covid vaccine lump at injection site

COVID-19 vaccine has been associated with enhanced local/injection site reactions l (e.g., pain, swelling, redness). Epub 2021 Sep 21. These cookies may also be used for advertising purposes by these third parties. Curr Opin Virol 2021; 49: 5257. (2021). Eleven (52%) had received the Moderna mRNA vaccine while the remaining 10 (48%) received the Pfizer-BioNTech mRNA vaccine. Drago F, Ciccarese G, Guadagno A, Parodi A. J Eur Acad Dermatol Venereol. Any AEFI should be reported to the vaccine safety service in your state. The COVID19 vaccine development: a pandemic paradigm. Thank you for taking the time to confirm your preferences. Vaccine availability is subject to . Detailed discussion can be found here: Pinkbook: Vaccine Administration | CDC A detailed discussion of strategies to reduce procedural pain can be found here. There were 2 SAEs among 2 participants in the placebo group (affective disorder and COVID-19). Injection site reactions are areas of skin redness, swelling, and warmth. Anaphylaxis from a COVID vaccine is also very rare, occurring in only 5 cases per one million administered vaccines, which means the vaccines benefit still outweighs the risk. c Fatigue, Myalgia, Arthralgia Grade 3: significant; prevented daily activity; Grade 4: required emergency room visit or hospitalization. The median duration of lymphadenopathy was 1 to 2 days. This happens with many of the common vaccines that infants receive, such as DTaP, polio, PCV, hepatitis A and B, chickenpox, MCV, and influenza. In the placebo group serious adverse events, 1 participant experienced an abdominal wall abscess and 1 participant with rhinovirus infection and asthma. Before aGrade for fever: grade 3=39.6-40.0C; grade 4=> 40.0C. Each vaccine has a recommended administration route and site. xhr.setRequestHeader('Content-Type', 'text/plain;charset=UTF-8'); Stay up to date with COVID-19 vaccines including boosters. the spike-protein sequences used to design the vaccines) and human components and may thus explain some COVID-19 pathologies as well as adverse skin reactions to COVID-19 vaccinations. Injection site reactions will go away on their own. Axillary swelling or tenderness was reported more frequently in the younger age group than the older age group (16.0% vs 8.4% after dose 2). bsevere: any use of prescription pain reliever/prevents daily activity; Grade 4: emergency room visit or hospitalization for severe pain at the injection site. Axillary swelling or tenderness was reported more frequently post dose 1 (23.2%) than dose 2 (21.0%). Authors: Mel Addison (SAEFVIC Research Nurse, Murdoch Childrens Research Institute), Rachael McGuire (SAEFVIC Research Nurse, Murdoch Childrens Research Institute) and Georgina Lewis (Clinical Manager, SAEFVIC, Murdoch Childrens Research Institute), Reviewed by:Mel Addison (SAEFVICResearch Nurse, Murdoch Childrens Research Institute). sharing sensitive information, make sure youre on a federal Type I hypersensitivity reactions (e.g. Often, more than one vaccine is needed during the same doctors visit, requiring more than one shot. Unable to load your collection due to an error, Unable to load your delegates due to an error, An old man had a history of intense itch and erythematous skin lesions after his first, Chilblainlike lesions (a) on the left big toe of a patient who had received his first shot, Widespread purpuric rash on the left thigh (a) of an elderly male which had developed a few days after his first, A young healthy female had a history of an asymptomatic petechial rash developing 1day after her first, Showing a female patient with a 2week history of widespread dry purpuric skin lesions on her extremities (a). Other serious adverse events in the vaccine group included dehydration, metapneumovirus, foreign body respiratory tract infection, mastoiditis, bronchiolitis, pyrexia, rhinovirus, asthma, adenovirus infection, erythema multiforme, croup infectious, viral gastroenteritis, and 1 participant with Type 1 diabetes and diabetic ketoacidosis. 