Vaccines have a utility, and people should get them, but its important that people also realize there can be injuries, says Paul Brazil, a Philadelphia attorney who represents about 150 clients with vaccine-related shoulder injuries. They can also happen during everyday activities. The COVID-19 vaccines are the best way to protect yourself and others. In a small study, about half of people hospitalized with COVID-19 had antibodies in their blood that could mistakenly attack thebodys own proteins and tissues. COVID-19 is a life threatening condition, and the vaccine is highly protective against the virus SARS-CoV-2, which causes . FOIA Scientists have wondered if infection with SARS-CoV-2 could also result in the production of autoantibodies in people who didnt have them before they got sick. Patients tend to say their chest hurts more when they lean forward. Absolute numbers of long-haulers aren't known, but a recent survey in the U.K. found about 13% of people who had COVID-19 continued to have symptoms three months after their initial infection.. Herein, we report a 58 year old woman hospitalized following COVID-19 infection and was discharged after a week. For this reason . Chronic bursitis may involve repeated attacks of pain, swelling, and tenderness. Common COVID-19 symptoms, according to the WHO, include: a dry cough fatigue a fever Other symptoms may include: aches and pains breathing difficulties gastrointestinal symptoms, such as diarrhea. A: Zeasorb AF contains the antifungal medication miconazole. Postmedia is committed to maintaining a lively but civil forum for discussion and encourage all readers to share their views on our articles. Ketamine therapy may help with chronic pain that doesn't respond to other treatments. My orthopedist says I have subacromial bursitis, which is chronic inflammation and excess fluid buildup in the bursa (a thin, lubricated sac that prevents friction between a bone and surrounding soft tissue) separating the acromion bone at the top of the shoulder from the rotator cuff. The most common causes of bursitis are injury or overuse, but it can also be caused by infection. Symptoms from improperly administered vaccinations - known as SIRVA, for "shoulder injury related to vaccine administration'' - include chronic pain, limited range of motion, nerve damage, frozen shoulder (the inability to move the shoulder) and rotator cuff tear. We have enabled email notificationsyou will now receive an email if you receive a reply to your comment, there is an update to a comment thread you follow or if a user you follow comments. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. In addition to a complete medical history and physical exam, diagnostic tests for bursitis may include: X-ray. Product Description Material: Neoprene Size: Free size (adjustable) Bust: 78.8-140 cm Armpit size: 22.9 -43.2 cm Range of use: Both left and right shoulders can be used Color: rose red, blue Quantity: 1 piece Package content: 1 piece * Shoulder strap 1. The scientists found that about 20% of these didnt have any autoantibodies when they were first admitted but developed them over the course of their illness. We ask you to keep your comments relevant and respectful. The report said it had drawn the data from . This was years ago when I first learned about it. But rare and serious complications may occur. Excessive inflammation could also boost production of autoantibodies that had previously only existed in the body at very low levels. Europe PMC is an archive of life sciences journal literature. Similarly, a fatal blood disorder suffered by a Florida physician two weeks after receiving a COVID-19 vaccine raised concerns that it was triggered by the vaccine. These sacs cushion areas where bone would otherwise rub on muscle, tendons or skin. Cushion at risk joints by using elbow or knee pads. Access all of our expanded, online-only, subscriber exclusive opinion writing. It hurt, more so than the usual injection. "Syncope can happen if you have a sudden drop in blood pressure, a drop in heart . Elbow bursitis. This is minor compared with health challenges that other people face. One of the doctors suggested I take ibuprofen for a few days. Office of Communications and Public Liaison. High on the list are nonsteroidal anti-inflammatory drugs such as ibuprofen. Shoulder injury related to vaccine administration (SIRVA) following mRNA COVID-19 vaccination: Report of 2 cases of subacromial-subdeltoid bursitis. Shoulder Injury Related to Vaccine Administration (SIRVA) in 16 Patients Following COVID-19 Vaccination Who Presented to Chiropractic, Orthopedic, and Physiotherapy Clinics in Hong Kong During 2021. The soreness was gone in 24 hours. Vaccine safety experts are always on the lookout for a range