Initial information and follow up information has been received from a licensed practical nurse and medical records concerning a overweight 68 year old female who wears corrective lenses and has allergies itching to amoxicillin (-) clavulanate potassium Augmentin, grass and trees, hypertension (controlled), bilateral lower extremity edema (controlled. Physiologic flow murmur, coronary artery disease, hypothyroidism (recently decreased levothyroxine sodium dose because of TSH suppression), GERD, degenerative joint disease, post nasal drip and asthma, and a history of cholecystectomy, tonsillectomy and 5 week history of dry cough (probably secondary to post nasal drip), who on 12/05/1997 was vaccinated with a first dose of Pneumococcal 23v polysaccharide vaccine, who on 10/13/05 at 10:15am was vaccinated SC in the right arm with a second 0.5ml dose of Pneumococcal 23v polysaccharide vaccine (lot 650452/0753P). Other vaccine therapy administered on that same day, 10/13/05 at 10:15am included a 0.5cc IM dose of Influenza virus split virion 3v vaccine inactivated Fluzone (lot U1811AA) administered in the left deltoid. Concomitant medications include lisinopril, levothyroxine sodium Synthroid, levothyroxine sodium Levoxyl, ranitidine, multivitamin, atenolol, calcium carbonate + cholecaloiferol Caltrate 600-D, aspirin, and hydrochlorothiazide (manufacturer unknown). During the night on 10/13/2005 she developed pain, swelling, redness and warmth of the right upper arm and transient chills. There was no other known injury, fever or related symptoms of concern. On 10/14/2005, she presented to the physicians office and on examination was found to have 2/4+ edema, erythema, tenderness, and warmth of the posterolateral right upper arm. There was no other external evidence of injury or inflammation. No lymphangitis or local adenopathy. Her circulation, sensation and function were intact. The local reaction at the injection site was diagnosed as cellulitis that affected the entire right upper arm and was probably secondary to the Pneumococcal 23v polysaccharide vaccine. the plan was to reassure the patient, perform standard wound precautions, elevation and heat application. She was given acetaminophen for fever control and or discomfort and cephalexin 500 mg PO TID for 10 days. On 10/15/2005 she was seen in the express care physicians office as her right upper arm continued to be red, swollen and slightly tender. She had normal range of motion of joints and normal neurovascular assessment of right arm and no lymphangitis. The treatment was for outpatient antibiotic treatment and required that home health place an intravenous heplock and administer IV ceftriaxone sodium Rocephin 2 grams on 10/15/2005 and daily for two additional days. She was instructed to return to express care the next day for follow up. On 10/16/05 warmth and redness were about the same and pain tenderness had increased to the right arm. She was instructed to continue with the same treatment and return the next day for follow up. On 10/17/05 she received her third dose of ceftriaxone sodium and had a decrease in the swelling and redness and tenderness of the right upper arm as per the patient, but increased redness to forearm with minimal tenderness. The cellulitis was reported to have a variable response. She was instructed to have a fourth dose of ceftriaxone sodium on 10/18/05 and follow up with the physician when it would be evaluated whether for a different PO antibiotic. On 10/16/05 she returned to the express care where she received a fourth dose of ceftriaxone sodium and the IV heplock was discontinued. Her right arm cellulitis was much improved, the redness and warmth had decreased. She was instructed to continue the heat and PO cephalexin. The patient was reported to have recovered on 10/18/2005. The nurse stated that she had seen an increased rate of local reactions recently and that it seemed the more severe reactions were with subcutaneous administration (WAES0510USA08183). A product quality complaint was not involved. Follow up information was received from a licensed practical nurse and medical records on 11/10/2005. It was noted that cellulitis that affected the entire arm was determined to be an other important medical event by the reporter (OMIC). Follow up information received on 11/10/05 contained the following adverse experiences syncope 3/22/04, headache 3/22/04, tears in right medial and lateral meniscus 6/04, increased blood pressure 3/2/05 recovered 3/17/05, lower extremity edema 3/2/05, systolic ejection murmur 3/4/05, sinusitis 1/8/05, asymptomatic bacteriuria with negative culture 10/05, pulled muscle in buttock/leg 10/24/05, pain in right lower chest that increased with deep breathing 10/26/05.Other business partner numbers include E200505267. Additional information is not expected.