Shoulder pain, soreness or tenderness are all common side effects that may be experienced following a vaccine injection. In some cases, however, improper administration of intramuscular vaccines, particularly above the deltoid muscle can result in a more severe vaccine injury, commonly known as SIRVA or Shoulder Injury Related to Vaccine Administration.
SIRVA is caused by an injury to the musculoskeletal structures of the shoulder (i.e.: tendons, ligaments, bursa) due to the improper administration of a vaccine. The most common cases of SIRVA occur in patients who received a seasonal flu shot because the vaccine is given in the deltoid muscle of the arm. In those patients who suffer from SIRVA, many report that the vaccine administration was “too high” into the deltoid muscle. Symptoms of SIRVA typically occur in patients in the days or weeks following the injection. It is important to note that SIRVA is caused by the injection or administration of the vaccine itself, not from the contents of the vaccine being administered. Symptoms of SIRVA include prolonged shoulder pain, limited range of use, fluid collections in the deep deltoid or overlying the rotator cuff tendons, shoulder tendonitis, shoulder bursitis, fluid buildup within the bursa, or rotator cuff tears. Cases of SIRVA have also been associated with Adhesive Capsulitis following an injection. The following is an article published by the Journal of American Pharmacists Association. The article provides important information for medical providers and vaccine administrators for how to prevent shoulder injuries related to the improper administration of vaccines.
Erroneous administration of intramuscular vaccines, particularly above the deltoid muscle, can result in serious shoulder injuries and diminished vaccine efficacy. With few studies published addressing injection technique before 2002, inconsistencies arose regarding optimal vaccine administration, thus causing variations in current practice. We will examine cases of serious shoulder injuries as a result of incorrect technique and provide a step-by-step guide to the proper administration of intramuscular injections.
In 2006, Bodor and Montalvo reported two cases of vaccine-related shoulder dysfunction. One patient received the 23-valent pneumococcal vaccine and the other an influenza vaccine. Both patients reported receiving injections high into the deltoid muscle, within 1 to 2 cm of the acromion. Both patients noticed severe shoulder pain and loss of range of motion within 2 days and increasing pain during a period of 2 to 5 months. One patient was diagnosed with subacromial bursitis that later progressed to adhesive capsulitis or frozen shoulder; the other was diagnosed with bicipital tendonitis, subacromial bursitis, and a mild C6 sensory radiculopathy. The authors recommended that guidelines specify avoiding vaccine injections in the upper third of the deltoid muscle. They recommended that health professionals consider vaccine-related shoulder dysfunction in patients presenting with shoulder pain and weakness following a vaccine injection.
Atanasoff et al. reported a series of 13 cases submitted to the Vaccine Injury Compensation Program between 2006 and 2010, in which patients experienced shoulder injury related to vaccine administration. Of the cases, 62% received influenza vaccine and the remainder received tetanus–diphtheria toxoids, Td–acellular pertussis, or human papillomavirus vaccine. The proposed mechanism of injury was that vaccine, an antigenic substance, injected into synovial tissue resulted in an immune-mediated inflammatory response. Of patients, 46% stated that the vaccine was injected “too high” into th