SIRVA case settled for client following negligently administered COVID-19 vaccination

We have settled a case for our client who developed a SIRVA (‘shoulder injury resulting from vaccine administration’) following a COVID-19 vaccination in January 2021 at her GP practice. Her injury continues to be intrusive, affecting her day-to-day activities. We achieved an out of court settlement for our client, without the need to start proceedings.

Our client’s story

Our client attended her GP surgery for her first AstraZeneca COVID-19 vaccination, which was administered by a doctor. The vaccination was placed into her left non-dominant arm. After receiving the injection, the site was immediately painful and bled profusely. This was unlike any other injection she had had in the past. Later the same day, a bruise appeared at the site of the vaccination, high on her left shoulder, and her arm was achy and painful.

After two weeks, the bruise remained visible. The pain in her shoulder continued and became progressively worse. Movement in her arm was restricted and painkillers did not ease the pain. She found sleeping very difficult due to the pain. She sought help from her GP and was prescribed naproxen. Despite the painkillers, the pain persisted, and the range of movement remained limited in her left shoulder.

As her pain was not improving, she returned to her GP surgery and was prescribed tramadol and diazepam, and a telephone call was arranged with a physiotherapist. She was given some gentle exercises by the physiotherapist, but found these too painful to complete. Our client continued to be unable to do any of her usual activities with her left arm. She could not move it away from the side of her body at all, and though she had limited use of her forearm, this caused aggravation to her shoulder around the vaccination site. The physiotherapist felt that there was nothing further he could do, and suggested that a steroid injection would probably be beneficial.

Following a telephone consultation with a GP at the practice, she was advised to arrange a private appointment with an orthopaedic surgeon, to avoid delay in being seen due to the pandemic. She was prescribed more diazepam as well as Oramorph to take at night.

Our client arranged a private appointment with a consultant orthopaedic surgeon in March 2021. She was referred for an urgent investigation the following day at the fracture clinic as the surgeon was very concerned at the severity of the injury and the possibility of infection of the joint. She was advised that there was a risk she would suffer permanent impairment.

Our client attended the fracture clinic where blood tests, x-rays and ultrasound scans were carried out. She was advised by the radiologist that she had severe bursitis as a result of an incorrectly sited vaccination. She had a telephone consultation with another orthopaedic surgeon to discuss the results, and was told that she likely had injection-related bursitis which was causing pain and inflammation.

She was advised to have an ultrasound guided steroid injection to see if this would alleviate the pain and treat the bursitis. She was also informed that the vaccine may not have provided full or any protection from COVID-19 due to it being administered into the bursa, rather than the deltoid muscle, and that she should seek advice about vaccination.

A steroid injection was administered the following week, which helped to alleviate some of the pain initially. However, she still had some moderate pain and intermittent restricted movement of her left arm. Full range movement occasionally continued to cause pain, although not as severe as before having the steroid injection. By this stage she was also developing muscle wastage in her left arm.

Our client received a second dose of the same AstraZeneca COVID-19 vaccine in April into her right arm, without any complications.

After our client wrote a letter of complaint to the practice, the GP who had administered the vaccination in January responded, apologising for the administration of the vaccine being too high in her left shoulder. He stated that it seemed that the administration of the COVID-19 vaccine was responsible for her pain and shoulder stiffness caused by a bursitis.

By July, our client’s symptoms had started to return. She received a second steroid injection into her left shoulder the following month. Once again, she had some improvement immediately following the injection, but still suffered slight restriction and pain with certain movements. Her sleep continued to be disrupted due to pain. A third steroid injection was given in April 2023. In the weeks leading up to this third injection, our client’s pain had returned to 10/10 in intensity. The possibility of surgery (an arthroscopic decompression) was discussed, though our client opted for conservative management.

In October 2024, our client began intensive physiotherapy, and following perseverance with the exercises, found that the condition of her left shoulder was much improved. Nevertheless, she still struggled with heavy household chores, and the heavy aspects of gardening she had previously enjoyed.

How we helped

Our client initially instructed another firm of solicitors, which prepared a letter of claim on her behalf setting out allegations against the GP practice. A letter of response was received, indicating that though it did not seek to resile from the GP’s comments that the injection was placed too high in the shoulder, it did not consider that this would amount to a breach of duty. However, as the GP was of the view that the injection was placed too high, he accepted that this fell below the standard expected. Causation was denied: the defendant argued that our client’s bursitis was not as a result of the administration of the vaccination, and the outcome would have occurred even if it had been administered lower in the deltoid muscle. They argued that it is more likely to have been an unavoidable immune response to the vaccination which could not have been foreseen.

The previous solicitors were unable to take the claim forwards, and so our client sought our assistance with her claim. Given our experience at investigating and settling similar claims, we accepted instructions. We went on to obtain supportive expert evidence from an orthopaedic surgeon confirming that on the balance of probabilities, our client’s bursitis was a result of administration of the COVID-19 vaccination into the bursa, causing inflammation. Our expert considered that surgery should be considered to treat her symptoms, which were still intrusive and debilitating. Conservative management would involve further subacromial steroid injections, and physiotherapy.

As set out in our article, ‘Understanding SIRVA injuries’, intramuscular vaccinations administered into the upper arm should be delivered with the needle at a 90-degree angle into the middle of the deltoid muscle. This tends to be around 2.5cm below the acromion process, which is a bony prominence at the top of the shoulder joint. The acromion process should be located and used as a landmark in order to administer the injection correctly into the deltoid muscle. In this case, we argued that the needle had been inappropriately administered into the bursa, rather than the deltoid muscle.

The defendant continued to pursue their position in respect of an immunological response, and so we sought preliminary views from two immunology experts, who supported our client’s case.

Settlement

We continued to fight our client’s case through pre-action correspondence, in order to resolve her claim without the need for litigation. The defendant continued to deny causation, arguing that any bursitis our client suffered was caused by an unavoidable immunological inflammatory response to the vaccination itself, unrelated to its placement. Nevertheless, we managed to settle our client’s case out of court, for a sum she was very happy with. Damages reflected the pain, suffering and loss of amenity she had endured as a result of her injury, past and future care and assistance provided by her husband, the cost of future medical treatment required, and the cost of employing a gardener – among other heads of loss.

Rosie Nelson, senior associate in the medical negligence team, commented: “I am delighted to have achieved a settlement for our client, with the assistance of my colleague Sophie Bullimore. The circumstances of our client’s injury are very similar to other SIRVA claims we are currently investigating, and we have received a high volume of enquiries about these injuries. I would encourage anyone who suffered an injury in similar circumstances to come forward to see whether they may have a claim.”

Our client added: “I was delighted that Penningtons Manches Cooper were able to take on my claim (backed with ‘after the event’ insurance which they helped arrange), when my home insurer-appointed firm had failed to make progress with it. From first initial contact with Rosie Nelson, they were able to quickly assess the claim, and I received clear advice and an outline of prospects. She and Sophie Bullimore were always easy to contact, responded promptly to any queries I had, and their thoroughness was outstanding. I was kept well updated on progress in a timely manner at all times, and was very pleased with the settlement that they achieved for me, especially without needing to take the claim to court.”