Avoiding shoulder injury related to vaccine administration

Shoulder injury related to vaccine administration (SIRVA) is a rare complication of incorrect vaccine administration, when the vaccine is given too high into the shoulder joint. This can cause shoulder pain and restricted range of movement. Diagnoses include bursitis, tendinitis and rotator cuff tears. Bursitis is the most commonly reported diagnosis on ultrasound. Symptoms often begin at the time of injection and can last from weeks to years.

Correct injection technique and positioning will avoid SIRVA.

• Step 1: Choose the correct size needle
  • Use an appropriate needle length to improve vaccine delivery and reduce pain.
  • Use 22–25 gauge, 25 mm long needle for child or adult – note that the deltoid muscle is not recommended for vaccination of infants less than 12 months of age. 
  • Use 22–25 gauge, 38 mm long needle for a very large or obese person 
• Step 2: Expose the entire upper arm
• Step 3: Find the correct injection site using either the triangle or fingertips method
• Step 4: Relax the muscle
• Step 5: Insert the needle at 90° to the skin, to the needle hub
• Step 6: Inject the vaccine

Reporting SIRVA

If a vaccinee reports symptoms suggestive of SIRVA, advise them to see their general practitioner to discuss further assessment, investigation and management, as required.

Report all cases of SIRVA to the Therapeutic Goods Administration (TGA) and the state or territory health department: https://aems.tga.gov.au