2023 Feb 20:1-4. doi: 10.1007/s13691-023-00598-7. COVID-19 is a life threatening condition, and the vaccine is highly protective against the virus SARS-CoV-2, which causes COVID-19. Accessibility Sanomachi T, Sumiyoshi Okuma H, Yonemori K. Int Cancer Conf J. Referral to a Specialist Immunisation Clinic should be considered for specialist consultation. Pain at the injection site was the most frequent and severe reported solicited local reaction among vaccine recipients. The https:// ensures that you are connecting to the COVID arm is a delayed hypersensitivity skin reaction that occurs on or around the injection site. Type IV hypersensitivity reactions may be observed, including delayed large local skin lesions ("COVID arm"), inflammatory reactions in dermal filler or previous radiation sites or even old BCG scars, and more commonly morbilliform and erythema multiforme-like rashes. Other serious adverse events in the vaccine group were bronchial hyperactivity, respiratory distress, adenovirus infection, seizure, rhinovirus infection (bronchiolitis due to rhinovirus), Epstein-Barr infection, urinary tract infection, and humerus fracture. Importantly, molecular mimicry exists between SARS-CoV-2 (e.g. All information these cookies collect is aggregated and therefore anonymous. (Table 3, Table 4). The symptoms of COVID arm typically last about 5 days but may last as long as 21 days. This is referred to as an overexuberant immune response. Bookshelf [emailprotected]. Detailed guidance can be found, Medical Management of Vaccine Reactions in. Occupational Safety and Health Administration (OSHA) regulations typically do not required gloves to be worn when administering vaccines unless the person administering the vaccine is likely to come in contact with potentially infectious body fluids or has open lesions on the hands. Recently, people who have been vaccinated are sharing stories online about feeling lumps in their armpits, which might seem like cause for concern, but is in fact, to be expected. The majority of systemic reactions were mild or moderate in severity, after both doses. There were 9 SAEs among 6 vaccine recipients (appendicitis, diarrhea, vomiting, drug-induced liver injury, pectus excavatum, post-procedural fever, suicidal ideation [2], depression suicidal). Get the details on dosage, side effects, cost, and more. 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. Injecting vaccines rapidly without aspiration, Using tactile stimulation (rubbing/stroking near the injection site before and during injection), Distracting the patient (done by either the parent or clinician), Having the patient seated rather than lying down. Grade 4 fever (>40.0C) was reported by four vaccine recipients after dose 1 and 11 vaccine recipients after dose 2. The majority of reactions occurred within the first 1 to 2 days after each dose and persisted for a median of 2 days. Grade 4 fever (>40.0C) was reported by one vaccine recipient after dose 2 and one placebo recipient after dose 2. (b) In presence of secondary allergens, increased COVID19 vaccinemediated immune recruitment may manifest as delayed (type IV) allergic reactions, such as COVID arm, maculopapular rashes, erythema multiforme and dermal filler reactions. They can develop after you get a vaccine or an injectable medication. FOIA Receiving any of the COVID-19 vaccines is better than remaining unvaccinated. d Severe: prevents daily activity, requires intravenous hydration; Grade 4: emergency room visit or hospitalization for hypotensive shock. While not impossible, it is less likely to occur with a booster shot if you havent experienced it before. Other skin reactions can also occur after getting the shot that may look like COVID arm but develop closer to the time you get the shot. You may want to consider talking with your doctor to learn more about the COVID-19 vaccines benefits and side effects. doi: 10.1111/jdv.18418. If you didnt get it before, youre less likely to get it after a booster shot. If possible, administer COVID-19 vaccine and other reactogenic vaccines (e.g., MenB, Tdap) in different limbs. Miao G, Chen Z, Cao H, Wu W, Chu X, Liu H, Zhang L, Zhu H, Cai H, Lu X, Shi J, Liu Y, Feng T. Biomed Pharmacother. If you get a COVID-19 vaccine and you think you might be having a severe allergic reaction after leaving the vaccination provider site, seek immediate medical care by calling 911. document.addEventListener( 'DOMContentLoaded', function() { Cutaneous findings following COVID‐19 vaccination: Review of world literature and own experience. We are based at Murdoch Childrens Research Institute (MCRI), a research organisation, and are affiliated with SAEFVIC (Surveillance of Adverse Events Following Vaccination in the Community), the Victorian Vaccine Safety Service. It is mostly associated with mRNA vaccines like Moderna and Pfizer. Fever was more common after the second dose (12.1%) compared to the first dose (2.5%). COVID arm is a delayed hypersensitivity reaction that occurs mostly from the Moderna