Shoulder injury related to vaccine administration (SIRVA) can occur when an intra-muscular vaccine is delivered to an unintended site - tendon, ligament, bursa, nerve or periosteum.

Signs and symptoms:

(1) shoulder pain

(2) reduced range of motion

(3) numbness, tingling or paresthesia

(4) swelling or erythema

(5) weakness


Risk factors:

(1) female sex

(2) influenza vaccine

(3) performed at pharmacy or doctor's office

(4) administration error


Administration errors:

(1) injection too high

(2) extremely painful

(3) hit bone

(4) improper technique

(5) difficult administration

(6) injection too deep

(7) wrong site

(8) wrong needle length

(9) hit nerve

(10) vaccinator not looking


It is important to separate an adverse effect due to the vaccination from a pre-existing shoulder disorder. For example, a rotator cuff tear is difficult to explain as being due to vaccination

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