COVID-19 Vaccines for SIRVA’d Folks

 

I have a few posts from past years worrying about getting the flu shot again after suffering a shoulder injury related to vaccine administration (SIRVA) from that vaccine in 2017. Fast-forward to 2021, and there is one question that just about everyone who ever got SIRVA in years past is asking: what is the best practice for getting my COVID-19 vaccine now?

I realize this post comes too late for many of you who’ve already gotten it (and any of you who got SIRVA from your COVID-19 vaccine—welcome, and I’m sorry you’re here in this boat), but I have been busy lately and also wanted to experience it firsthand before posting. Being in a late vaccination eligibility group, it took me this long.

I reached out to doctor friends and sent emails around, but no one was willing to “go on the record” about alternative injection sites for such a new and novel vaccine. The best help came from a Facebook group—you can find it by searching for the group “SIRVA – Shoulder Injury Related to Vaccine Administration”—where folks actively discussed this. Questions included:

  • “If I have an active case of SIRVA pain happening in one arm, should I get the shot in my good arm or the bad one?”
  • “Will vaccine administrators be willing to give me the shot in another part of the body?”

The discussion seemed to converge on asking the vaccine-giver to please use the injection site in your thigh. A member of the Facebook group posted these CDC documents for each of the US-approved vaccines, which definitively state that they may be given in the thigh (for each one, look on page 2 below the table):

Moderna – pdf

Pfizer – pdf

J&J – pdf

For example, for Moderna, the critical statement is highlighted in yellow, and a similar statement is found in each of the others: “Alternatively, the anterolateral thigh can be used.”

I would highly, highly, highly recommend printing out the one for your vaccine, bring it, show it, and explain why you would like to receive the vaccine in your thigh. I am not a doctor, so you definitely want to discuss with your health care practitioners whether the thigh site is recommended for you, by them. Some folks got notes from their primary care doctors. While I did not get a doctor’s note, I scheduled a telehealth appointment with my primary care doctor before the shot and we discussed it and she agreed that the thigh would be appropriate for the COVID-19 vaccine for me.

So far, folks are reporting that they have been able to get the shots there (including myself!!) but it may depend on who you get administering the vaccine. In some cases, people have said that a “supervisor’s approval” was needed, etc., so it took them longer.

For me, today, I got a very kind, sympathetic vaccine administrator who listened to my (brief version) explanation about getting SIRVA and was shocked (she’d never heard of it—sadly all too common), and had no problem jabbing me in the thigh. I hope those of you who ask for the thigh injection site also find a compassionate person who can confidently find the safe spot on the thigh.

Because I’ve learned a lot less about safe injection in the anterolateral thigh site, I had a PT friend who came over and he marked on me with a Sharpie both the deltoid site (looking for the “meat” or the “belly” of the deltoid and doing the classic inverted triangle seen, e.g., here and in the photo at the top of this page) and the thigh site, which is in the vastus lateralis muscle. My primary care doc had given me this document with information about the thigh (vastus lateralis) site, although it comes from dentistry sedation, not immunization. There are still some considerations for finding the right spot for injection in the vastus lateralis muscle, including:

  • “Overly deep penetration of the needle may strike the femur, resulting in discomfort and possible needle breakage”
  • Injections in the rectus femoris muscle (more on top of the thigh, if they miss doing it on the outer side of the thigh) may cause considerable discomfort

But, on the plus side, the thigh overall seems (???) to have less chance than the deltoid to screw things up. It’s certainly a whole lot bigger.

From https://pocketdentistry.com/10-intramuscular-sedation

 

If you can’t get the shot in your thigh, because the provider refuses or you have reason to be worried about that site (e.g., will the vaccine still work?), then I would personally still get the COVID-19 vaccine in my deltoid and I was mentally prepared for that possibility. So far, folks with SIRVA from other shots who got a properly administered COVID-19 vaccine in the arm have not come back to the group to report that they got SIRVA’d again. There is, hopefully, no “predisposition” to getting injured again that comes from getting a bad shot once. You just need to have someone who is competent enough to find the deltoid muscle. An actively raging SIRVA case may be different than a recovered one, and you may still consider getting it in your “good” arm. But I would personally ask for the thigh, myself, especially if I had a raging case with a lot of inflammation still going on in the shoulder.

Plus, after my thigh injection of the Pfizer vaccine today, my thigh is pretty sore. I would hate to have that pain in my arm and be wondering, until it subsides, if I’m screwed again. It would definitely have been a miserable reminder.

