Shoulder Injury Related to Vaccine Administration (‘SIRVA’) is a term used to describe one of a number of possible injuries sustained to the shoulder following the administration of an intramuscular vaccine such as the seasonal flu vaccine, Tetanus vaccine and DTP (tetanus, diphtheria and pertussis (whooping cough)).
These injuries, which are often preventable, are caused by the administration of the vaccine into the shoulder joint rather than the deltoid muscle and they are usually the result of poor or substandard technique. These injuries can also be caused by an autoimmune response to a component of the vaccine.
When a vaccine is incorrectly administered into the shoulder joint, instead of the deltoid muscle, an inflammatory process is triggered causing damage to ligaments, tendons and bursae. The most common symptoms of a SIRVA are shoulder pain (which can be severe), inflammation and reduced/restricted mobility.
The symptoms of a SIRVA usually begin within 48 hours of the administration of the vaccine which distinguishes them from other shoulder injuries. Over-the-counter pain relief, which can be bought from a pharmacy without a prescription (such as Ibuprofen) does not improve the symptoms.
The injury sustained by the recipient of the vaccine can range from any of the following:
- Frozen shoulder
- Rotator cuff injury
- Nerve injury (in rare cases)
Individuals who sustain a SIRVA are usually referred to an orthopaedic expert for diagnosis and treatment; surgery (depending on the extent of the injury) is sometimes required.
Guidance for immunisation procedures for medical staff is set out in chapter 4 of the Green Book.
Page 29 confirms that for intramuscular injections, the needle needs to be sufficiently long to ensure that the vaccine is injected into the muscle. Page 30 states that intramuscular injections should be administered with the needle at a 90 degree angle to the skin.
In instances where vaccine technique is poor or substandard, this can amount to breach of duty and an individual who sustains a SIRVA may have a clinical negligence claim.
A SIRVA can have a big impact on the life of an individual who has sustained this injury. They may be unable to work to the severity of the pain and restriction of their mobility and will therefore lose earnings due. They may require care and assistance with housework and shopping and also with personal tasks such as dressing and washing. They may not be able to drive and they may also be unable to participate in sports, hobbies and activities that they had enjoyed prior to their vaccination. The impact of the injury and any financial losses will all be taken into account as part of a clinical negligence claim.
The seasonal flu vaccine is given to millions of people throughout the world and although there is a risk of sustaining a SIRVA, it is a rare injury. It is however essential that medical professionals are trained and fully aware of the correct techniques for administering vaccines in order to stop these debilitating injuries from occurring.