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):
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.
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.