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Vaccines have greatly reduced, and even completely eliminated, many infectious diseases in the United States and across the world.

Scientists estimate that the first rounds of COVID-19 vaccines administered between December 2020 and December 2021 prevented 20 million deaths in 1 year. According to the World Health Organization (WHO), vaccines routinely prevent four to five million deaths per year from other serious diseases, including polio, whooping cough, measles, and the flu.

Yet one of the most common complaints from people who’ve received a vaccination is soreness in the upper arm or shoulder where they receive the vaccination.

Most of the time, this soreness is mild and will go away without treatment in a few days. However, you may sometimes experience more severe side effects related to vaccination in the upper arm, including intense shoulder pain and limited range of motion.

The most common side effects from vaccination, including the COVID-19 vaccines and boosters, are mild.

It’s very common to experience some temporary soreness where you receive an injection. But an estimated 1 to 2 million people who are vaccinated each year with just the flu shot experience severe shoulder pain and limited range of motion. That number is larger when factoring in all the various vaccinations beyond just the flu vaccine. The number is also expected to grow as vaccination numbers increase worldwide.

Such severe reactions to vaccines are very rare, but they do occur.

One condition that may result is known as shoulder injury related to vaccine administration (SIRVA). This can occur within 48 hours of vaccination.

Symptoms may include:

SIRVA can result in chronic or sometimes permanent injury to the arm and shoulder. Some studies have found that the symptoms of SIRVA may last at least 6 months.

Most cases of SIRVA appear to be caused by poor needle placement by the person administering the vaccine or a localized reaction to the vaccine serum.

The Immunization Action Coalition (IAC) provides information on vaccine administration based on the Advisory Committee on Immunization Practices (ACIP) guidance:

  • The ideal placement for a vaccine in the upper arm is in the central and thickest part of the upper arm’s deltoid muscle. This location should be above the level of your armpit when your arm is held straight by your side.
  • It should be 2 to 3 fingerbreadths (the width of your fingers when held together) down from your acromion process — the bony part of your shoulder above your deltoid muscle.
  • The vaccine should be injected just into the surface of the muscle, not injected too deep.
  • To avoid injury, it’s important not to inject the vaccination too high or too low on the upper arm. Medical professionals can avoid causing their patients unnecessary and avoidable harm by staying up to date on their vaccination knowledge and by practicing proper vaccination techniques, including correct placement.
  • It’s also important for medical professionals to be aware of SIRVA so that patients may be treated in a timely, effective manner.

For most people, getting a vaccine is a simple procedure that causes few if any side effects. Some people may experience the following effects after receiving a vaccine:

  • a low grade fever
  • headache
  • chills
  • nausea
  • fatigue
  • redness, swelling or bruising at and around the injection site.

SIRVA symptoms usually arise within 48 hours of vaccination.

Symptoms are severe if they’re persistent and do not resolve with taking over-the-counter pain medications. If your shoulder pain is intense and doesn’t resolve on its own within a week of vaccination, you should make an appointment with a doctor.

Diagnosing SIRVA can be challenging, as shoulder pain is a common symptom shared by a variety of medical conditions. What makes SIRVA different from other shoulder injuries is its association with vaccination.

A SIRVA diagnosis can involve a medical professional:

  1. performing a physical examination and requesting a focused medical history, including history of vaccinations
  2. ordering magnetic resonance imaging (MRI), which can show the extent of damage to the tendons and muscles caused by SIRVA and help inform treatment
  3. possibly recommending medical imaging of your shoulder to get a definitive diagnosis of SIRVA

SIRVA can be painful and even debilitating, but treatment is available. Often, SIRVA treatment includes one or more of the following:

  • a course of prescription anti-inflammatory medication, such as an NSAID or oral steroid
  • physical therapy to help alleviate pain and increase range of motion
  • steroid injections
  • surgery

The exact treatment a person receives differs from person to person, depending on their symptoms.

Vaccines have worked to significantly reduce disease in many parts of the world.

Most people do not experience any serious lasting side effects as a result of vaccination. However, in rare cases when a vaccine is administered improperly, a person may experience more severe symptoms, including intense shoulder pain classified as SIRVA.

While SIRVA may be long lasting, and even permanent, its symptoms are treatable. A SIRVA diagnosis should not prevent receiving future vaccines.