Information has been received from a case in litigation from a 64 year old female who on 29-OCT-2008 was vaccinated in the right arm with a dose of PNEUMOVAX 23 (lot # not provided). Concomitant therapy that same day included a vaccination of an unspecified flu vaccine (manufacturer and lot # not reported) into the patients left arm. The patient reported that she had "been vaccinated with the pneumonia vaccine nine years ago and had no problems with it". The patient stated that she "always had good luck with the flu vaccine and had only a slight flu reaction like a raised itchy red spot about a half dollar size 5 years ago. This time I had a totally rare experience with the vaccines". The patient reported that at the time of vaccination she "felt a shock that very quickly went up the right arm through the right shoulder and to the top of the spine all the way down to the tip of the spine. It was ever so slight but I felt the reaction. The flu vaccine shot in the left arm was fine and had no swelling except for the normal ache of a needle shot". The patient reported that she went home and about an hour later began feeling flu like symptoms. The patient reported that she "knew that was normal and just ignored the symptoms". She reported that as the hours passed from 10 A.M. to noon the morning of the injections, she noted that her right arm was hurting more than it was at the time of initial injection. She stated that she had trouble lifting the arm without having pain, so she "rested and tried to not focus on it too much". The patient thought that the next day it would be fine. However by the noon that same day of the vaccinations, she reported that she felt like she had the flu. She reported that she rested and again thought that would be 100% fine the next day. She reported that by that evening, the patient had a lot of pain in the right arm in the area of the injection. The patient had to use the left arm to lift the right arm to move it to another position. The patient reported that at the time of the vaccination she told the nurse that the PNEUMOVAX 23 hurt much more than the flu shot. She stated that the administering nurse agreed that it usually does, so the patient decided to rest. The patient reported that when she went to bed that night, she had an awful lot of pain in the entire upper right arm and could not move the arm without the using the left had. She reported that she was awake most of the night in pain and took two extra strength acetaminophen tablets, which she reported "did not help". She reported that the "arm was very itchy and had a large rash about 12" long and 9" wide, the arm was swollen twice its size and very warm to the touch". She reported that she became very alarmed. She also reported that she had a severe headache. The patient reported that she took a shower and noticed red blotches on the right leg just below the calf. She stated that she had hives the diameter of 4" by 4" on the front lower and back lower leg just below the calf. She reported that her aunt then took her to the emergency room. The patient reported that she was seen by physician who said that "she had a reaction from the pneumonia shot". The patient noted that the emergency room nurse noted the large rash, swelling and warmth of her skin on her arm. The patient reported that "all her joints, muscles and bones hurt". She also reported that her abdomen was swollen and hurt and the lining of her abdomen was burning". She reported that her body was achy all over and her eyes and nose ran constantly. Additionally, she stated that she was "in excruciating pain, had a light bluish color at the top of rash area, stiff neck, pressure in both ears, an odd taste in her mouth that was odd, felt lightheaded and dizzy". She stated that her throat felt like it was "raspy and almost as if I was getting a sore throat". The patient reported that the physician prescribed her PERCOCET, BENADRYL and VISTARIL. The patient reported that she went home and "could not eat". She reported that she drank some tea and ate some crackers, toast and water. She stated that she was very concerned about what was happening. She reported that she rested all day and again that night. She stated that when she awoke and looked at the arm area, the swelling had traveled from the elbow, all around the shoulder to 1/3rd down the back bone (scapular), that the color of the swollen area was all bluish with a raised rash and a very stiff neck". The patient returned to the emergency room. She reported that she was given intravenous fluids (NOS) and MOTRIN "for the ever so constant headaches". She reported that she had CAT scan to view if he/she had further problems from the pneumonia injection (result not provided). She reported that at that time that she "had poor balance, memory forgetfulness, especially where time was concerned. She reported that she was confused and had trouble concentrating on anything from time, reading and remembering. My balance was very unstable and was still not that good". She reported weight loss and an ongoing poor appetite. The patient stated that "the pneumonia vaccine has exacerbated a small stroke that I had which has caused forgetfulness and poor balance". She also reported that she became "depressed since 19-NOV-2008". She also reported that she had "developed tremors (date not specified) during church and was very tired all the time". On an unspecified date she stated that she had developed "sneezing, thick mucous and had been coughing for two days". Upon internal review the "aggravation of the small stroke I have" was determined to be an other medical event. Additional information has been requested.