Sex: U
Vaccine: FLU4
Symptoms: Arthritis bacterial, Drug administered at inappropriate site, Immediate post-injection reaction, Musculoskeletal pain, Periarthritis
Clinical narrative: This case was reported in a literature article and described the occurrence of septic arthritis in a adult subject who received Flu Seasonal QIV Dresden. On an unknown date, immediately after receiving Flu Seasonal QIV Dresden, the subject developed septic arthritis. Serious criteria included GSK medically significant. Additional event(s) included adhesive capsulitis of shoulder, shoulder pain and vaccine administered at inappropriate site. The outcome of septic arthritis was recovering/resolving. The outcome(s) of the additional event(s) included adhesive capsulitis of shoulder (recovering/resolving), shoulder pain (recovering/resolving) and vaccine administered at inappropriate site (unknown). The investigator considered that there was a reasonable possibility that the septic arthritis, adhesive capsulitis of shoulder and shoulder pain may have been caused by Flu Seasonal QIV Dresden. Additional information was provided. This case was reported in a literature article and described the occurrence of adhesive capsulitis, septic arthritis in a patient aged between 18 and 89-year of unspecified gender who was vaccinated with unspecified influenza vaccine (manufacturer unknown). The patient was presented in a case series of 11 cases with adhesive capsulitis following influenza vaccination as a  part of retrospective chart review to identify the basic characteristics of these patients. The patients who had previous injury, surgery, or dysfunction in the shoulder diagnosed with adhesive capsulitis and prisoners were excluded in the study. (In this study, of the 11 patients, 10 were female. 10 were right-handed dominant and 8 of the patients had their non-dominant shoulder affected. 8 of the patients were between the ages of 49 and 64 and the mean age was 51). No information on patient's medical history or family history or concurrent condition or concomitant medication was provided. On an unspecified date, the patient received intramuscular injection (unknown deltoid) of unspecified influenza vaccine in the shoulder (dosages unknown: batch number not provided). The age of vaccination was not provided. On an unspecified date, immediately following or within 1 day, the patient developed pain in the shoulder. (In this study, 7 of the patients presented following influenza vaccination and 4 of the patients presented in the month of November). Duration of symptoms prior to presentation averaged 125 days and ranged from 2 weeks to 12 months. Subsequently, the patient was diagnosed with adhesive capsulitis using International Classification of Diseases (ICD) codes. It was discovered that the patient had septic arthritis which was thought to be secondary to the injection. The patient went on to have surgery for adhesive capsulitis which improved the symptoms. (In this study, 10 of the patients were given a referral to physical therapy, which was effective 60% of the time. 4 patients received steroid injections, which had 75% efficacy. Patients came to the office of an average of 3.9 visits each). The authors considered the event of adhesive capsulitis related to unspecified influenza vaccine and the event of septic arthritis secondary to the injection. The authors stated, "Adhesive capsulitis can develop following vaccine injection. Patients often present in the late fall or winter months, perhaps following "flu blitzes" or other required vaccination events related to their employment. Patients often relate that the inciting injection was delivered "higher than normal" or "too high" in the deltoid muscle, reflecting improper technique. Patients can have symptoms that continue for months, necessitating multiple follow-up visits, physical therapy, injections, or even surgery. Public awareness of this condition is increasing, and there can be severe economic implications involved; the Agency, which has been designated to handle such claims, has settled at least 112 of these injury claims since 2011, with plaintiffs receiving as much as $1 million in compensation per case. We aim to increase awareness of this condition among orthopaedic surgeons". This is 1 of the 2 valid cases reported in the same literature article