science says that. But good luck with your logical fallacies and spamming.

      • Ethyl

        Funny this should come up. I just got done listening to a video where Polly Matzinger claimed the shots were given deep in the deltoid to hide the damage, that if a parent saw the damage it did, they would never bring them back again. Then again, she no longer works for the NIH in the immunology department.

        Haven’t nodules had to have been cut out in order for the injection site to heal? Seems I remember reading that.

    • Dorit Reiss

      Most people realize the difference between problems with the injection process – something which can happen with any needle – and problems with the vaccine content. Doesn’t mean we shouldn’t work on better administering, but it’s not the same type of problem as saying vaccines are harmful or, as you say, proven safe only for healthy people and should only be given to the healthy.

      I’m not sure why you think that children with health problems don’t deserve protection from preventable diseases. If anything, I’d think they need it more.

      • Maxwell Killion

        Because the vaccines are not tested on children with health problems and if they aren’t tested on them they can’t and are not proven safe for them.

        • Maxwell Killion

          You can consent to vaccinate your jaundice new born (who is having difficulty expelling toxins through their liver) if you choose. Or choose to vaccinate your children with vaccines that are “recommended” but not necessary for everyone, that’s your right and go for it if you think it’s the best thing to do, you know best for your children. I do however thank the heavens that you aren’t making the decisions for everyone.

  • Sandy Perlmutter

    Interesting! I actually knew someone whose arm hurt that way after the flu shot. We didn’t know you could file a claim about it, however.

    I would love to know why they give this shot in the relatively small (especially in small women) deltoid muscle when they could give it in the huge gluteus maximus. It seems to me that we used to get a lot of shots there as children. Modesty aside, it is easy for even the most inexperienced nurse to hit. Even regarding modesty, there need not be a large exposure to get to this muscle.

    • Vaccines need to be delivered intramuscularly to induce the maximum immune response. The gluteus maximus has a very thick fat layer, so depending on the person, you might need to use a very long, and frankly, a very scary needle.

      The deltoid muscle is the most accessible for a healthcare worker.

      • Sandy Perlmutter

        My biceps muscle is much more accessible!

        • I’m going to say that that’s not necessarily true. There’s a layer of subcutaneous fat (not insult intended, it’s just a fact for almost all men and women) around the bicep. The deltoid is just very easily identified, and the injection spot should be easy.

          Let’s remember, SIRVA is very rare. None of us should really worry about it.

          • Sandy Perlmutter

            If a close friend had not had this problem, I would not have thought about it. But I was there — we received the flu shot at work. It has not stopped me from getting flu shots, though.

            The skills of some of our health care workers vary a lot! Once I got this shot, and the worker withdrew the needle while still pressing on it, leading to a stream of vaccine going into the air. I didn’t say anything. Now I get my shots at CVS.

  • Maxwell Killion

    Dorit this article is a very weak attempt to uphold your belief that the Vaccine Compensation Program works. It’s a joke, you know it and if you with your legal expertise think this is a working system you have none. Your argument that vaccine didn’t cause the adverse reaction the vaccination did, is a clever twist and may indeed be true, but it also proves that NO ONE should be forced to get them whether it’s the vaccine or the person giving is doing it wrong. Honestly I have more faith in vaccine than I do withe people giving them, considering that medical mistakes are the 3RD LEADING CAUSE of death in the US. Also if it’s not the vaccine it shouldn’t be presented to vaccine court, it should be a malpractice suit against the person giving the vaccine. All your article did for me was confirm that now there are two things to worry about, the possible effect from the vaccine and the fact that the person administering it may be incompetent. I think that you bring up a great point, and that is that doctors should not be exempt if it has to do with a vaccine, from what you are saying these reactions we see may be because the doctors are injecting people wrong and they have no liability or accountability. I am pretty sure if they were liable you would see A LOT more medical exemptions given out. Here’s a little ditty on how efficient vaccine court is. http://www.gao.gov/assets/670/667136.pdf. Also another fun fact about the vaccine injury compensation program is that if you die they have a cap on the payment at 250,000.00 I think I am worth more than that personally. I also think my children are worth more than that to me.

    • Dorit Reiss

      The article, if you notice, did not say the vaccine did not cause the injury. It points out the reaction has nothing to do with the content of the vaccine, but with problems with injection. Any injection can cause it. And appropriately, if it happens, people are compensated.

      In contrast, if people die from a disease they were not vaccinated against, there is no compensation.

      If anything, it shows NVICP works – compensates where appropriate easily.

      I agree that it’s appropriate to raise the death cap. That does not negate the value of NVICP. And again: if your child dies from flu, measles, etc’ – much, much more likely than vaccine – you get nothing.

      Of course, adults are not forced to get vaccines. And children have no choice either way. If their parents do not vaccinate them, they are forced to bear the risk of the disease.

      • Sia

        Dorit Reiss, if I’m understanding this article correctly, SIRVA is really more malpractice-related than vaccine-content-related, yes?

        • Dorit Reiss

          I think that’s a fair description, yes. If you’re asking whether the act covers malpractice, it covers any vaccine injury suit v. provider or manufacturer – whether based on negligence or product liability: https://www.law.cornell.edu/uscode/text/42/300aa-11. My reading of section 300aa-21 is that for doctors, you can sue in the courts if you’re unhappy with the NVICP resolution. But I don’t know of a case that tested this.

          I may be reading more into your comment than you intended.