This is a spontaneous report from a contactable physician through a Pfizer sales representative. A 90 year old female patient received PREVNAR 13 on 05Sep2014. Immediately following administration of PREVNAR 13, the patient became acutely presyncopal. The patient complained of nausea, vomiting with dizziness, dry heaving and became diaphoretic. The subject also complained of sudden severe pain in her left lower back/buttock radiated down left leg. Her heart rate was 40 before the shot and it was 50 after the shot. She was unable to ambulate. The subject presented with dehydration. She was admitted in ED observation for serial examinations, IV fluid hydration and pain management. At the time she was seen in the ED her blood pressure was elevated systolically between 188 and 193 and diastolic 74 to 82. Has felt quite weak and lightheaded. The subject felt fine prior vaccination and was eating and drinking well. She did receive this vaccination prior without any complications. It was also reported that likely the patient has demonstrated allergic reaction to the pneumococcal vaccination. Medical history included hypertension, breast cancer status post lipectomy left side, basal cell carcinoma x2 of the face, paroxysmal atrial fibrillation, hyperlipidemia and glaucoma. The subject was on long-term COUMADIN therapy, has memory loss concerns and has a history of low back pain in the setting of standing for a long period of time. The subject was allergic to Cosopt SOLN. Immunization history included: Influenza - Series 1: 18Oct2013, Pneumococcal - Series 1: at Hospital, PNEUMOVAX vaccine at approx age 65, Tetanus Vaccination (Last vaccination: less than 5 years before this report). Concomitant medications included: NORVASC 5 mg oral tablet (1 tablet by mouth every day) from 14Jun2011 ongoing, TIMOLOL mal 22.3-6.8 mg/ml ophthalmic solution (1 drop into both eyes 2 times daily) from 27Oct2010, hydrochlorothiazide 25 mg oral 1 tablet daily requested on 14Apr2014 ongoing; XALTAN 0.005% ophthalmic solution (1 drop in both eyes at bedtime) from 12Jun2012 ongoing; Lisinopril 40 mg oral 1 tablet daily from 27Oct2010 ongoing; metoprolol succinate ER 24 Hour tablet 25 mg oral once daily from 02Feb2010 ongoing; OCUVITE tabs 1 tablet daily; polyethylene glycol 3350 oral powder 17 grams daily from 24May2013 ongoing; simvastatin 20 mg oral tablet once daily at bedtime from 26Jan2010 ongoing: warfarin sodium 2.5 mg oral tablet, 1 tab daily or as directed. She was given TYLENOL initially for the pain with minimal relief. An order was written for morphine 1 mg IV x 1 which did not help her either. An order was written for TORADOL 15mg IV x 1 which did help. Her lab tests on 05Sep2014 revealed glucose 163 mg/dL, Cl 96 mEq/L, carbon dioxide Co2 18. CBC revealed a WBC of 13.8 upon repetition the white count was slightly more elevated at 16.8. Otherwise the CBC is unremarkable and there was no evidence of shift. On 05Sep2014 CMP was notable   [Due to memory limitations, the remainder of this text could not be compared.]  for mild hyponatremia of Na 131 mg/dL and BUN of 21 with a creatinine of 0/9 mg/dL. Anion gap was 17 mEg/L on 05Sep2014. There was evidence of a mild anion gap acidosis. She received IV fluids. Lumbosacral x-ray revealed degenerative joint disease but otherwise was unremarkable. All other systems were reviewed and were negative. At the time of this report the patient was completely asymptomatic and there has been interval improvement metabolic derangement. Patient was awake and appropriate oriented, appeared very functional ambulating without assistance and without restriction. She continued to deny headache. Injection site appeared non-inflamed non-tender. The subject felt much better and her symptoms were improved. She complained of a very mild nonproductive cough. Follow-up (10Oct2014): New information received from a contactable physician includes: medical history; concomitant medications; course of events; event outcome; lab tests; treatment.