Swelling, redness (erythema), pain and itch at the site of injection can be a common side effect from any vaccine. Symptoms are usually mild and localised to the site of vaccination, with onset commonly occurring within the first 48 hours of vaccination and symptoms lasting 1-2 days. In some cases, however, injection site reactions (ISR’s) can appear more significant, last up to a week or have delayed onset.

Severe injection site reactions

Severe ISR’s can present with pain, erythema and induration (hard, tight swelling) which extends from “joint to joint” (eg. from the shoulder joint to the elbow joint) or “crossing joints” (eg. swelling that crosses at least one joint). Localised itch is also often reported. Resolution of these symptoms usually occur within 5-7 days with no long-term sequelae. Most affected individuals do not experience a high grade fever and remain systemically well.

Delayed injection site reactions following COVID-19 vaccines

Delayed ISR’s have been reported to occur following COVID-19 vaccination. Symptoms commonly present within 4-11 days of vaccination, with a median onset of 8 days and can last 4-5 days.

Injection site reactions following pneumococcal vaccines

Pneumococcal vaccines are administered to both children and adults via the National Immunisation Program (NIP). In children, injection site reactions are more commonly reported as occurring within 24-48 hours following immunisation. In adults, ISR’s may occur >3 days following the 13vPCV dose given at >70years.

Treatment of injection site reactions

ISR’s can generally be managed at home with symptomatic relief such as oral analgesia and a cold compress. Immobilising the affected limb should be avoided to enhance lymphatic drainage. Antibiotics and antihistamines are generally not required.

Implications for future doses

In any age group, previous experience of an ISR is not a contraindication to future doses of vaccines and vaccine recipients are encouraged to complete the recommended vaccine schedules. Recurrence of symptoms following future vaccination may occur in some individuals but severity is not likely to be worsened.

Reporting to SAEFVIC

Any event felt to be significant following vaccination, including any symptoms which have not gone away after a few days should be reported to SAEFVIC. Providing a photograph of the ISR can assist with SAEFVIC management and advice. For information on how to photograph an injection site reaction please refer to MVEC: Photographing a severe local reaction.

Author: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Reviewed by: Rachael McGuire (SAEFVIC Research Nurse, Murdoch Children’s Research Institute)

Date: October 18, 2022

Materials in this section are updated as new information and vaccines become available. The Melbourne Vaccine Education Centre (MVEC) staff regularly reviews materials for accuracy.

You should not consider the information in this site to be specific, professional medical advice for your personal health or for your family’s personal health. For medical concerns, including decisions about vaccinations, medications and other treatments, you should always consult a healthcare professional.