I did a head-scratch too. The needle combined with the gaping hole in the apple (plus the blood IN the needle, matching the blood on the apple) make it seem like the needle caused the hole...which makes no sense, considering the size of the hole. If you look at the image again, the apple is drained of color, as if the needle sucked out the color and into the syringe. Again, this makes it look like the puncture should be from the needle, not a gunshot (a gun, btw, which is not present anywhere in the cover).
I hope that makes sense. Otherwise, it really is a fine looking cover.