Shoulder injury related to vaccine administration

Shoulder injury related to vaccine administration (SIRVA) is "shoulder pain and limited range of motion occurring after the administration of a vaccine intended for intramuscular administration in the upper arm . . . thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle into and around the underlying bursa of the shoulder".[1][2]

SIRVA has been described as under-reported and preventable, and "caused by incorrect technique or landmarking for intramuscular deltoid injections".[3] Because the injury is a result of the injection technique rather than the substance injected, SIRVA can occur irrespective of the vaccine being administered. Although the injury is typically associated with vaccination, it can also occur as the result of any other kind of injection into the shoulder area. However, examination of injury reports suggests that this type of injury is of increased severity when administration of a vaccine is involved, which "may be due either to the antigenic or nonantigenic components of the vaccine".[4] In order to avoid this type of injury, injection administrators are advised to avoid injecting the patient too high, too low, or too far to the side, and to avoid using needles that fail to penetrate deeply into the muscle, or that penetrate too deeply and contact the bone.[3]

Cause

SIRVA is not caused by any specific medicine that is in an injection. Instead, it is caused by improper insertion of the needle used in injections. It is "a preventable occurrence caused by the injection of a vaccine into the shoulder capsule rather than the deltoid muscle. As a result, inflammation of the shoulder structures causes patients to experience pain, a decreased range of motion, and a decreased quality of life."[5]

Treatment

"Treatment for SIRVA is the same as treatment for routine inflammatory injuries."[5] People who suffer from SIRVA typically require physical therapy, pain management medications, and in some severe cases, surgery.

Compensation

In the United States, SIRVA was added to the list of compensable injuries on the Vaccine Injury Table used by the National Vaccine Injury Compensation Program in 2017.[6][7] This inclusion allows persons claiming an injury to seek compensation from a government fund set up under the program, while immunizing vaccine manufacturers and administrators from legal liability. In April 2020, however, the U.S. Department of Health and Human Services began considering a proposal to remove the injury from that table, following a substantial increase in the number of claims asserting this injury.[8][9]

References
  1. Brian Dean Abramson, Vaccine, Vaccination, and Immunization Law (Bloomberg Law, 2019), 8-5.
  2. VAERS Table of Reportable Events Following Vaccination (as of March 21, 2017).
  3. Bancsi, Ashley; Houle, Sherilyn K.D.; Grindrod, Kelly A. (Jan 2019). "Shoulder injury related to vaccine administration and other injection site events". Canadian Family Physician. 65 (1): 40–42. PMC 6347325. PMID 30674513.
  4. Barnes, Matthew G.; Ledford, Christopher; Hogan, Karen (2012). "A "Needling" Problem: Shoulder Injury Related to Vaccine Administration". Journal of the American Board of Family Medicine. 25 (6): 919–922. doi:10.3122/jabfm.2012.06.110334. PMID 23136333.
  5. Bancsi, Ashley; Houle, Sherilyn K.D.; Grindrod, Kelly A. (January 2019). "Shoulder injury related to vaccine administration and other injection site events". Canadian Family Physician. 65 (1): 40–42. ISSN 0008-350X. PMC 6347325. PMID 30674513.
  6. Brian Dean Abramson, Vaccine, Vaccination, and Immunization Law (Bloomberg Law, 2019), 9-7.
  7. 82 Fed. Reg. 6294 (January 19, 2017).
  8. Wadman, Meredith (April 2, 2020). "United States wants to end most payouts for leading vaccination-related injury". Science.
  9. Fleischer, Jodie; Yarborough, Rick; Piper, Jeff (April 20, 2020). "Feds Quietly Seek to Remove Leading Cause of Vaccine Injuries From Federal Payout Program". WRC-TV. Retrieved May 17, 2020.


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