of possible side effects following any new vaccine. The Pes Anserine bursa is located between the shin bone and the three tendons of the hamstring muscles, on the inside of the knee. Some people may experience the following effects after receiving a vaccine: SIRVA symptoms usually arise within 48 hours of vaccination. I have arthritis in my right knee. Some patients undergo surgery. Physical therapy after an injury can help keep the shoulder flexible and strengthens the muscles that control the shoulder blade. My inoculation took place in a physicians office, administered by a nurse. Some studies have found that the symptoms of SIRVA may last at least 6 months. Disclaimer. However, after my Moderna booster shot, I noticed a big change in my bone-on-bone shoulder pain. When should you see a doctor for shoulder pain after a vaccine? Write to them in care of King Features, 628 Virginia Drive, Orlando, FL 32803, or email them via their website: PeoplesPharmacy.com. Shoulder injury related to vaccine administration: A rare reaction. (2020). Pfizer-BioNTech COVID-19 vaccine reactions & adverse events. In public settings, some people go in . Yale J Biol Med. Subscribe now to read the latest news in your city and across Canada. These usually last from a few hours to a few days after vaccination. Localized shoulder pain at the site of your vaccine injection is also normal. The tear is in line with the fibers of my cuff, much like a split in a seam. As soon I got the shot, it hurt so bad, I jumped, says Debby Russo, 60, of Eagleville, Pa., who got a flu shot in 2011 at a pharmacy. What causes shoulder injury after a vaccination? Vaccines have worked to significantly reduce disease in many parts of the world. I remember thinking: Will I ever be able to roll out another pie crust for my grandchildren?. However, each person may experience symptoms differently. Moya D, Gmez D, Altamirano N, Alfano F, Pereira Corvaln JM, Dobkin F, Menon PH, Patinharayil G. J Orthop. Bursitis can be treated with rest and medicines to help with the inflammation. These are not serious and will go away on their own. Some of those pieces might resemble human proteins enough to trigger the production of autoantibodies. A bursa is a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body. Studies are underway to evaluate the effectiveness of this approach; this research may eliminate one of the reasons it is not covered by insurance. More than a year and a half into the COVID-19 pandemic, much about how the human body responds to SARS-CoV-2, the virus that causes COVID-19, remains unclear. Vaccines have greatly reduced, and even completely eliminated, many infectious diseases in the United States and across the world. If your shoulder pain is intense and doesnt resolve on its own within a week of vaccination, you should make an appointment with a doctor. 2023 Feb;26(2):267-277. doi: 10.1111/1756-185X.14482. Weisel B, et al. Like any vaccine, the COVID-19 vaccines do come with potential side effects. Treatments for shoulder bursitis focus on reducing inflammation and minimizing symptoms. However, in rare cases when a vaccine is administered improperly, a person may experience more severe symptoms, including intense shoulder pain classified as SIRVA. An August 2021 report from U.S. health officials found that, with 187 million people in the U.S. getting at least one dose, the vaccine benefits are far greater than the risks. The CDC had information on the recovery of patients in 220 cases; in more than 80 percent of these cases, patients got better on their own. I dont like taking drugs unless unavoidable and in this case I felt it would only be masking the pain so I ignored the advice. She had tried multiple biologics and baricitinib (Olumiant), a JAK inhibitor, and was being treated with the JAK inhibitor upadacitinib (Rinvoq) and the corticosteroid prednisone (5 mg per day) with a partial response. This meant that there were an additional 2.5 cases of bursitis for every million people who got a flu vaccine that year. Prostaglandins elevate body temperature and make nerve endings more sensitive to pain . Some of those pieces might resemble human proteins enough to trigger the production of autoantibodies. The primary symptom of shoulder bursitis is pain, which can feel like: 3. Infection may also cause it. But nobody suffered any bad side effects from the vaccine in the phase 1 . This causes pain and swelling. Its unclear whether I had the tear before the shot or whether the shot caused it. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website. 