During influenza vaccination season, and at all times of the year, it is critically important that clinic staff who administer vaccines avoid injury to patients’ shoulders by being knowledgeable about how to properly administer intramuscular injections in the deltoid muscle.

At the October 2017 Advisory Committee on Immunization Practices meeting, a presentation titled “Reports of Shoulder Dysfunction Following Inactivated Influenza Vaccine in the Vaccine Adverse Event Reporting System (VAERS), 2010–2016”, included the following background information about shoulder injury related to vaccine administration (SIRVA):

  • Definition: SIRVA is caused by injury to the musculoskeletal structures of the shoulder (e.g., tendons, ligaments, bursae, etc.)
  • It manifests itself as shoulder pain and limited range of motion occurring after a patient receives a vaccine intended for intramuscular administration.
  • These symptoms are thought to occur as a result of unintended injection of vaccine antigen or trauma from the needle going into and around the underlying bursa of the shoulder, resulting in an inflammatory reaction.

SIRVA may result in patients having chronic shoulder pain and limited range of motion, and require ongoing medical intervention.

To avoid SIRVA, make sure clinic staff who administer vaccines recognize the anatomic landmarks for identifying the deltoid muscle and use proper intramuscular administration technique.

Helpful resources to assist with staff education

IAC resources

CDC resources

Materials in this section are updated as new information and vaccines become available. The Vaccine Education Center staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family's personal health. You should not use it to replace any relationship with a physician or other qualified healthcare professional. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult your physician or, in serious cases, seek immediate assistance from emergency personnel.