Shoulder injury following COVID-19 vaccine administration: a case series and proposed diagnostic algorithm

ABSTRACT

Background

Shoulder Injury Related to Vaccine Administration (SIRVA) is a preventable adverse event following incorrect vaccine administration, which can result in significant long-term morbidity. There has been a notable surge in reported cases of SIRVA as a rapid national population-based COVID-19 immunization program has been rolled out across Australia.

Methods

Surveillance of Adverse Events Following Vaccination in the Community (SAEFVIC) in Victoria identified 221 suspected cases of SIRVA following the commencement of the COVID-19 vaccination program, reported between February 2021 and February 2022. This review describes the clinical features and outcomes of SIRVA in this population. Additionally, a suggested diagnostic algorithm is proposed, in order to facilitate early recognition and management of SIRVA.

Results

151 cases were confirmed as SIRVA, with 49.0% having received vaccines at state vaccination centers. 75.5% were suspected incorrect administration site, with most patients experiencing shoulder pain and restricted movement within 24 hours of vaccination, lasting on average 3 months.

Conclusion

Improved awareness and education regarding SIRVA is imperative in a pandemic vaccine roll-out. The development of a structured framework for evaluating and managing suspected SIRVA will aid in timely diagnosis and treatment, essential to mitigate potential long-term complications.

KEYWORDS:

• COVID-19 vaccine
• SIRVA
• shoulder injury
• vaccine adverse event
• vaccine complication

Article highlights

• There has been an increase in cases of SIRVA following mass COVID-19 immunization programs in Australia.

• A standardized diagnostic modality will aid in early recognition of SIRVA

• SIRVA has the potential to cause significant morbidity

• Ongoing efforts are required to formulate treatment guidelines for SIRVA

Acknowledgments

The SAEFVIC nursing team for their assistance and support in clinical surveillance of patients.

This work has been presented as an oral presentation at the CDIC 2022 and IPA 2023 conferences.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.