fluid issues; slight chills; worsening of the right knee swelling.; began to have swelling in her right knee/taken to ER due to worsening of right knee swelling, knee was severely swollen/right knee had begun to resolve, then her left knee started to swell; woke up very lethargic; Initial information received on 13-Oct-2023 regarding an unsolicited valid  non-serious case received from a pharmacist.  This case involves a 95 years old female patient who woke up very lethargic, began to have swelling in her right knee/taken to er due to worsening of right knee swelling, knee was severely swollen/right knee had begun to resolve, then her left knee started to swell, worsening of the right knee swelling, fluid issues and slight chills after receiving Influenza Quadrival A-B High Dose Hv Vaccine [Fluzone High-Dose Quadrivalent].  The patient's past medical history included Meniscus removal with in the 1990s. The patient's past medical treatment(s), vaccination(s) and family history were not provided. At the time of the event, the patient had ongoing Walking aid user.  Concomitant medications included meloxicam (mobic); and aspirin [acetylsalicylic acid] (aspirin [acetylsalicylic acid]).  On 04-Oct-2023, the patient received 0.7 ml total (1X) dose of suspect Influenza Quadrival A-B High Dose Hv Vaccine (with an unknown strength, expiry date, formulation, lot number) via unknown route in unknown administration site for immunization.  On 05-Oct-2023, the patient woke up very lethargic (lethargy) (latency: 1 day).   On 06-Oct-2023, the patient began to have swelling in her right knee/taken to er due to worsening of right knee swelling, knee was severely swollen/right knee had begun to resolve, then her left knee started to swell (joint swelling) (latency: 2 days).  On 07-Oct-2023, the patient had worsening of the right knee swelling  (condition aggravated) (latency: 3 days).  On an unknown date, the patient had fluid issues (fluid imbalance) and slight chills (chills) (unknown latency).  It was reported, The caller's mother is . Her mom lives independently in . She is normally mobile with a walker or cane. She has received flu vaccines for years. On 04Oct2023, the caller, her male partner (she referred to him with male pronouns), and her mom all went to the Health Department for vaccination with Fluzone HD QIV. Of the three of them, only the mom had a reaction. The mom received Fluzone HD QIV in her left arm. No other vaccines were administered to the mom that day. The next day, she woke up very lethargic. The mom has no artificial knee hardware. She has a history of removal of the left knee meniscus in the 1990s. On 06Oct2023, the mom began to have swelling in her right knee. On Saturday, 07Oct2023, the mom called her daughter and asked to be taken to the ER due to worsening of the right knee swelling. At that point, the mom could not bear weight on the knee and had to use a wheelchair for transport to the ER. In the ER, the physician's assistant recommended draining the knee, which was refused. The knee was severely swollen. The patient had an appointment with an orthopod yesterday, 12Oct2023. The right knee had begun to resolve by that visit. Then her left knee started to swell. The mom is now able to bend her right knee and is back to independent living. The left knee remains a little swollen but is improving with ice, rest, and elevation. The mom tried Mobic from the ER visit, which did not work. She does well with aspirin, so they have been using aspirin with care due to her age. She was having fluid issues and the daughter was making sure her mom took in appropriate amounts of water. The patient also had slight chills after Fluzone HD QIV. The chills are resolved.  Action taken: not applicable.  It was not reported if the patient received a corrective treatment for the events (woke up very lethargic, began to have swelling in her right knee/taken to ER due to worsening of right knee swelling, knee was severely swollen/right knee had begun to resolve, then her left knee started to swell, worsening of the right knee swelling. , fluid issues, slight chills).  At time of reporting, the outcome was Unknown for the event woke up very lethargic, was Recovering / Resolving for the event began to have swelling in her right knee/taken to er due to worsening of right knee swelling, knee was severely swollen/right knee had begun to resolve, then her left knee started to swell, was Recovering / Resolving for the event worsening of the right knee swelling. , was Unknown for the event fluid issues and was Unknown for the event slight chills.