Within a few hours of getting her first COVID-19 shot, Leah Jackson had severe pain in her left shoulder.

The New York City-based veterinarian said the nurse lodged the shot “extraordinarily high” into her left shoulder, hitting the bursa rather than the deltoid muscle. When the nurse got resistance, she redirected the vaccination into the joint space, Jackson said.

As a veterinarian, Jackson is well versed in giving injections: “This was just poor administration technique,” she told MedPage Today.

For weeks, she had severe pain that didn’t respond to over-the-counter anti-inflammatory medications. Her primary care doctor referred her to a physical medicine & rehabilitation specialist who, after confirming bursa and joint inflammation on imaging, prescribed steroid and lidocaine injections along with physical therapy.

The pain largely resolved but returned, albeit to a lesser extent, after 6 weeks, and a follow-up MRI confirmed persistent bursa inflammation.

Jackson can still do her job as a veterinarian, but it can be painful lifting animals during surgery, for instance. Sometimes it hurts while driving.

“I just can’t move my arm in certain motions,” she said.

Shoulder injury related to vaccine administration, or SIRVA, has been documented long before COVID-19 vaccination, and is most frequently reported after influenza vaccination. However, the medical community cautions that it’s more of a medicolegal determination rather than a distinct diagnosis at this point.

The condition is also plagued by the lack of a solid evidence base, and causality is difficult to pin down.