Shouldering responsibility for a vaccine related injury

Abstract

We report a paediatric case of suspected shoulder injury related to vaccine administration (SIRVA). A 15-month-old child presented to a paediatric acute care facilty with a 10-day history of localised tenderness and limitation of movement of his right shoulder and arm. Twelve month immunisations had been administered 4 days prior to the onset of initial symptoms. Abnormalities within the shoulder joint were detected on ultrasound and magnetic resonance imaging (MRI). Symptoms resolved with conservative management including non-steroidal anti-inflammatory medication. SIRVA is a rare adverse event following immunisation. SIRVA is thought to occur when a vaccine has been given incorrectly either too high in the deltoid or too deep into the joint space damaging surrounding structures including bursa/tendons and potentially inducing an immune-mediated response locally resulting in pain and restricted movement. 1-4 Following an extensive literature search, SIRVA has not been identified or reported in any other paediatric cases. The risk of SIRVA would be reduced if immunisation