C/O (R) arm pain, redness & swelling  from inj. site to elbow and flu-like symptoms. States arm so painful she was unable to move or use it & couldn't sleep on it. Refers to erythema as rash. The reason that I decided to provide a narrative along with the actual VAERS worksheet is due to the length of time from the date of Vaccination to the date of reporting. The original vaccinations took place on Monday 09/19/11 and the the couple returned one week later (Tuesday 09/27/11) to notify the clinic of their reactions to the vaccines. The nurse working at the clinic that day asked them if they had sought any health services for their complaints and they responded that they had not, nor had they taken any of medication for the symptoms experienced throughout that time. At that time they presented back to the clinic, both continued to complain of soreness of their arm (no erythema observed by the RN at this time) and both denied Fever. The wife had provide a written account and the information was brought back to the health department Director for follow-up and reporting. I then laid the information aside and neglected to follow-up until this time. I wanted to be certain that all the available information was provided to the State Immunization Program for review and felt that this accompanying narrative would be the best way to provide all the information in a complete and legible format. 09/19/11 - An elderly couple, came to the County Health Dept. and were administered both the PNEUMOVAX and Tdap vaccines on the same day (09/19/11). The injections were given (one in each arm) with PNEUMOVAX administered IM in "opposite" arms (Patient per Right Deltoid and Husband per Left Deltoid). 09/27/11 - The couple returned to the clinic to report that both had experienced a Vaccine Related Event. Patient also provided a hand-written document of the symptoms that the two had experienced. Therefore I am recreating her document below for your review in addition to providing a copy of the original hand written note. See VAERS form for additional information. Per Patient's written documentation presented to health department. Monday (09/19/11): "Shots; increasing soreness until couldn't move or use arm or even sleep on". Tuesday (09/20/11): "Patient - Freezing cold & unable to get warm. PM - Excruciating pain in cartilage of left ear. Increasingly miserable overall - really felt lousy with flu-like symptoms". Wednesday (09/21/11): "Arms swollen from elbow to shoulders and covered with bright red rash. Husband was hot and couldn't cool down. Both felt miserable - still flu-like symptoms. Neither had fevers." Thursday (09/22/11): "Today - Both have continued to feel quite under-the-weather with malaise and no energy. Swelling and rash have gradually subsided, although we both still have itching and I still have slight redness." "Problems taking deep breaths x 8 days". 12/06/11 F/U Telephone Call to the couple at their home today to gather information that had not been captured when they came to health department to report the adverse reaction initially. My conversation was entirely with patient today. She clarified that when she had written "rash" in her notes (re-typed above), she was referring to the erythema. She also states that the swelling was so significant from the deltoid area down to the elbow that there appeared to be a 1/4 inch "ridge" at the level of the elbow (which was true for both she and her husband). She also noted that on Tuesday 09/20/11, when she had begun to experience c/o feeling "freezing cold and was unable to get warm" it began while she was at the Beauty Shop (and it was not cold in the shop). Upon returning to home she bundled up in her robe and a blanket in an effort to get warm. Although she felt as though she were having "chills", she was afebrile. When asked regarding her documentation of Left ear "cartilage" pain, she states that usually she lays on one side or the other to sleep. She was very miserable that first night as she was having "excruciating left ear pain", so was unable to lay on her left side, but because of the severe right arm pain, she was unable to sleep on her right side. The notation at the bottom of the page regarding "Problems taking deep breaths x 8 days" Patient describes as having her breathing feel "quite restricted" for several days initially and then taking several more days to recover. She also notes that patient had this same symptom. Except where differentiated on her own documentation, all of the same symptoms were experienced by each client (c/o severe arm pain & swelling from inj. Site down to elbow, Erythema, "Flu-like" symptoms and problems taking deep breaths). Patient notes that she has a med allergy to Erythromycin with a reaction involving the same type of restriction to her breathing as noted following the vaccination. Husband does not have any known med allergies. The couple also reported that they felt" drained of energy" which lasted beyond the time that the reaction was first reported on 09/27/11. Patient wanted to be sure that this information was documented as a VAERS as she thought the severity of the symptoms was such that this needed to be reported and also that it was unusual for both she and her husband to have experienced the same type of reaction, with symptoms involving the arm (Patient - Right arm, and Husband - Left arm) that had been immunized with the PNEUMOVAX vaccination. Additionally, Patient wants to add to the previous documentation: more than 5 weeks later (on Friday 10/28) she had a rapid onset of the same symptoms noted above ("Flu-like symptoms" with chilling {no fever}, that lasted into the next day (10/29). Although she was feeling better by that evening, she did not feel well enough to go to a Halloween bonfire that she had previously planned to attend.