OCT 04, 2005@13:28       *Pneumovax:           Patient received pneumococcal vaccine  0.5 ml I.M.            Injection site: Right Deltoid             Reaction: None             CDC Vaccine Information Statement (7/29/97 edition) given to           patient.  Pneumonia vaccine being given 5 years ago.  CURRENT MEDICATIONS:  Ibuprofen 600 mg 1 p.o. t.i.d. with meals, Omeprazole 20 mg p.o. every day, baclofen 10 mg p.o. t.i.d.   OCT 05, 2005@11:30                                        Patient given an injection yesterday and today patient has called to question if he is having a reaction to the shot.  Patient stated that he feels dizzy, felt like "passing out" he returned to bed and woke up with a swollen arm and feeling "Feverish" Patient at present time denies any breathing difficulties.  OCT 05, 2005@14:22    A 63-year-old gentleman who came to the clinic because of swelling and redness of his arm after injection of pneumonia vaccine yesterday.  The patient called and reported to the nursing staff that he was having a swollen right arm along with a feeling of feverishness.  The patient was occasionally dizzy and was feeling as if he was going to pass out, but when the patient came to the clinic, the patient was feeling fine with no dizziness.    PHYSICAL EXAMINATION: VITAL SIGNS: Temperature 97.8, pulse 78, respirations 18, blood pressure 124/60.    EXTREMITIES: Examination of the patient's right arm revealed an area of erythema over the triceps area along with induration of the overlying skin. The patient also had some tenderness on palpation and increased warmth throughout the area. So, the patient however denied any sweating or chills.    ASSESSMENT AND PLAN: Patient with a local reaction to pneumonia vaccine. The patient was recommended to apply ice to the area.  The patient will be started on Diphenhydramine.  The patient will have 25 mg p.o. x1 now, 50 mg at bedtime today and from tomorrow the patient will start 1 capsule 3 times a day. The patient will return to this clinic in 2 days.  The patient was however cautioned to call this clinic if there was any worsening of his symptoms.   OCT 07, 2005@14:  2-day follow-up The patient reported that after taking Diphenhydramine 25 mg by mouth three times a day, the patient has seen some improvement in the rash, but the rash has now gone down from his arm to his right forearm.  There is redness, as well as swelling.  The patient denies any fever, chills or any intense itching.                     VITAL SIGNS:  Temperature 99, pulse 57, respirations 18, blood pressure 146/70.  RIGHT UPPER EXTREMITY:  Revealed that the patient had diffuse erythema Extending on the extensor surface of the right forearm overlapping to the ventral surface or flexor surface of the forearm.  This erythema was accompanied by swelling of the skin and subcutaneous tissue.    ASSESSMENT AND PLAN:   1.  A patient with allergic reaction to pneumonia vaccine with a rash.   increase the dose of Diphenhydramine to 50 mg by mouth three times a day.  The patient, however, was cautioned that he should not be driving if the Diphenhydramine was causing any sort of drowsiness.  The patient reported that he not been drowsy on taking the 25 mg by mouth three times a day.  2.  The patient was given a prescription for prednisone 20 mg 3 tablets by mouth daily into 2 days, 2 tablets into 2 days, 1 tablet into 3 days and then 1/2 tablet for 4 days.  The patient, however, was requested to return to this clinic on 10/10/05 if his condition was not improving.