Stroke Syndrome; Ventricular Tachycardla; Cerebral Ischemia; Cervical Radiculopathy; Hypertension; heberden's nodes; Nail pitting; Psoriatic arthritis; Progressive DIP erosions; Osteoarthritis Hand; This case was reported by a physician via other manufacturer and described the occurrence of psoriatic arthritis in adult patient who received Flu Seasonal QIV Dresden (Influenza vaccine Quadrivalent 2019-2020 season) for prophylaxis.   The patient's past medical history included benign essential hypertension, gastroesophageal reflux disease, esophagitis, hyperlipidemia, cardiac ablation (the patient underwent catheter ablation on 19th June 2012), nonsmoker (no tobacco use and smoking status. Never smoker) and coronary artery disease. The patient had a Family History of hand osteoarthritis (father and mother), cancer, essential hypertension, psoriasis (sister's son), stroke syndrome and osteoporosis (maternal). Previously administered products included Methotrexate (stopped in November), NSAIDS and NSAIDS. Concurrent medical conditions included drug allergy (Compazine 10 mg oral tablet, reaction- asthma, shortness of breath). Concomitant products included finasteride, diclofenac sodium (Voltaren (Diclofenac Sodium)), tofacitinib citrate (Xeljanz), acetylsalicylic acid (Aspirin), fish oil, flecainide acetate, losartan potassium, methylprednisolone (Medrol), methotrexate, omeprazole, pravastatin sodium, infliximab (Remicade), tamsulosin hydrochloride, verapamil hydrochloride and ezetimibe (Zetia).   On an unknown date, the patient received Influenza vaccine Quadrivalent 2019-2020 season at an unknown dose. On 18th July 2019, less than a year after receiving Influenza vaccine Quadrivalent 2019-2020 season, the patient experienced psoriatic arthritis (serious criteria GSK medically significant), hand osteoarthritis and esophageal erosion (serious criteria GSK medically significant). On 19th February 2020, the patient experienced heberden's nodes and nail pitting. On an unknown date, the patient experienced stroke syndrome (serious criteria GSK medically significant), ventricular tachycardia (serious criteria GSK medically significant), cerebral ischemia (serious criteria GSK medically significant), cervical radiculopathy and hypertension. The action taken with Influenza vaccine Quadrivalent 2019-2020 season was unknown. On an unknown date, the outcome of the psoriatic arthritis, stroke syndrome, ventricular tachycardia, cerebral ischemia, heberden's nodes, cervical radiculopathy, hand osteoarthritis, hypertension, esophageal erosion and nail pitting were unknown.   It was unknown if the reporter considered the psoriatic arthritis, stroke syndrome, ventricular tachycardia, cerebral ischemia, heberden's nodes, cervical radiculopathy, hand osteoarthritis, hypertension, esophageal erosion and nail pitting to be related to Influenza vaccine Quadrivalent 2019-2020 season.  Additional details were provided as follows: The age at vaccination was not reported. The patient's concomitant products included acetylsalicylic acid (Finasteride) 5 mg oral tablet, diclofenac sodium (Voltaren (Diclofenac Sodium)) 1% gel four times a day PRN- apply to affected area, 30 days, tofacitinib citrate (Xeljanz) 11 mg oral tablet extended release 24 hour, acetylsalicylic acid (Aspirin) 325 mg tablet once a day, fish oil 1000 mg capsule once a day, flecainide acetate 50 mg oral tablet twice a day, losartan potassium 25 mg oral tablet once a day, methylprednisolone (Medrol) 4 mg oral tablet therapy pack as directed, methotrexate 2.5 mg oral tablet 10 tabs per weeks spilt dose, omeprazole 40 mg oral capsule once a day, pravastatin sodium 40 mg oral tablet once a day, infliximab (Remicade) 100 mg intravenous solution, tamsulosin hydrochloride 0.4 mg oral capsule 30 days, verapamil hydrochloride and ezetimibe (Zetia) 10 mg oral tablet once a day. The patient visited on 19th February 2020 for the follow up for the problems which included psoriatic arthritis, cerebral ischemia, cervical radiculopathy, osteoarthritis of hand, stroke syndrome and ventricular tachycardia. The patient had improved on Xeljanz. He had stopped the Methotraxate as well in November 2019. No significant infections and no infusion reactions were observed since the last visit. Review of the remaining systems were negative. The patient underwent procedure which included sporadic PVCs artising from the left ventricular outflow tract. Not ablated due to paucity of beats. In 19th June 2012, sporadic PVCs that she was right coronary cusp of the aorta and RVOT. Both were ablated. The patient never used tobacco and never smoked, also never consumed alcohol. The patients acute hepatitis panel was normal in June 2015, serum 25-hydroxycholecalciferol was 29 ng/ml in June 2018. TB QFT-G test was negative in 2017. The patient did numerous lab test which showed result normal.   Upon internal QC review below corrections are done on 11th May 2020: The patient's age group was updated as adult.