vaccine. HHS Vulnerability Disclosure, Help We take your privacy seriously. Your immune system has already indicated its responding robustly. asevere: > 50 mm; Grade 4: necrosis or exfoliative dermatitis, bsevere: prevents daily activity; Grade 4: emergency room visit or hospitalization, a Grade 3: > 100 mm; Grade 4: necrosis or exfoliative dermatitis. It is unclear what causes a nodule however, vaccine components (e.g. Histopathological Patterns of Cutaneous Adverse Reaction to Anti-SARS-CoV-2 Vaccines: The Integrative Role of Skin Biopsy. Doctors and the CDC say this coronavirus. Wei N, et al. Prepare each injectable vaccine using a separate syringe. Disclaimer. The most common manifestations of localized injection-site reactions were swelling (44% after the first dose, 68% after the second), erythema (49% and 67%), and pain (35% and 59%). 2022 Sep;21(9):3692-3703. doi: 10.1111/jocd.15209. Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. Abstracts of Presentations at the Association of Clinical Scientists 143. Reports of lymphadenopathy were imbalanced with 1.1 % of persons in the vaccine group and 0.6% in the placebo group reporting such events; lymphadenopathy is plausibly related to the vaccine. In the placebo group there was 1 participant with bronchiolitis, rhinovirus and acute respiratory failure. Multiple studies have found that COVID-19 vaccines, including boosters, are safe, and that adverse reactions are rare. Ann Clin Lab Sci. Usually, the symptoms of COVID arm resolve on their own. Administer vaccines that are known to be painful when injected (e.g., MMR, HPV) last. Ramos CL, et al. Deviation from the recommended route may reduce vaccine efficacy or increase local adverse reactions. Detailed discussion can be found here: Multiple Injections/Coadministration of Vaccines, COVID-19 vaccine and coadministration with other vaccines, Routine and Influenza Immunization Services During the COVID-19 Pandemic: Interim Guidance | CDC, Vaccine Administration: Intramuscular (IM) Injection Children 7 through 18 years of age, Vaccine Administration: Intramuscular (IM) Injection Adults 19 years of age and older], Vaccine Administration: Needle Gauge and Length, Giving all the Doses Under 12 Months of Age, COVID-19 vaccines can be given during the same visit, How to Hold Your Child During Vaccinations, General Best Practice Guidelines for Immunization: Best Practices Guidance of the Advisory Committee on Immunization Practices (ACIP), Reducing the pain of childhood vaccination: an evidence-based clinical practice guideline, Subcutaneous (SC or Subcut) Injection: Sites [3:26 minutes], Subcutaneous (SC or Subcut) Injection: Administration [6:27 minutes], Intramuscular Injection: Sites [5:07 minutes], Live, Attenuated Influenza Vaccine (LAIV) [4:09 minutes], Comfort and Restraint Techniques for Children [4:46 minutes], You Call the Shots: Vaccine administration training for healthcare professionals, National Center for Immunization and Respiratory Diseases, Healthcare Professionals / Providers Home, Vaccine Adverse Event Reporting System (VAERS), Pediatric Vaccination Practices During COVID-19, Childhood Vaccination Toolkit for Clinicians, You Call The Shots: Vaccine Storage and Handling, Screen for Contraindications and Precautions, Temporary, Satellite, or Off-Site Vaccination Clinics, Easy-to-Read Recommended Immunization Schedules, Resources for Parents of Infants and Toddlers, Resources for Parents of Preteens and Teens, Resources for College Students, Young Adults, and Adults, Understanding Risks & Responsibilities, If You Choose Not to Vaccinate, Talking with Parents about Vaccines for Infants, Understanding Vaccines and Vaccine Safety, U.S. Department of Health & Human Services, DTaP, DT, HepA, HepB, Hib, HPV, , IIV4, RIV4, ccIIV4, IPV*, MenACWY, MenB, PCV13, PPSV23*, RZV, Td, Tdap, TT, Fatty tissue of thigh for infants younger or upper outer triceps area, DTaP-IPV, DTaP-IPV-HepB, DTaP-IPV/Hib, DTaP-IPV-HepB/Hib, HepA-HepB. 2005-2023 Healthline Media a Red Ventures Company. They help us to know which pages are the most and least popular and see how visitors move around the site. a mild: 25-50 mm; moderate: 51-100 mm; severe: >100 mm; Grade 4=necrosis or exfoliative dermatitis. In conclusion, there are numerous cutaneous reaction patterns that may occur following COVID-19 vaccination, whereby many of these skin findings are of immunological/autoimmunological nature. At-home treatments that reduce pain, swelling, and itching include: COVID arm is a minor annoyance that will