Do Vaccines Cause Deltoid Bursitis?

Conclusion | Epidemiological Evidence | Proposed Biological Mechanism | Archives | References


Vaccines can cause deltoid bursitis when administered incorrectly.

Epidemiological Evidence

The 2012 report by the Institute of Medicine (IOM), now called the National Academy of Medicine (NAM), described one study assessing an association between the injection of a vaccine and deltoid bursitis [1]; however, this study did not provide convincing evidence due to a lack of validity and precision [2]. No relevant studies of quality have been published since this report.

Proposed Biological Mechanism

A vaccine that is unintentionally injected into the synovial tissue structures underlying the deltoid muscle can induce a prolonged immune-mediated inflammatory response [3-5]. Such an error in vaccine administration could occur due to inappropriate needle length or improper injection technique involving administration in the upper one-third of the muscle [6-10]. The 2012 IOM report described several cases providing strong clinical evidence that vaccine injection was a contributing cause of the rapid development of deltoid bursitis [11, 12]


1. Black S, Shinefield H, Hansen J, Lewis E, Su L, Coplan P. A post-licensure evaluation of the safety of inactivated hepatitis A vaccine (VAQTA, Merck) in children and adults. Vaccine 2004;22:766-72.
2. Institute of Medicine. In: Stratton K, Ford A, Rusch E, Clayton EW, eds. Adverse Effects of Vaccines: Evidence and Causality. Washington (DC): National Academies Press (US); 2012.
3. Cooke TD, Hurd ER, Ziff M, Jasin HE. The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. II. Preferential localization of antigen-antibody complexes to collagenous tissues. The Journal of experimental medicine 1972;135:323-38.
4. Cooke TD, Jasin HE. The pathogenesis of chronic inflammation in experimental antigen-induced arthritis. I. The role of antigen on the local immune response. Arthritis Rheum 1972;15:327-37.
5. Dumonde DC, Glynn LE. The production of arthritis in rabbits by an immunological reaction to fibrin. Br J Exp Pathol 1962;43:373-83.
6. Bodor M, Montalvo E. Vaccination-related shoulder dysfunction. Vaccine 2007;25:585-7.
7. Cook IF, Williamson M, Pond D. Definition of needle length required for intramuscular deltoid injection in elderly adults: an ultrasonographic study. Vaccine 2006;24:937-40.
8. Koster MP, Stellato N, Kohn N, Rubin LG. Needle length for immunization of early adolescents as determined by ultrasound. Pediatrics 2009;124:667-72.
9. Lippert WC, Wall EJ. Optimal intramuscular needle-penetration depth. Pediatrics 2008;122:e556-63.
10. Poland GA, Borrud A, Jacobson RM, et al. Determination of deltoid fat pad thickness. Implications for needle length in adult immunization. Jama 1997;277:1709-11.
11. Atanasoff S, Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA). Vaccine 2010;28:8049-52.
12. Vellozzi C, Burwen DR, Dobardzic A, Ball R, Walton K, Haber P. Safety of trivalent inactivated influenza vaccines in adults: background for pandemic influenza vaccine safety monitoring. Vaccine 2009;27:2114-20.