31, Rm. Almost universally, when I ask where the shot went, they point really high up on the arm.. To look at this question, researchers screened for a range of autoantibodies in blood samples from almost 150 people hospitalized with COVID-19 and 41 healthy volunteers. Most of the time, this soreness is mild and will go away without treatment in a few days. This attaches the calf muscle to the back of the heel. Hibbs BF, et al. New-onset inflammatory arthritis after COVID-19 vaccination: A systematic review. I saw a remarkable improvement after the first application, and, a few days later, the rash was gone. My doctor told me to take Tylenol for the pain instead of ibuprofen. . Many people feel very little after the first shot, but have more side effects after the second coronavirus vaccine shot. If you are a Home delivery print subscriber, unlimited online access is. Until definitive links are made, health officials overwhelmingly recommend Covid-19 vaccinations for everyone ages 12 and older. Ultrasound. The agency noted that 95 of the cases were serious and required hospitalization. Acute injuries usually require prompt medical evaluation and may include: The consequences of getting a vaccine-preventable disease can be far more serious. The vaccine should be injected just into the surface of the muscle, not injected too deep. Always see a healthcare provider for a diagnosis. These may lead to the deterioration of muscles and a limited range of motion in the affected joint. It's unclear how many patients were admitted to the hospital, or, for example, were discharged following a visit to the emergency room. Some victims cannot use their shoulder at all and must find ways to compensate using the other one. A recent study showed that, in COVID, macrophages and monocytes respond to high levels of glucose with worrying consequences. This site needs JavaScript to work properly. These cookies perform functions like remembering presentation options or choices and, in some cases, delivery of web content that based on self-identified area of interests. By the time I got home, I couldnt lift my arm out to the side., Elizabeth Cassayre, 81, a retired schoolteacher from Napa, Calif., developed frozen shoulder that plagued her for months after getting her flu shot at a grocery store about 10 years ago. Most cases are generally mild and go away on their own. Having rejected surgery, Ive decided to try something else, safe but still regarded in some circles as experimental. However, you may sometimes experience more severe side effects related to vaccination in the upper arm, including intense shoulder pain and limited range of motion. Zeitoun A, Hallit S, Helali M, Chehade S, Allam C, Ibrahim A, Dimassi H, Karam R. J Pharm Policy Pract. The shoulder is one of the most complex and unstable joints in the body, making it especially vulnerable to wear and tear, and to injury. What is shoulder injury related to vaccine administration (SIRVA)? Case 3: A 59-year-old woman with seropositive rheumatoid arthritis experienced a shingles episode after COVID-19 vaccination. Create an account or sign in to continue with your reading experience. Its caused by things like injury, disease, or shoes with rigid back support. Read more about cookies here. After all, a lot of people have died from COVID-19. My conclusions about getting vaccinated See this image and copyright information in PMC. One condition that may result is known as shoulder injury related to vaccine administration (SIRVA). Vaccination process evaluation at COVID-19 vaccination centers in Lebanon: a national study. Aug. 10, 2022 While research has revealed that children and adults hospitalized with COVID-19 are more susceptible to developing long COVID symptoms, a new study found that children infected . 82nd Civil Affairs Battalion Surgeon, U.S. If you experience difficulty breathing, chest pain, confusion, loss of speech or mobility after your vaccine, contact your healthcare provider immediately. In a separate study that looked at COVID vaccination, none of the healthy volunteers developed autoantibodies. I recently went to see John Ferrell, who practices regenerative orthopedics in the Washington area, to find out whether I might benefit from a therapy that uses the bodys own blood platelets to heal injuries. This Mix of Non-Opioid Medications Can Help Soothe Lower Back Pain, Study Finds, Former President Jimmy Carter Entered Hospice: Here's What That Means, Chronic Pain: Why Antidepressants May Not Be Effective, What to Know About Ketamine Therapy for Pain Management, Chronic Pain and Cannabis: Research Finds it May Help Some People Cut Down on Opioids, Debra Rose Wilson, Ph.D., MSN, R.N., IBCLC, AHN-BC, CHT, decreased arm mobility, including range of motion in the shoulder. We encountered an issue signing you up. The CDC will hold a meeting of its Advisory Committee on Immunization Practices on June 18 to further look at the evidence and assess the risk