disappear within a few days. Cutaneous manifestations of COVID-19 and COVID-19 vaccination. Moving your arm and using a cool compress should help soothe the pain. Lindgren AL, et al. The proportions of participants who reported at least one serious adverse event were 1% in the vaccine group and 1% in the placebo group. Injection site reactions are common after vaccines or treatments delivered through a shot. They help us to know which pages are the most and least popular and see how visitors move around the site. 8600 Rockville Pike However, if you do experience a severe allergic reaction, it will usually happen immediately after receiving the injection. Vaccines available in the United States are administered by 4 routes: When administering a vaccine by injection, choose the correct needle size based on the route, age, patient size, and injection technique. b Headache Grade 3: significant; any use of prescription pain reliever or prevented daily activity; Grade 4: requires emergency room visit or hospitalization. official website and that any information you provide is encrypted aGrade for fever: grade 3=39-40.0C; grade 4=> 40.0C. If you experience swelling of your lips, eyes, or tongue, that could be an allergic reaction to the vaccine. Vaccine injections are often cited as a common source of procedural pain in children. They usually resolve spontaneously without treatment or investigation. In a CDC report on the Moderna vaccine, the agency said that the swelling of lymph nodes, also known as lymphadenopathy, can occur in either the arm or the neck. e Chills Grade 3: prevented daily activity and required medical intervention; Grade 4: required emergency room visit or hospitalization. 2023 Feb;158:114208. doi: 10.1016/j.biopha.2022.114208. CDC and the Advisory Committee on Immunization Practices (ACIP) guidance states COVID-19 vaccines can be given during the same visit with other vaccines, including flu vaccine, if the recipient is eligible for the vaccines. Front Med (Lausanne) 2021; 8: 664179. Saving Lives, Protecting People, National Center for Immunization and Respiratory Diseases, Use of COVID-19 Vaccines in the U.S.: Appendices, FAQs for the Interim Clinical Considerations, Myocarditis and Pericarditis Considerations, Jurisdictions: Vaccinating Older Adults and People with Disabilities, Vaccination Sites: Vaccinating Older Adults and People with Disabilities, Vaccinating Patients upon Discharge from Hospitals, Emergency Departments & Urgent Care Facilities, Vaccines for Children Program vs. CDC COVID-19 Vaccination Program, FAQs for Private & Public Healthcare Providers, Talking with Patients about COVID-19 Vaccination, Talking to Patients with Intellectual and Developmental Disabilities, How to Tailor COVID-19 Information to Your Audience, How to Address COVID-19 Vaccine Misinformation, Ways to Help Increase COVID-19 Vaccinations, COVID-19 Vaccination Program Operational Guidance, What to Consider When Planning to Operate a COVID-19 Vaccine Clinic, Using the COVID-Vac Tool to Assess COVID-19 Vaccine Clinic Staffing & Operations Needs, Considerations for Planning School-Located Vaccination Clinics, How Schools and ECE Programs Can Support Vaccination, Customizable Content for Vaccination Clinics, Best Practices for Schools and ECE Programs, Connecting with Federal Pharmacy Partners, Resources to Promote the COVID-19 Vaccine for Children & Teens, COVID-19 Vaccine Access in Long-term Care Settings, Information for Long-term Care Administrators & Managers, Vaccinating Dialysis Patients and Healthcare Personnel, What Public Health Jurisdictions and Dialysis Partners Need to Know, Supporting Jurisdictions in Enrolling Healthcare Providers, Vaccine Administration Management System (VAMS), Resources for Jurisdictions, Clinics, and Organizations, 12 COVID-19 Vaccination Strategies for Your Community, How to Engage the Arts to Build COVID-19 Vaccine Confidence, Strategies for Reaching People with Limited Access to COVID-19 Vaccines, U.S. Department of Health & Human Services, Use of antipyretic or pain medication, n (%). Upon further review, 3 of the 13 fever events were incorrectly reported as grade 4, given that none of these 3 participants recorded any elevated temperature resulting in 10 confirmed grade 4 fevers: 8 (0.3%) in the mRNA-1273 group and 2 (0.2%) in the placebo group in the 2-5 age group. government site. The following were higher in the placebo group compared with the vaccine group by at least 1%: upper respiratory tract infection (12.2% vs 10.3%), COVID-19 (4.9% vs 