Information has been received from a licensed practical nurse concerning a 48 year old female patient with hypertension, chronic joint pain, hyperlipidaemia, oesophageal reflux, a pituitary disorder, coeliac disease, penicillin allergy and drug allergies/reactions to morphine, and sulfa drugs, opiates, ULTRAM, KADIA, ROCEPHIN who at 9:00AM on 21-MAY-2012 was vaccinated intramuscularly with a dose of PNEUMOVAX 23 (lot# 672752/1786AA). Concomitant therapy included NEURONTIN, cyclobenzaprine HCI, LIPITOR, VICODIN, simvastatin and XANAX. Later that evening on 21-MAY-2012 the patient noted that her arm was hurting and kept getting worse. On 22-MAY-2012 there was redness, swelling and pain at the injection site. The patient put ice on the area for two hours but it did not help and she came back to the office for evaluation. The patient had not recovered. There was no laboratory studies performed. The patient was treated with prednisone dose-pack and KEFLEX. Follow up information has been received from the nurse concerning the patient with allergy to nitrofurantoin, who on 21-MAY-2012 at 9:44, was vaccinated with the first dose of PNEUMOVAX 23 intramuscularly in the left deltoid. The nurse reported that on 21-MAY-2012 at 14:00, the patient experienced redness, swelling and paint at the injection site. The patient had persistent pain. The patient was given prednisone dose pack and KEFLEX 500 mg for ten days. Follow up information has been received from the Certified Medical Assistant concerning a patient, living with spouse, tobacco user (smokes <pack of cigarettes per day), married non drinker/no alcohol use, with no illness at time of vaccination, diabetes mellitus - maternal grandmother, cancer - maternal aunt, hypertension - mother, maternal grandmother, coronary artery disease - mother, maternal grandmother. Concomitant medications included acetaminophen (+) hydrocodone bitartrate, vitamin D (unspecified), promethazine, livinity relief Active, tru-blu Active, blue essentials Active, morphine sulfate and NeuroLiv. Yesterday I was in and got a pneumonia shot. When I got home I fell asleep but when I woke up my arm was hurting. I didn't think much bit it keeps getting worse. Redness, swelling and pain around injection site. I called this morning and they told me to try ice. I have tried ice off and on for about 2 hrs, not helping and still getting worse with pain. The physician included the following information in the clinical history of the patient: the patient is a 48 year old female who presents with a complaint of swelling. The onset of the swelling has been sudden and has been occurring in a persistent pattern for hours. The course has been increasing. The swelling is described as severe. Note for "swelling": left arm around injection site from yesterday on 21-APR-2012. Vital signs (22-MAY-2012): temperature 98.7 (Tympanic), blood pressure 130/80 (reading type manual, left arm, sitting). Physical exam: Skin: Rashes: Location of rash - upper extremities (left upper extremity is swollen and the upper arm has some erythematous spots not consistent with cellulitis. The patient received KEFLEX 500 mg for ten days starting 22-MAY-2012 and dexamethasone 0.75 mg, 1 tablet as directed on package for 5 days starting 22-MAY-2012. The patient recovered on 26-MAY-2012. Additional information is not expected.