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The Triple Heater (TH)
Published in Narda G. Robinson, Interactive Medical Acupuncture Anatomy, 2016
Wayward injections (e.g., vaccinations) into the deltoid muscle risk injury to the shoulder if fluids find themselves “shot” into the subacromial bursa, leading to a condition known as “shoulder injury related to vaccine administration (SIRVA).2” Acupuncture and related techniques may aid in the resolution of resultant pain and inflammation.
Shoulder injury following COVID-19 vaccine administration: a case series and proposed diagnostic algorithm
Published in Expert Review of Vaccines, 2023
Nikki Petrakis, Mel Addison, Bianca Penak, Silja Schrader, John Mallard, Hazel J Clothier, Jim P. Buttery, Nigel W. Crawford, Daryl R Cheng
One such significant AEFI is shoulder injury related to vaccine administration (SIRVA). Whilst transient shoulder pain at the local injection site is common following administration of a vaccine, SIRVA is a rare and under-reported side effect that can result in debilitating disease and even permanent shoulder dysfunction [5,6]. SIRVA can occur when vaccines are delivered into the sub-deltoid bursa or shoulder joint space instead of the deltoid muscle[7]. Most commonly, this can be a consequence of incorrect technique, whereby vaccines are unintentionally delivered too high into the shoulder joint [8,9].
Pharmaceutical Aspects and Clinical Evaluation of COVID-19 Vaccines
Published in Immunological Investigations, 2021
Kirk Hofman, Gautam N. Shenoy, Vincent Chak, Sathy V. Balu-Iyer
With Moderna, BioNtech, and AstraZeneca vaccines now available for priority populations around the globe, data on adverse reactions to these vaccines continues to grow. Reactions such as lymphadenopathy and shoulder injury related to vaccine administration were witnessed in Phase 3 studies for BNT162b2, but occurrence of anaphylaxis was not observed. When given to the general population anaphylactic reactions are occurring and have prompted advisories by the CDC for the management of anaphylaxis when dosing. Providers of mRNA vaccines are required to monitor patients after vaccine administration and have treatments for immediate anaphylaxis reactions on hand. This has prompted inquiries on what is driving this anaphylaxis to provide insight for newly developing therapies as well as prevent occurrence when giving these products to the general population. While the active ingredient of BNT162b2 and mRNA-1273 therapies are mRNA encoding S protein, this is not likely the cause of anaphylaxis due to their rapid elimination by nucleases present throughout the body. Lipid nanoparticles have been implicated in the past as a cause of anaphylaxis. It has been shown complement can more efficiently bind to liposomes with increasing charge (Bradley et al. 1999). Though this is possible the more likely culprit of these reactions is incorporation of PEG moiety. BNT162b2, mRNA1273, and AZD122 incorporate 2-[(polyethylene glycol)-2000]-N,Nditetradecylacetamide (ALC-0159) and 1,2-dimyristoyl-racglycero3- methoxypolyethylene glycol-2000 (PEG2000- DMG), and Polysorbate 80 respectively. PEG moieties are present in many everyday products and used in liposomal formulations to prevent nonspecific events and opsonization. Pre-existing immunity to PEG has been shown to induce immediate hypersensitivity reactions dependent on molecular weight (MW) and cross react with Polysorbate 80 (increasing MW results in increased antibody binding) (Stone et al. 2019). It is not clear whether PEG in these formulations plays a role in anaphylactic reactions, but the incident rate is extremely low following vaccination and is effectively managed with common medications.