3.5%), and otitis media (3.7% vs 2.6%). . Some patients are reporting a lump in their armpit after getting the COVID vaccine. Swelling, redness (erythema), pain and itch at the site of injection can be a common side effect from any vaccine. A higher frequency of unsolicited adverse events was reported in the vaccine group compared to the placebo group (29.6% vs 25.1%). Whether the patient is behind or at risk of becoming behind on recommended vaccines. Recently, people who have been vaccinated are sharing stories online about feeling lumps in their armpits, which might seem like cause for concern, but is in fact, to be expected. a Pain grade 3: any use of prescription pain reliever or prevented daily activity; grade 4: required emergency room visit or hospitalization. If you get the Moderna COVID-19 vaccine, there is a small chance that you could develop a skin reaction. Gambichler T, et al. This information is included in the manufacturers package insert for each vaccine. Injection site redness and swelling following either dose were reported less frequently. Serious adverse events were defined as any untoward medical occurrence that resulted in death, was life-threatening, required inpatient hospitalization or prolongation of existing hospitalization, or resulted in persistent disability or incapacity. Ongoing pruritus can alter the appearance of the skin leading to excoriation, hair growth and pigmentation changes. Even though its not serious, COVID arm can be uncomfortable. Separate injection sites by 1 inch or more, if possible. Doctors say this is a normal side effect of the COVID vaccine. Functional angiopathies (chilblain-like lesions, erythromelalgia) may also be observed. 2023 Mar;50(3):280-289. doi: 10.1111/1346-8138.16651. After dose 1, the younger age group reported pain more frequently than the older age group (86.9% vs 74.0%); a similar pattern was observed after dose 2 (90.1% vs 83.4%). The Rare COVID Vaccine Side Effect Doctors Want You to Prepare For, vaccine side effect that hasn't been as discussed, This COVID Vaccine Side Effect Could Show Up a Week After Your Shot, If You Take These OTC Meds, You Have to Stop Before Getting the Vaccine, If You're Over 65, You Shouldn't Get This New Vaccine, Experts Warn, The CDC Doesn't Recommend This One Type of Face Mask, immunologist with Allergy & Asthma Network, Click here for all An imbalance of unsolicited adverse events in the skin and subcutaneous tissue disorders was also observed between the vaccine group (1.1%) and placebo group (0.6%). A recent study by the National Institute of Health (NIH) also found that these vaccines are effective, leading to a low hospitalization rate with severe symptoms or death from COVID-19. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). The development of a nodule at the injection site is a known but rare adverse event following immunisation (AEFI). The rabies vaccine can save your life after a bite or scratch from an unvaccinated animal. Healthline Media does not provide medical advice, diagnosis, or treatment. During the study period, there were 322 patients referred for post-COVID-19 vaccine cutaneous reactions. Careers. The COVID-19 vaccines are beginning to significantly slow the spread of the virus, but the Pfizer and Moderna and vaccines are having an unforeseen consequence for breast cancer doctors. Injection site nodules The development of a nodule at the injection site is a known but rare adverse event following immunisation (AEFI). Onset is typically around one week after vaccination. What to Do if You Get COVID Arm and Other Side Effects iStock The CDC has warned that vaccine side effects include: Pain Redness Swelling As well as Tiredness Headache Muscle pain Chills Fever Nausea Contact your doctor if you feel you need medical attention. After leaving a vaccination provider site, if you think you or your child might be having a severe allergic reaction, seek immediate medical care by calling 911. Our content is fact checked by our senior editorial staff to reflect accuracy and ensure our readers get The overall incidence of unsolicited adverse events up to 28 days after any dose were similar in the vaccine group (49.3%) and the placebo group (48.2%) for participants ages 523 months. The following unsolicited adverse events were higher in the vaccine group compared with the placebo group by at least 1%: injection site lymphadenopathy (1.4% vs 0.2%); croup (1.3% vs 0.3%); diarrhea (3.2% vs 2.2%). Adverse events in the vaccine group were similar in nature and incidence to those in the placebo group, with the exception of higher incidence of injection site erythema in the vaccine group compared to the placebo group (1.3% vs 0.2%) and COVID-19 in the placebo group compared to the vaccine group (5.5% vs 3.1%). Last medically reviewed on November 27, 2022. No other systemic grade 4 reactions were reported. Redness and swelling were more common after dose 2. 