What was the hotfixing process - please describe all the steps and actions you did. I would say this is a coincidence as the hotfix is not changing this. There must have been changed something else. Are you able to reproduce the issue consistently at will after you restore the backups and apply the hotfix following all the instructions to the point? Including the additional notes. How was the hotfixed project deployed to Azure. How was the hotfix SQL script applied on Azure SQL?
Where are the files stored? Are you storing files in the DB or in the file system? IF on file system, are the files present in the front end app's file system?