Information has been received from a RN concerning an 81 year old retired white female patient with hypercholesterolemia, hypertension, type II diabetes, obesity, osteoporosis, depression, ongoing complaints of chest heaviness and some shortness of breath (she was in the middle of a Persantine Stress Test at the time of vaccination), and urinary frequency, and a history a laminectomy for a herniated disc in 1996, three caesarean section, a cholecystectomy, bilateral breast cyst removal (all benign), left foot surgery, and a negative colonoscopy in 05/1999 and no known drug allergies who on 01/30/2003 at 10:30 AM was vaccinated IM in the left deltoid with a second booster dose of pneumococcal vaccine 23 polyvalent (Lot # 644219/1079M).  There was no illness at the time of vaccination.  Concomitant therapy included furosemide, enalapril maleate, rosiglitazone maleate, raloxifene, exybutynicDl, spironolactone, zolpidem tartrate, multivitamins, and calcium.  Concimitant medications previously reported included atorvastatin calcium and venlafaxine HC1.  On 01/31/2003, the patient experienced pain at the injection site and developed an erythematous rash at the injection site that measured 6 x 6 inches in circumference.  Unspecified medical attention was sought.  No additional information is available.  Follow up information received from a RN indicated that on 01/30/2003, at approximately 05:17 PM, (also reported as 01/31/2003 in the AM), the patient experienced pain at the injection site, noting that "it did not hurt when she got the injection, but it is painful now".  She denied any redness or swelling.  It was indicated that the patient was unable to raise her left arm completely over her head.  The patient was concerned that she might not be able finish the second part of her stress test on the following day.  She was advised to keep the appointment and call the office later in the day with an update.  The medical records indicated that "she will finish the second part of the stress test" and advised her to "return in one month for followup".  On 01/31/2003 at approximately 04:52 PM when the patient arrived in the office to have the injection site checked, the left upper arm area had an area of erythema six inches in diameter.  No swelling was noted.  The area was warm to touch.  She was still unable to lift her arm over her head.  She was afebrile at 97.7 degrees.  The patient was advised to apply ice to the area, take acetaminophen or ibuprofen for discomfort, monitor and record temperature, and call if symptoms worsen or temperature elevated.  The area was also marked with a pen and the patient was instructed to call if reddened area enlarged.  On 02/03/2003 at approximately 04:15PM, the patient called the office with complaints of nausea from the antibiotic prescribed over the weekend.  She also indicated that the red rash on her left deltoid remained.  The patient was instructed to call the office if the rash "returns".  On 02/05/2003 at approximately 09:50AM, the patient reported that her left arm was fine and the rash was gone.  At this time, the patient was also advised that she had a UTI (incidental finding), and that a prescription for levofloxacin was called into the pharmacy.  No further information is expected.