Age: 66.0
Sex: F
Vaccine: FLUA4, PPV, VARZOS
Symptoms: Discomfort, Pain in extremity, Peripheral swelling, Skin warm
Clinical narrative: Both her arms were swollen (the size of an orange on both arms); Both her arms were hot to touch; Both arm felt heavy; Both her arms were painful; Fluad Quadrivalent and Shingrix both administered in the same arm; This spontaneous case was retrieved on 21-Dec-2020 from Vaccine Adverse Event Reporting System (VAERS) (reference number: 894236-1) reported by other health professional and concerned a 66-year-old, female patient.  The patient's concurrent conditions included chronic back pain, gastroesophageal reflux disease (GERD), allergy related asthma, high cholesterol, high blood pressure and she was sensitive to opioids but not allergic (with reactions constipation, itching and nausea). The patient's concomitant medications included naproxen, Flexeril (cefixime) and unspecified over-the-counter (OTC) vitamins, all used for an unreported indication. It was reported that the patient took those medications in the am, before her appointment.  On 28-Oct-2020, the patient was vaccinated with Fluad Quadrivalent (influenza vaccine, inactivated influenza virus surface antigen (subunit), egg-derived, mf59; route of administration: intramuscular, anatomical location: left arm, dose and indication: not reported). The batch number reported was 279799.  On the same day, the patient was vaccinated with non-company co-suspects Pneumovax (pneumococcal vaccine polysacch 23v; batch number: S012822, route of administration: intramuscular, anatomical location: right arm, dose and indication: not reported) and Shingrix (pneumococcal vaccine polysacch 23v; batch number: 454S2, dose: reported as two, route of administration: intramuscular, anatomical location: left arm and indication: not reported) (explicitly coded as 'Product administration error').  On the same day, after receiving Fluad Quadrivalent and co-suspects Pneumovax and Shingrix, the patient's both arms were swollen, painful and hot to touch. The area was the size of an orange. Her both arms felt heavy.   On 29-Oct-2020, the patient visited her chiropractor. It was reported that vaccine was released through chiropractic manipulation. The patient was treated with Dilaudid (hydromorphone hydrochloride) for pain.   At the time of initial reporting, the patient was not recovered from event arms swollen and was recovering from other events. She felt better, but her arms remained sore.  The reporter did not provide causality assessment.  This case was assessed as non-serious.  Company comment: A 66-year-old female patient experienced peripheral swelling, skin warm, limb discomfort and pain in extremity on the same day after administration of Fluad Quadrivalent and a non-company co-suspects Pneumovax in separate arms. It was reported that vaccine was released through chiropractic manipulation. Causality is assessed as possibly related for all events since they occurred on both arms but possibly confounded with chiropractic manipulation. Product administration error is assessed as unrelated per company conventions.; Sender's Comments: A 66-year-old female patient experienced peripheral swelling, skin warm, limb discomfort and pain in extremity on the same day after administration of Fluad Quadrivalent and a non-company co-suspects Pneumovax in separate arms. It was reported that vaccine was released through chiropractic manipulation. Causality is assessed as possibly related for all events since they occurred on both arms but possibly confounded with chiropractic manipulation. Product administration error is assessed as unrelated per company conventions.