of myocarditis following vaccination. official website and that any information you provide is encrypted It hurts to put my arm through a sleeve or to pull a T-shirt over my head. She then had an operation to remove the inflamed tissue, which solved the problem. I decided to try it and had the injection on Oct. 23. It will take weeks before I know whether it has worked. Please try again. Army, Ft. Stewart, Georgia, 2012-2015 It should be 2 to 3 fingerbreadths (the width of your fingers when held together) down from your acromion process the bony part of your shoulder above your deltoid muscle. Honarmad AR, et al. ncbi.nlm.nih.gov/pmc/articles/PMC6347325/, cdc.gov/vaccines/hcp/acip-recs/general-recs/administration.html, sciencedirect.com/science/article/pii/S1930043321005872, who.int/news-room/facts-in-pictures/detail/immunization, cdc.gov/vaccines/covid-19/info-by-product/pfizer/reactogenicity.html, cdc.gov/vaccines/vac-gen/side-effects.htm, ncbi.nlm.nih.gov/pmc/articles/PMC8094125/, journals.sagepub.com/doi/pdf/10.1177/2165079919875161, ncbi.nlm.nih.gov/pmc/articles/PMC6707642/, thelancet.com/journals/laninf/article/PIIS1473-3099(22)00320-6/fulltext, journals.lww.com/jaaos/Abstract/2021/09010/Shoulder_Injury_Related_to_Vaccine_Administration.2.aspx, ncbi.nlm.nih.gov/pmc/articles/PMC8797178/. The Centers for Disease Control and Prevention (CDC) recommends a range of vaccines for most people to help prevent dangerous diseases. Myocarditis is condition that involves inflammation of the heart muscle. Aberdeen Proving Ground, Maryland, 2015-Present; Researchers are beginning to understand how the human immune system contributes to the varied responses to COVID-19. 2022 Jun 30;95(2):217-220. eCollection 2022 Jun. Shahbaz M, et al. and deltoid bursitis, or frozen shoulder, characterized by shoulder pain and loss of motion.. From a tailored suit to hair wax to keep his coif in place, Don't miss this deal on Microsoft Office's full suite of applications and tools, Best Buy, Fable and DAVIDsTEA, to name a few. Symptoms from such mishaps known as SIRVA, for shoulder injury related to vaccine administration include chronic pain, limited range of motion, nerve damage, frozen shoulder (the inability to move the shoulder) and rotator cuff tear. doi: 10.1177/1758573214560258. Epub 2022 Nov 12. PMC Subacromial-subdeltoid bursitis following COVID-19 vaccination: a case of shoulder injury related to vaccine administration (SIRVA). Q: I am surprised no one has given you this information for under-breast rash. Vaccine. Results were published on September 14, 2021, in Nature Communications. In the early stages of the pandemic, many patients were concerned about nonsteroidal anti-inflammatory drugs (NSAIDs) - which are often prescribed to treat arthritis and joint pain - and whether they could worsen a COVID infection. Swelling and redness if the inflamed bursa is close to the surface of the skin. Rodrigues TS, et al. However, the health agency said that "the data from safety monitoring are not sufficient to conclude a causal relationship between vaccination and tinnitus." COVID Q&A Mar 23, 2022 Boston Mar 16, 2022 Shoulder problems are incredibly common, says Christopher Annunziata, head orthopedic physician for the Washington Redskins, whom I went to see after the pain did not go away. Vaccination injection site adverse reactions are usually mild and transient, and post-vaccination musculoskeletal symptoms, such as myalgia and arthralgia, are very common. The bursa is not infected. The opinions expressed in reader comments are those of the author only and do not reflect the opinions of The Seattle Times. (2021). Such severe reactions to vaccines are very rare, but they do occur. Sharp pain with lifting or reaching overhead. -, Atanasoff S, Ryan T, Lightfoot R, Johann-Liang R. Shoulder injury related to vaccine administration (SIRVA) Vaccine. An MRI showed excessive fluid buildup in the bursa. Keywords: Curr Sports Med Rep. 2022 Mar 1;21(3):78-83. doi: 10.1249/JSR.0000000000000939. What makes SIRVA different from other shoulder injuries is its association with vaccination. There is no single way to treat shoulder injuries, regardless of how they occur. Fernndez Martnez AM, Cuesta Marcos MT, Rodrguez Prieto J. Cardiovasc Intervent Radiol. In the days that followed, the pain in my left shoulder worsened. Advisory Committee on Immunization Practices (ACIP). Clipboard, Search History, and several other advanced features are temporarily unavailable. Shoulder injury related to vaccine administration. They are right up there with the aging knee and aching lower back.. Common targets of these misdirected antibodies included immune system proteins such as cytokines, which normally help coordinate the immune response. