Temp folder has not been changed, PDF24 is installed with all defaults. I've gone to C:\Windows\SysWOW64 and created folders and deleted on those user accounts so I know they have permissions to that directory.
After ending the PDF24 process and restarting the program, printing to PDF works. I've checked the SysWOW64 directory and there is not even a PDF24 folder in there, even after the PDF printing is working.
This error is occurring for all users that login to our full cloud environment (about 50 people, across 5 terminal servers).