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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

Use a clean, sterile technique for injections

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For patients with severe renal impairment (eGFR less than 30 mL/min/1.73 m2) or with end-stage renal disease (ESRD) requiring hemodialysis or peritoneal dialysis, the dose of JANUVIA is 25 mg once daily