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Shoulder Injury Related to Vaccine Administration or SIRVA, SIRVA

Why Are Shoulder Injuries Related to Vaccine Administration So Common?

Shoulder injuries related to vaccine administration (SIRVA) are among the most common types of vaccine-related injuries. In fact, by many accounts, they are the single most common type of injury resulting from immunization in the United States.

Through the first 10 months of 2022, we helped 77 individuals and families obtain financial compensation under the VICP. Of the 77 VICP claims we resolved from January through October, 67 involved claims for SIRVA. Our VICP claim statistics have been similar in prior years. So, why is this the case?

Understanding Shoulder Injuries Related to Vaccine Administration

To understand why shoulder injuries related to vaccine administration (SIRVA)are so common, it first helps to understand these injuries themselves. The term “SIRVA” refers not to a single type of injury but rather a group of injuries that can result from nerve and soft tissue damage during the vaccine administration process. The different types of SIRVA include:

  • Adhesive capsulitis (frozen shoulder)
  • Brachial neuritis
  • Rotator cuff tears
  • Shoulder bursitis
  • Tendonitis

Another important fact to understand about SIRVA—and one of the main reasons why SIRVA are so common—is that these injuries are not specific to any individual vaccine. While most types of vaccine injuries result from adverse reactions to vaccine ingredients, SIRVA result from errors during vaccine administration. This means that SIRVA is a risk with all vaccines administered via shoulder injection, including the CDC-recommended vaccines against:

  • Diphtheria, tetanus and pertussis
  • Haemophilus influenzae type b (Hib)
  • Hepatitis A and B
  • Human papillomavirus (HPV)
  • Influenza (flu)
  • Measles, mumps and rubella
  • Meningitis
  • Pneumonia
  • Polio
  • Rotavirus
  • Varicella (chickenpox)

Understanding the Many Potential Causes of SIRVA

In addition to the fact that all vaccinations administered via shoulder injection present a risk for SIRVA, another factor contributing to the prevalence of these injuries is the fact that they can result from multiple different types of errors during vaccine administration. For example, vaccine-related shoulder injuries can result from administration errors including:

1. Failure to Provide Proper Instructions

When administering vaccines, the medical professionals who perform vaccinations need to provide proper instructions to vaccine recipients. A common cause of SIRVA involves instructing or allowing vaccine recipients to pull their collars down over their shoulders instead of rolling up their sleeves to expose their upper arm. This can not only result in incorrect needle placement, but it can also restrict the medical professional’s ability to administer the vaccine correctly.

2. Using the Wrong Size Needle

Vaccine administrators must use different size needles for different individuals. Using a needle that is either too short or too long for a particular patient can lead to SIRVA. For example, when administering intramuscular injections, the appropriate needle length for a child can be as short as 5/8 of an inch, while the appropriate length for an adult can be as long as 1.5 inches. The appropriate gauge, or width, of needles used for vaccination can vary as well.

3. Inserting the Needle at the Wrong Angle or To the Wrong Depth

Generally, during vaccine administration, the needle should be inserted at a 90-degree angle to the surface of the skin. Inserting the needle at an angle of less than 90 degrees risks causing subcutaneous damage that can result in various forms of SIRVA.

Inserting the needle to the wrong depth can also cause vaccine-related shoulder injuries. While this most often involves inserting the needle too deep (resulting in nerve or soft tissue damage), inserting the needle to too shallow of a depth below the surface of the skin can cause problems as well.

4. Administering the Vaccine Too High on the Shoulder

When administering vaccines via shoulder injection, the proper location for insertion of the needle is as close to the center of the deltoid muscle as possible. This is the muscle located on the outside of the shoulder at approximately chest height. Administering vaccines too high on the shoulder, above the deltoid muscle, is a common cause of SIRVA. In many cases, this results from the vaccine administrator providing improper instructions, as discussed above.

5. Administering the Vaccine Too Low on the Arm

Administering the vaccine too low on the arm is also a common cause of SIRVA. When the needle is inserted below the deltoid muscle, this significantly increases the risk of nerve or soft tissue damage, as there is generally less muscle mass in this area. Improper instructions are a frequent factor in these cases as well, with the medical professionals who administer vaccines failing to instruct vaccine recipients to fully expose their upper arm.

The Vaccination Errors That Lead to SIRVA are Preventable

As the Children’s Hospital of Philadelphia explains, “SIRVA (shoulder injury related to vaccine administration) is preventable by paying careful attention to the anatomical landmarks for correct placement in the deltoid.” In other words, there is no excuse for SIRVA. Yet, these preventable injuries remain exceedingly common.

Several resources for proper vaccine administration are available. These include a guide on How to Administer Intramuscular and Subcutaneous Vaccine Injections to Adults and a Skills Checklist for Vaccine Administration published by Unfortunately, despite the fact that these resources exist, it is clear that some vaccine administrators lack a clear understanding of proper immunization practices, and, in many cases, vaccine administrators rush when they should be taking the time to ensure that they are injecting patients correctly.

But, for most vaccine recipients who receive SIRVA diagnoses, proof of negligence is not required to recover financial compensation. The National Vaccine Injury Compensation Program (VICP) covers SIRVA from most CDC-recommended vaccines without evidence of fault. Vaccine recipients and their families can file VICP claims to recover their medical expenses and other losses, and they can hire a lawyer to handle their claims at no cost.

Talk to a Lawyer About Filing a Claim for SIRVA

If you or a loved one has been diagnosed with SIRVA, we strongly encourage you to contact us for more information about the VICP. To discuss your family’s legal rights with experienced vaccine attorney Leah V. Durant in confidence, please call 202-800-1711 or tell us how we can reach you online today.

Leah Durant Bio

Experienced litigation attorney Leah Durant focuses on representing clients in complex vaccine litigation matters. Leah Durant is the owner and principal attorney of the Law Offices of Leah V. Durant, PLLC, a litigation firm based in Washington, DC. Leah Durant and her staff represent clients and their families who suffer from vaccine-related injuries, adverse vaccine reactions and vaccine-related deaths. The Law Offices of Leah V. Durant, PLLC is dedicated to assisting individuals in recovering the highest level of compensation as quickly and efficiently as possible. To learn more, contact vaccine attorney Leah Durant today.

About Leah Durant

Leah Durant is a former U.S. Department of Justice trial attorney who specializes in vaccine injury claims covered by the National Vaccine Injury Compensation Program. These cases are filed before the U.S. Court of Federal Claims (more commonly known as the “vaccine court”) in Washington, DC, where she has been admitted to practice since 2008. Originally from the Pacific Northwest, Leah Durant is a graduate of the University of Maryland College Park and received her law degree from the University of Maryland School of Law. Leah Durant’s legal practice concentrates on litigating complex vaccine injury and medical related cases. She has an extensive legal background and has experience representing individuals with complex medical claims.


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