Highlighting shoulder injury related to vaccine administration

I would like to highlight an important, though rarely discussed or reported, issue: shoulder injury related to vaccine administration (SIRVA). I implore any pharmacists who offer travel or flu vaccinations to take note.

SIRVA is a result of the body’s immune response to direct injection of a vaccine into the shoulder capsule instead of the deltoid muscle.

In summer 2018, I was injected at a pharmacy travel clinic and suffered SIRVA. Even after 12 months, rehabilitation and a steroid injection, it was not completely resolved. Symptoms included considerable pain, inability to use the arm and lack of range/mobility, not to mention many sleepless nights.

I believe — and have the expert opinions of allied healthcare professionals to support this — that I was injected too high (into the shoulder capsule) with too long a needle for my frame size. I have heard of several other similar cases of SIRVA in relation to pharmacist injectors.

My experience led me to research the training that pharmacists are given before they can administer any injections and their required competencies. The ‘National Minimum Standards and Core Curriculum for Immunisation Training for Registered Healthcare Practitioners’[1]
sets the standards and lists the essential topics that should be incorporated into training for immunisations in the national schedule, but, as the document states, it “does not set out the processes for commissioning, procuring and delivering training”. SIRVA does not feature in the document, and it is a challenge to find any publicly available information on this topic, possibly owing to under-reporting. And it is difficult to source any publicly available information on training requirements for pharmacists administering travel vaccines.

Several published articles mention SIRVA and link it to a lack of anatomical understanding and inadequate training[2]
. In 2018, Bancsi et al. highlighted to pharmacist injectors the risk of SIRVA and provided a useful diagram to help landmark the patient’s arm and a guide for things to watch out for, such as needle length[2]

I call on the profession to review and improve the current training requirements and ensure regular renewal of skills training. With the increase in pharmacy injectors, appropriate injection technique is crucial to avoid SIRVA and uphold the expected standards of the profession.

Pharmacists should not inject patients if they are not completely sure of what they are doing; the consequences of getting it wrong are considerable for the patient and the profession.


Anonymous pharmacist, London


[1] Public Health England, Royal College of Nursing. 2018. Available at: https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/679824/Training_standards_and_core_curriculum_immunisation.pdf (accessed October 2019)

[2] Bancsi A, Houle SKD & Grindrod KA. Can Pharm J (Ott) 2018;151(5):295–299. doi: 10.1177/1715163518790771

[3] Cross GB, Moghaddas J, Buttery J et al. Aust Fam Physician 2016;45(5):303–306. PMID: 27166466

[4] Cook IF. Hum Vaccin Immunother 2014;10(3):605–606. doi: 10.4161/hv.27232

[5] Shahbaz M, Blanc PD, Domeracki SJ et al.  Workplace Health Saf 2019;67(10):501–505. doi: 10.1177/2165079919875161

Last updated
The Pharmaceutical Journal, PJ, October 2019, Vol 303, No 7930;303(7930):DOI:10.1211/PJ.2019.20207155

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