The majority of vaccines on the National Immunisation Program are administered as injections, either into the muscle (intramuscular- IM) or just under the skin (subcutaneous- sc). A common, expected side effect of vaccines is therefore a local reaction. They may occur following any vaccine usually within 24 hours post immunisation The majority of these local reactions are small, do not limit activity and no further action is required. Symptoms usually resolve with minimal intervention. Symptomatic relief may include analgesia and cool compress.

Some Injection Site Reactions (ISR), however, can be more severe: defined as an enlargement or swelling at the injection site that, depending on severity, may extend from joint to joint (e.g. shoulder to elbow) or crossing a joint.  Other features of ISR’s may include redness, pain and tenderness. Symptomatic relief is again all that is usually required (e.g. analgesia and cool compress).


To confirm the diagnosis of the moderate to severe ISR, it would be helpful to have a photograph of the affected limb.

Here are some simple steps to follow:

  1. Ensure you are standing in a position lit by plenty of natural light (i.e. a window with lots of sunlight or outside).
  2. You will need a ruler to show the length of the reaction against the affected limb.
  3. When photographing the limb, we need to see from above the shoulder to below the elbow. No more and no less. Try and keep identifying features such as the face, out of the picture. Clothing needs to be removed or minimised so as not to cover the area.
  4. The limb needs to be photographed from 2 angles. The first of which should be looking directly onto the limb with the ruler being held up at the side as a reference. See example below.

Injection Site Reaction - 1

5. The next image needs to show the profile of the arm from behind, so we can identify any swelling of the limb. Standing behind the child, photograph the limb from above the shoulder to below the elbow, again holding the ruler against the limb to reference the size of the reaction. See example below.


6. Once images have been taken, please email them together to using your SAEFVIC report number as a reference in the subject line.

If you have any queries regarding any of the information posted above, please contact SAEFVIC either by email or by calling 1300 882 924 (Option 1).


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

Date: February 2018

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.