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. About 2.9 million people received a flu shot in the 2016-2017 flu season. In their column, Joe and Teresa Graedon answer letters from readers. Please enable it to take advantage of the complete set of features! Its very common to experience some temporary soreness where you receive an injection. Federal government websites often end in .gov or .mil. Szari S, et al. It is treated with physical therapy and sometimes steroid injection.. COVID-19 Resource Center; Bursitis Submitted by covid-admin on Sun, 08/16/2020 - 19:46. Symptoms may include: intense shoulder pain. Despite 10 dermatologist appointments to get rid of it, I thought I was stuck with it. Vaccines are intended to cause a response by the body, but doing so in the bursa will cause weeks of poor shoulder function. According to the World Health Organization (WHO), vaccines routinely prevent four to five million deaths per year from other serious diseases, including polio, whooping cough, measles, and the flu. Vaccines are continually monitored to detect and respond to rare adverse events. To avoid injury, its important not to inject the vaccination too high or too low on the upper arm. Bruising and swelling may develop soon after the injury. Authorities are investigating this and similar cases. Q: For many years, I have suffered with bursitis in my right shoulder. This can occur within 48 hours of vaccination. Medical professionals can avoid causing their patients unnecessary and avoidable harm by staying up to date on their vaccination knowledge and by practicing proper vaccination techniques, including correct placement. . U.S. Department of Health & Human Services, NIH Institute and Center Contact Information, Misdirected Antibodies Linked to Severe COVID-19, Early Treatment with Convalescent Plasma for COVID-19 Doesnt Show Benefit. Millions of doses of vaccines for the prevention of COVID-19 have been administered to adults worldwide during the pandemic. Board Certified: Preventive medicine. This type of bursitis is more common in women and middle-aged and older people. Autoantibodiesimmune system proteins that mistakenly target the bodys own tissuesmay underlie some of this variation. The chances of any of these side effects occurring after vaccination differ according to the specific vaccine . Colorized scanning electron micrograph of a cell (red) infected with a variant strain of SARS-CoV-2 virus particles (green), isolated from a patient sample. Our experts continually monitor the health and wellness space, and we update our articles when new information becomes available. The following are the most common symptoms of bursitis. An imaging test that uses high-frequency sound waves to look at the internal organs and tissues. COVID-19 vaccines can cause mild side effects after the first or second dose, including: Pain, redness or swelling where the shot was given Fever Fatigue Headache Muscle pain Chills Joint pain Nausea and vomiting Swollen lymph nodes Feeling unwell Most side effects go away in a few days. An imaging test that uses a combination of large magnets, radiofrequencies, and a computer to make detailed pictures of organs and structures within the body. Shoulder Injury Related to Vaccine Administration and a Growing Challenge: A Focused Review. (2019). The next issue of NP Posted will soon be in your inbox. Inactivated vaccines, which are made from killed virus, contain adjuvants, or additional chemicals, that help promote a robust immune response. We report a case of subacromial-subdeltoid bursitis after COVID-19 vaccination, related to the unintentional injection of vaccine solution into the bursa resulting in a robust immune-mediated inflammatory reaction. Widespread and long-term inflammation during severe COVID-19 may cause the immune system to produce antibodies to pieces of the virus it wouldn't normally recognize. Shoulder injury related to vaccine administration (SIRVA) following mRNA COVID-19 vaccination: Report of 2 cases of subacromial-subdeltoid bursitis. By continuing to use our site, you agree to our Terms of Service and Privacy Policy. Otherwise, eligible adults can feel safe to roll up their sleeves. NIH Research Mattersis a weekly update of NIH research highlights reviewed by NIHs experts. Learn how long COVID-19 vaccines may protect you, including data from Moderna, Pfizer-BioNTech, Johnson & Johnson, AstraZeneca, and NovaVax vaccines. That can sometimes cause a problem termed SIRVA, shoulder injury related to vaccine administration. On the other hand, we have also heard from numerous readers who report unexpected benefit. "Similar to the flu vaccine, the side effects are pretty mild, and the most common one is fatigue," says Malaty Rivera. More serious or long-lasting side