Sex: F
Vaccine: FLUX
Symptoms: Muscle injury, Rhabdomyolysis
Clinical narrative: Rhabdomyolysis; This literature case was received on 29-Aug-2022 and concerned an adult, female patient of an unreported age. At the time of initial reporting, the patient was 46-year-old.  The patient's family history included maternal systemic lupus erythematous. The patient's concomitant medications were not reported. The patient's historical vaccine included influenza vaccine (brand not specified), received on an unspecified date in 2006, after which the patient was hospitalized due to rhabdomyolysis (refer to the case 202203964).  On an unspecified date in 2016, the patient was vaccinated with influenza vaccine (brand not specified; dose, route of administration, anatomical location and indication: not reported). The batch number was not reported.  On unspecified date in 2016, an unknown amount of time after receiving influenza vaccine, the patient was hospitalized due to episode of rhabdomyolysis. Autoimmune myositis was ruled out.   The outcome of the event was not reported.  Rhabdomyolysis could be an adverse event to vaccine administration, most commonly influenza vaccination. Although no pathophysiologic mechanism was established, several hypotheses exist to explain muscle damage including genetic factors, autoimmune reactions to the virus nucleic material, or external adjuvant. This was described as autoimmune/inflammatory syndrome induced by adjuvants. Our patient had a history of recurrent episodes of rhabdomyolysis after receiving influenza and COVID immunizations, as well as viral infection. In conclusion the mechanism of our patients' reaction was unknown. Reported cases support autoimmunity as the major risk factor for vaccine related rhabdomyolysis. Genetic predisposition might also play a role. African Americans have higher prevalence of slow acetylation and carnitine palmitoyltransferase II deficiency, a disorder of fatty acid. The myopathic form presents with high creatine kinase (CK) values. Therefore, patients should be counselled to seek medical attention when symptoms occur, and physicians should consider vaccination as a possible cause.  The reported assessed the event of 'rhabdomyolysis' as possibly related to influenza vaccine. As reported, rhabdomyolysis could be an adverse event to vaccine administration, most commonly influenza vaccination.  The event of 'rhabdomyolysis' was considered to be serious due to seriousness criterion of hospitalization. Additionally, the event was considered to be medically significant by a Physician within Seqirus's Pharmacovigilance and Risk Management Department.   This case is linked with the case 202203964 (the same patient).  Company comment: A patient of unreported age developed rhabdomyolysis an unknown amount of time (within the same year) after vaccination with the suspect product influenza vaccine. Information regarding the related diagnostic findings was not provided. As presented by the author, the same patient developed another episode of rhabdomyolysis after influenza vaccination ten years prior (linked case). Based on presented information, causality for the reported event is assessed as possibly related.; Reporter's Comments: As reported, rhabdomyolysis could be an adverse event to vaccine administration, most commonly influenza vaccination.; Sender's Comments: A patient of unreported age developed rhabdomyolysis an unknown amount of time (within the same year) after vaccination with the suspect product influenza vaccine. Information regarding the related diagnostic findings was not provided. As presented by the author, the same patient developed another episode of rhabdomyolysis after influenza vaccination ten years prior (linked case). Based on presented information, causality for the reported event is assessed as possibly related.