Initial unsolicited valid serious case report received from the literature on 24-Apr-2019. This case is linked to cases 2019SA114648 and 2019SA114646 (Same literature). Abstract- Objectives: A variety of environmental risk factors are capable of triggering the onset of rheumatic disorders. Vaccines stand next to antibiotics as a nineteenth-century medical breakthrough impacting the human evolution and survival. Evidently, an age-old process of conferring immunity without active infection, practiced in civilizations, introduced and advocated in modern medicine at the time of renaissance by prominent European physicians. Vaccines tend to stimu-late both the humoral and cellular immunity depending on the type of antigenic stimulation. As with any other medical-intervention, even vaccines sometimes result in adverse events. Vaccine-related side effects are increasing exponen-tially with higher availability, awareness, and reporting. Methods: Standard dose, inactivated, trivalent influenza vaccine was adminis-tered to two middle-aged healthy women, one was being treated for palindromic rheumatism. Another young woman on her late twenties also received an un-specified influenza vaccine. The first two developed rheumatoid arthritis, and the third developed systemic lupus erythematosus, initially manifesting with lupus neuritis presenting as classical fortification spectra permeated by the diver-sity of different colors. All in close proximity to their immunizations. All three disease processes. remained chronic, requiring continuous standard treatment. We discuss the above case details along with the summary of the available vaccine side-effects related studies. It is still unclear regarding the risk autoimmune disorders with vaccinations, while few studies support the norm, others refute, still, the data is insufficient to draw a conclusion, given the rarity and under-recognition of these outcomes and inability to separately observed incidence rates in the susceptible population apart from the general population. Results: The vaccine-induced auto-immune disease may have atypical presen-tation when compared to the idiopathic origin counterpart. This might direct to-wards slightly altered pathologic mechanisms directed at vaccine-related phenomena. The incidence of autoimmune reactions to influenza vaccines is currently unknown, but it can no longer be assumed that a coincidental (i.e., un-related) association exists between immunization and the onset of RA and SLE. Few studies show the increased odds of developing arthritis with MMR vaccine, Sjogren syndrome, reactive arthritis with influenza, psoriatic arthritis with Ru-bella vaccine and severely neurologic disorders post Rabies vaccination. A caus-ative link was seen between influenza vaccine in mid-seventies with Guillain Barre syndrome, forcing the discontinuation of the vaccine. These may be re-lated to the molecular mimicry or adjuvant related mechanisms, which are yet to be fully unveiled. Conclusions: Although no strong evidence exists to contraindicate vaccina-tions, even in patients with existing autoimmune conditions, though the immune response if not as strong as in normal individuals, the benefits granted for routine vaccination. There might be a special group of the population with more predisposition to vaccine-related adverse effects, and only with more epidemio-logic data and physician awareness and reporting, we might be able to find the at-risk groups and lower the incidence similar to analyzing HLA-B-5801 status in the high-risk population before prescribing allopurinol for gout, we might be running special panels for those at-risk communities before vaccinating. This case involves a female patient of unknown age who experienced rheumatoid arthritis, while she received vaccine INFLUENZA VACCINE (TRIVALENT). The patient's medical treatment(s), vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing palindromic rheumatism. On an unknown date, the patient received a dose of suspect INFLUENZA VACCINE (TRIVALENT) produced by unknown manufacturer lot number, Exp. Date, dose, route and site of administration not reported. On an unknown date, the patient developed rheumatoid arthritis following the administration of INFLUENZA VACCINE (TRIVALENT). This event was assessed as medically significant. It was also reported that disease processes remained chronic, requiring continuous standard treatment. Details of lab data not reported. Final diagnosis was rheumatoid arthritis. No other corrective treatment was reported. The event outcome was not reported. List of documents held by sender: none.; Sender's Comments: This case concerns a female patient of unknown age who developed rheumatoid arthritis after vaccination with INFLUENZA VACCINE (TRIVALENT). The time to onset is unknown. Also patient has ongoing chronic palindromic rheumatism. Moreover, patient's concomitant medications and lab tests ruling out alternate etiologies were not reported. Based upon the reported information, the role of the vaccine cannot be assessed.