Compensation Growing for Botched Vaccine Administration

SEPTEMBER 09, 2015
Meghan Ross, Associate Editor
The US Department of Health and Human Services (HHS) is making it easier for patients with shoulder injury related to vaccine administration (SIRVA) to be compensated for their pain.

HHS recently made revisions to its vaccine injury table, which lists and explains potential injuries presumed to be caused by vaccines.

Citing scientific evidence demonstrating a causal relationship between a vaccine injection and deltoid bursitis, HHS Secretary Sylvia Mathews Burwell suggested adding “a more expansive injury of SIRVA” to the table.

There is also evidence of patients experiencing shoulder pain after getting vaccinated against tendonitis, impingement syndrome, frozen shoulder syndrome, and adhesive capsulitis, HHS noted.
“In order to capture the broader array of potential injuries, the Secretary proposes to add SIRVA for all tetanus toxoid-containing vaccines that are administered intramuscularly through percutaneous injection into the upper arm,” the agency stated.

With these changes, patients diagnosed with SIRVA may receive compensation 12 to 18 months faster, according to a report published in Wired.

How to Prevent SIRVA

SIRVA is thought to occur when a vaccine is incorrectly injected too high on the shoulder. Patients diagnosed with SIRVA have an onset of pain within 48 hours, limited mobility in the shoulder, and no prior history of shoulder pain.

In 2006, a pair of researchers published their findings in Vaccine on shoulder pain and weakness following influenza and pneumococcal vaccine injections administered high into the deltoid muscle. They posited that the injections caused periarticular inflammatory response, subacromial bursitis, bicipital tendonitis, and adhesive capsulitis.

“We conclude that the upper third of the deltoid muscle should not be used for vaccine injections, and the diagnosis of vaccination-related shoulder dysfunction should be considered in patients presenting with shoulder pain following a vaccination,” they wrote.

One of the researchers involved in the study, Marko Bodor, MD, told Wired that vaccine administrators must “feel where the needle is.”

“You feel it pop through the skin,” Dr. Bodor said. “The fat is like butter, and the muscle like steak.”

Dr, Bodor noted that patients who receive vaccines at a pharmacy may be pulling their shirt down just a little, which could lead the pharmacist to administer the vaccine higher up on the shoulder. In contrast, patients receiving vaccinations in a physician’s office may be dressed in a gown, which would allow for more space to administer the vaccine.

However, SIRVA cases have popped up in all settings, including well-regarded medical centers, Wired noted. 

In an article titled “Vaccine Administration: Preventing Serious Shoulder Injuries,” authors Stephan Foster, PharmD, FAPhA, FNAP, and McLisa V. Davis, PharmD, recommended that pharmacists make injections at a 90-degree angle in the thickest and most central part of the deltoid muscle to prevent injury.

“Health professionals need to remain knowledgeable about the anatomy of the shoulder to avoid injecting too high,” the authors noted. “Further, reviewing current recommendations for intramuscular injections helps ensure that proper technique is used.”