Shoulder injury related to Sinovac COVID-19 vaccine: A case report

INTRODUCTION: After a vaccination, patients frequently have clinical symptoms of pain and swelling over the injection area which usually resolve 2-3 days after the injection. If the symptoms do not improve, a shoulder injury related to vaccine administration (SIRVA) will be considered, perhaps related to an improper injection technique. Herein we report our first case of a SIRVA after a Sinovac COVID-19 vaccination which occurred due to deep penetration and direction of the needle. The clinical symptoms of the patient improved after treatment with combined oral non-steroidal anti-inflammatory drugs and a short course of intravenous antibiotic. CASE PRESENTATION: A 52-year-old Thai male without prior shoulder pain had a Sinovac COVID-19 vaccination at his right shoulder. The injection was given by a nurse using a 27-gauge needle, 1.5 inches in length. The injection landmark was 3 finger breadths below the midlateral edge of the acromial process. The direction of the needle was 45° to the skin cephalad. Three days after receiving the vaccine the patient began to have right shoulder pain with limited range of motion and acute fever. He was admitted for medical treatment which his clinical symptoms gradually improved. CONCLUSION: We report a case of subacromial-subcoracoid-subdeltoid bursitis following a Sinovac COVID-19 vaccine injection. This condition is rare, and usually related to an incorrect vaccination technique. To avoid this complication, nurses should identify the correct landmark, use an appropriate needle length, and point the needle in the correct direction.