effects to COVID-19 vaccines are extremely rare. Shoulder Pain and Injury after COVID-19 Vaccination. A hypothesis is that the first shot, the primer, gets your immune system ready. Epub 2022 Jun 8. Like many, I avert my eyes at the sight of an approaching needle. Trop Dis Travel Med Vaccines. Covid cases are rising among teens. A SIRVA diagnosis should not prevent receiving future vaccines. Research, Silver Spring, Maryland, 2010-2012 Resident [Preventive medicine The MHRA follows international standards of safety. Public health officials say to expect largely mild side effects. It might seem counterintuitive, but side effects are a sign the vaccine is doing its job, experts . These include NSAIDs, antidepressants, corticosteroids and estrogen. Bethesda, MD 20894, Web Policies That isn't a requirement, and you can get vaccinated sooner if you want to . All information these cookies collect is aggregated and therefore anonymous. Please visit the CDC's website for the most up to date information.. COVID-19 is characterized by a variety of symptomssome common to respiratory illness (fever, cough, runny nose) and others altogether strange (loss of taste and smell and "foggy brain"). CDC ACIP meeting, September 22, 2021. (2022). He also prescribed medication to lower my blood pressure. Last December during a routine physical exam, I received a vaccination to protect against several strains of pneumonia. Degenerative Disc Disease: Can Injections Help Relieve Back Pain? Pain may be sudden and severe. The condition, called myocarditis, is usually mild, but a handful of patients remain hospitalized. Vaccines have an impressive safety record. He received a diagnosis of. Posterior Achilles tendon bursitis. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. My dermatologist told me to use Zeasorb AF, an over-the-counter antifungal powder for athletes foot. "We clearly have an imbalance there," Shimabukuro said. Shoulder Joint Support & Pain Relief - Shoulder bandage not only provides strong support for the shoulder, but also relieves pain in the . Treatment may include: Repeated aspiration of the infected fluid (a needle is used to take out the fluid). Joint Symptoms You Can't Ignore. Teenagers and people in their early 20s accounted for more than half of the myocarditis cases reported to the CDC's safety monitoring systems following Covid-19 vaccination, despite representing a fraction of people who have received the shots. A vaccine is an immunologically sensitive substance, and if you were to receive an injection too high in the wrong place you could get pain, swelling and reduced range of motion in that area, says Tom Shimabukuro, deputy director of the Centers for Disease Control and Preventions immunization safety office. People with such symptoms often refer to themselves as "long-haulers." Other symptoms can include chest pain, heart palpitations, cough, brain fog and headache. The first time I had someone complain about shoulder pain following a vaccination was about five or six years ago, and I thought it was so unusual that I blew it off, says G. Russell Huffman, an associate professor of orthopedic surgery at the Hospital of the University of Pennsylvania. You need 2 doses for stronger and longer-lasting protection. Funding:NIHs National Institute of Allergy and Infectious Diseases (NIAID), National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK), National Heart, Lung, and Blood Institute (NHLBI), and National Institute of Arthritis and Musculoskeletal and Skin Diseases (NIAMS); Stanford Maternal and Child Health Research Institute; Stanford University; Carreras Foundation; Universities Giessen and Marburg Lung Center; German Center for Lung Research; University Hospital Gieen and Marburg (UKGM); Deutsche Forschungsgemeinschaft (DFG); Foundation for Pathobiochemistry and Molecular Diagnostics; Parker Institute for Cancer Immunotherapy; Stiftung P.E. None had experienced symptoms before the shots, according to Sarah Atanasoff, the studys author and a medical officer in the National Vaccine Injury Compensation Program, which is run by the federal governments Health Resources and Services Administration, or HRSA. Position your body properly when doing daily activities. Bursitis is inflammation of a bursa, a closed, fluid-filled sac that works as a cushion and gliding surface to reduce friction between tissues of the body. The major bursae (this is the plural of bursa) are located next to the tendons near the large joints, such as in the shoulders, elbows, hips, and knees. Wong W, et al. When needed, treatment may involve anti-inflammatory drugs, such as ibuprofen, and in some cases, an intravenous medication called IVIG.
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bursitis after covid vaccine