2023 Feb 9;11(2):397. doi: 10.3390/vaccines11020397. Bojan Story/Getty Images. asevere: >10 cm; Grade 4: necrosis (redness and swelling categories) or exfoliative dermatitis (redness category only). An increase in the incidence of injection site conditions were seen in the vaccine group (9.8%) compared to the placebo group (4.1%). Common Infections. After dose 1, the older age group reported pain more frequently than the younger age group (61.4% vs 37.4%); a similar pattern was observed after dose 2 (71.4% vs 46.2%). The majority of systemic reactions were mild or moderate in severity, after both doses and in both age groups. If youre hearing about COVID arm a lot, you may be concerned that you will have this reaction. 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. c Axillary swelling or tenderness was collected as a solicited local adverse reaction (i.e., lymphadenopathy: localized axillary swelling or tenderness ipsilateral to the vaccination arm); grade 3: any use of prescription pain reliever or prevented daily activity; grade 4: required emergency room visit or hospitalization. In Victoria reports can be made to SAEFVIC. Subcutaneous injection can happen inadvertently ( figure 1 ), affecting efficacy of vaccination and potentiate local adverse events. Typically, any minor discomfort goes away in one or two days. See this image and copyright information in PMC. Pityriasis rosea-like rashes and reactivation of herpes zoster have also been reported after COVID-19 vaccination. Autoimmune-mediated skin findings after COVID-19 vaccination include leucocytoclastic vasculitis, lupus erythematosus and immune thrombocytopenia. Learn more. ae0fcc31ae342fd3a1346ebb1f342fcb. bGrade 3: prevents daily activity; Grade 4: emergency room visit or hospitalization for severe pain at the injection site. a Fever Grade 3: 39.0 40.0C or 102.1 104.0F; Grade 4: >40.0C or >104.0F Ann Dermatol. These cookies allow us to count visits and traffic sources so we can measure and improve the performance of our site. COVID arm: Very delayed large injection site reactions to mRNA COVID vaccines. Therapists say it can damage your connection. Cookies used to enable you to share pages and content that you find interesting on CDC.gov through third party social networking and other websites. Cookies used to track the effectiveness of CDC public health campaigns through clickthrough data. Epub 2023 Jan 13. If you havent experienced COVID arm before after getting your first shot, youre even less likely to get it now. The CDC recommends an mRNA vaccine over the J&J vaccine. While this might seem strange or alarming, doctors want to assure patients that it's actually totally normal, even though it's on the rare side as far as side effects go. We pay our respects to their Elders, past, present and emerging. In this article, well clue you in on the symptoms and treatments of COVID arm. You can review and change the way we collect information below. Since the COVID-19 vaccines are new, we dont know definitively what exact mechanism triggers COVID arm symptoms. The majority of systemic reactions were mild or moderate in severity, after both doses. Gum disease. Fever was more common after the second dose (23.9%) compared to the first dose (3.3%). Axillary swelling or tenderness was the second most frequently reported local reaction. } This reaction and others are continuing to be studied worldwide. Vaccine recipients reported higher rates of local reactions after dose 2 than dose 1. In this review article, we provide a brief overview on cutaneous findings that have been observed since the emerging mass COVID-19 vaccination campaigns all over the world. Pain/tenderness at the injection site was the most frequent and severe reported solicited local reaction among vaccine recipients. Read on to find out more about this reaction and for another heads-up about vaccinations, know that This COVID Vaccine Side Effect Could Show Up a Week After Your Shot. Sometimes, your doctor or vaccination provider may recommend alternating arms if you had a strong skin reaction to your first vaccine.

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