Age: 81.0
Sex: M
Vaccine: UNK
Symptoms: Injection site pain, Insomnia, Lymph node pain, Lymphoedema, Musculoskeletal chest pain
Clinical narrative: Insomnia due to the residual tenderness of the involved regions; Insomnia due to the residual tenderness of the involved regions; Pain is now localized to the lower left diaphragm and ribcage below the axilla; The referred pain radiates to the left scapula; Lymphodema and low grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula; Lymphodema and low grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula; The tender lymph nodes; Lymphodema and low grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula; Lymphodema and low grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula; Lymphodema and low grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula; Inflamed areas still show hypesthesia and superficial and referred pain occurs with palpitation of deeper tissues; Inflamed areas still show hypesthesia and superficial and referred pain occurs with palpitation of deeper tissues; The referred pain radiates to the left scapula/Pain; Patient is still guarding his deep breathing to avoid moderate pain; This spontaneous case was retrieved on 23-Dec-2020 from Vaccine Adverse Event Reporting System (VAERS) (reference number: 890707-1), reported by other health professional and concerned an 81-year-old, male patient.  The patient's concurrent conditions included osteoarthritis, high cholesterol, hypertension and penicillin allergy. The patient's concomitant medications included cyclobenzaprine, celecoxib and rosuvastatin, all used for an unreported indication.    On 22-Aug-2020, the patient was vaccinated with Fluad Quadrivalent (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; dose: reported as one, route of administration: intramuscular, anatomical location: left arm and indication: not reported). The batch number reported was 279789.  On the same day, three hours after receiving Fluad Quadrivalent, the patient experienced lymphodema and low-grade pain in the left axilla, the inner left upper arm, the left ribcage and in the muscles of the left scapula. The patient was treated with 50 mg of diphenhydramine and 30 mg of prednisone. Also, the patient experienced tender lymph nodes.    On an unspecified date in Sep-2020, over two weeks as reported, the tender lymph nodes were resolved.   On an unspecified date in 2020, the patient experienced pain and was treated with Vicodin (hydrocodone bitartrate, paracetamol), one half of a tablet and with 100 mg of celecoxib.   On an unspecified date in 2020, the patient experienced inflamed areas with hypoesthesia and was guarding his deep breathing to avoid moderate pain, deep to the lower left ribcage.    By the end of 10-Oct-2020, all meds, as reported, were stopped except celecoxib.  On unspecified date in Oct-2020, the residual pain was localized to the lower left diaphragm and ribcage below the axilla. The patient was still guarding his deep breathing to avoid moderate pain, deep to the lower left ribcage. Previously inflamed areas still showed hypesthesia and superficial and referred pain occurred with palpitation of deeper tissues. The referred pain radiated to the left scapula. The patient was treated also with diphenhydramine at bedtime as needed for insomnia due to the residual tenderness of the involved regions.  At the time of initial reporting, the patient had not recovered from the events.  The reporter did not provide causality assessment.   All events were considered to be serious due to seriousness criterion of disability.  Company comment: A 81-year-old male patient experienced lymphoedema, axillary pain, musculoskeletal chest pain and lymph node pain 3 hours after administration of Fluad Quadrivalent in the left arm. Other reported events: inflammation, hypoaesthesia, diaphragmalgia, painful respiration, insomnia, tenderness, pain (reported as 'the referred pain radiates to the left scapula/pain'), pain in extremity, myalgia and arthralgia developed on an unspecified date in Oct-2020. The patient's concurrent conditions included osteoarthritis, high cholesterol, hypertension and penicillin allergy. Concomitant medications included cyclobenzaprine, celecoxib and rosuvastatin, all used for an unreported indication. Causality is assessed as possibly related for majority of the events, except for insomnia (confounded with pain), even though reaction onset dates are missing however, some of the reported event (arthralgia) may also be confounded with reported medical history of osteoarthritis.; Sender's Comments: A 81-year-old male patient experienced lymphoedema, axillary pain, musculoskeletal chest pain and lymph node pain 3 hours after administration of Fluad Quadrivalent in the left arm. Other reported events: inflammation, hypoaesthesia, diaphragmalgia, painful respiration, insomnia, tenderness, pain (reported as 'the referred pain radiates to the left scapula/pain'), pain in extremity, myalgia and arthralgia developed on an unspecified date in Oct-2020. The patient's concurrent conditions included osteoarthritis, high cholesterol, hypertension and penicillin allergy. Concomitant medications included cyclobenzaprine, celecoxib and rosuvastatin, all used for an unreported indication. Causality is assessed as possibly related for majority of the events, except for insomnia (confounded with pain), even though reaction onset dates are missing however, some of the reported event (arthralgia) may also be confounded with reported medical history of osteoarthritis.