Please comment below if you have had SIRVA before and you have now gotten your COVID-19 vaccine, and what your experience was like! Best wishes to you all.

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Hi, I'm Amy, and I started this webpage when I got SIRVA to help gather together information about treating it.

8 thoughts on “COVID-19 Vaccines for SIRVA’d Folks”

  1. I had the 1st covid vaccine mid Mid March- was fine that and about 1.5 weeks-2 weeks after I developed some shoulder discomfort… I am also feeling like my hand/ fingers are not 100% – just feeling a little week… I feel some aching in my elbow randomly too. Joint pain is a common side effect but it’s been almost 3 weeks and I don’t think that is common. My 2nd shot is coming up next week… I dont know where I should get it? I am worried I could have 2 arms that aren’t right… or it could make my original arm even worse. Any advise?

    1. Hey Nic, sorry you’re in this boat. I don’t have a solid answer for you, but I can tell you that this was very actively discussed on the Facebook group. I would first of all try asking politely to get it in your thigh (print out the CDC pdf above for your vaccine, Moderna or Pfizer, assuming you are in the US, if not you might try looking for something similar from your health agency). But even with that in hand, you might not get someone willing to give it in the thigh, in which case you should be prepared for which shoulder to ask for. I don’t think anyone solved this quandary but most people seemed to go for getting it in the same arm that was already injured. I can’t really speak to biomedical theory about whether this could trigger additional inflammation or damage in the shoulder joint even if it is PROPERLY administered in the deltoid this time, but so far most folks seem happy with that decision. Of course the arm is likely going to be extra sore from the normal shot side effects but whether it hurts the shoulder joint is another question.

  2. So glad I found this site. had my second Covid-19 vaccine 8 days ago. was told the second vaccine can be worse, so I assumed what I was experiencing was normal. I have very little muscle mass due to a disability. I read everything on the proper technique for vaccination, and expressed this during my first vaccine. The second time I was mum, other than letting the nurse know I was lacking in muscle mass. When she stood up, squeezed my arm to high heaven and jabbed, I froze. I immediately had radiating pain down into my biceps tp my elbow. I did not know that she taped my arm in that position with a big wad if gauze and thick fabric “bandaid”. I was unable to move my arm away from my body and thought it was just very swollen. I tried to force it as I heard you should move it. I could still move it forward however. Today, I cannot move it forward, outward, the pain encompasses my entire upper arm and also my forearm. It has exacerbated my pre-existing rotate cuff/biceps tendon tears. I am in misery. Called doctors for referrals. Not getting anywhere.

    1. I feel like one of the lucky ones. Pretty much recovered from flu shot SIRVA after 5 months (cortisone shot and PT). Took printed material to both Covid vaccine appointments, and had “the talk” with the nurse there. Got the shot in the same non-dominant arm with no significant long term soreness. Good luck to all of you still dealing with this.

  3. I still have active SIRVA from my September 2020 flu vaccine and I got both Covid shots in my non-SIRVA shoulder with no problems. I mentioned my SIRVA to both shot givers and made sure it was not too high etc.

  4. I am so grateful to have found this site, even if there is no clear pathway to feeling better. At least there is a reason for all this pain!

    I had the 2nd Covid Vaccine on March 28th and after a week of such intense pain that I couldn’t sleep or move my arm, it settled into a daily annoying throbbing.

    My question is what is the physical therapy that is prescribed? Can anyone share what type of movement exercise their PT gave them?

  5. Hello, I had my first COVID vaccine 3 days ago and ever since I had shoulder pain that goes from the upper arm to the shoulder blade. I can move it properly but it hurts, it’s not terribly painful yet it’s uncomfortable. I am taking Aleve 3 times/day, upon my doctor recommendation. I am very skinny and have no muscle at all, the nurse struggled to find a good site for the injection and I think she injected it too high. How long should my symptoms last to qualify as SIRVA?

  6. I received my Covid shots in March of this year. The first shot (Pfizer) was fine, no real pain at all. Three weeks later I got my second and within hours my shoulder started hurting and hasn’t stopped. It is a little less now than at first, but still painful and a loss of strength above shoulder level. I was wondering what was going on, but this explains it totally. I was sent a couple of links about SIRVA, and doing a GOOGLE search I found this. Thank you so much. I will set an appointment with my doctor and see what she says. I have also been hesitant about the booster shot because of the pain from the second one. This really helps.
    Keep up the good work.

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