Shoulder Injury Related to Vaccine Administration (SIRVA): Petitioner claims to the National Vaccine Injury Compensation Program, 2010-2016

Abstract

Background: Since 2010, petitioner claims of shoulder injury related to vaccine administration (SIRVA) to the National Vaccine Injury Compensation Program (VICP) have been increasing.

Objective: To conduct a scientific review of clinical characteristics of SIRVA petitions to the VICP.

Methods: We queried the VICP's Injury Compensation System database for medical reports of alleged SIRVA and SIRVA-like injuries. Medical reports are summaries of petitioner claims and supporting documentation along with a VICP clinician reviewer diagnosis and assessment of criteria for concession. We conducted a descriptive analysis of SIRVA petitioner claims recommended by the VICP for concession as SIRVA injuries.

Results: We identified 476 petitioner claims recommended for concession. Claims per year increased from two in 2011, the first full year in the analytic period, to 227 in 2016. Median age was 51 years, 82.8% were women, and median body mass index was 25.1 (range 17.0-48.9). Four hundred cases (84.0%) involved influenza vaccine. Pharmacy or store (n = 168; 35.3%) was the most common place of vaccination followed by doctor's office (n = 147; 30.9%). Fewer than half of cases reported a suspected administration error; 172 (36.1%) reported 'injection too high' on the arm. Shoulder pain, rotator cuff problems, and bursitis were common initial diagnoses. Most (80.0%) cases received physical or occupational therapy, 60.1% had at least one steroid injection, and 32.6% had surgery. Most (71.9%) healthcare providers who gave opinions on causality considered the injury was caused by vaccination. A minority (24.3%) of cases indicated that symptoms had resolved by the last visit available in medical records.

Conclusions: Most conceded claims for SIRVA were in women and involved influenza vaccines. Injection too high on the arm could be a factor due to the risk of injecting into underlying non-muscular tissues. Healthcare providers should be aware of proper injection technique and anatomical landmarks when administering vaccines.

Keywords: Concession; National Vaccine Injury Compensation Program (VICP); Petitioner claims; Shoulder injury; Shoulder injury related to vaccine administration (SIRVA); Vaccination.

Fig. 1.

Submitted petitioner claims for SIRVA and SIRVA-like conditions to the VICP by year and concession status (N = 913), July 2010-December 2016. *Data from 2010 includes petitioner claims from July through December. SIRVA – shoulder injury related to vaccine administration, VICP – National Vaccine Injury Compensation Program.

Fig. 2.

Total submitted petitioner claims and submitted claims for SIRVA to the VICP by year and concession status, January 2011-December 2016*. *Data are presented using different time points than released VICP data, which is presented by fiscal year, not calendar year. SIRVA – shoulder injury related to vaccine administration, VICP – National Vaccine Injury Compensation Program.

Fig. 3.

Identification of conceded SIRVA claims from all claims for shoulder injuries received by the VICP. SIRVA – shoulder injury related to vaccine administration, VICP – National Vaccine Injury Compensation Program.