Information had been received from a female who was given an injection of PNEUMOVAX23 on 15-AUG-2013 at the end of a yearly physical. The patient was feeling well and her lungs were clear. The patient was prescribed the vaccine by her physician as a precaution because she was over 65 years old. On 16-AUG-2013, the patient began to feel bad. By the end of the day, she experienced a very serious cough which led to gagging clear phlegm and dry heaves. The cough continued to get worse despite using her nebulizer and asthma medications. Although patient has asthma, she had been without symptoms since beginning XOLAIR injections several years ago. The patient's only significant trigger has always been tobacco smoke and the residue. By 20-AUG-2013, the patient knew something was really wrong and that her illness was more than asthma or allergy. Patient saw her asthma allergy specialist for a regular check-up on 21-AUG-2013. Patient did not do the scheduled pulmonary function test that day due to her extreme dizziness. Patient's lungs were now congested when they had been clear on 15-AUG-2013. Patient's physician prescribed her a course of prednisone and a Z-PAK as he also thought the problem was more than allergy. At the time of the appointment, the patient noted that she had not even thought about a possible connection to the PNEUMOVAX23 vaccine and did not mention it that day. By the weekend of 24-AUG-2013, the patient was much more sick. The symptoms were a horrible cough, shortness of breath, trembling, vomiting clear phlegm, dry heaves, chills, sweating, dizziness, and blurred vision. The patient had lost her voice and could not really speak without extreme effort. By 25-AUG-2013, patient noted she was sicker rather than better even though she finished up her Z-PAK that day. It was then that the patient thought of the injection. She looked up the side effects, but the web sites did not describe reactions such as hers. When the patient reported her reaction, she was finally told that 1.8% of patients who received PNEUMOVAX23 reported pulmonary infection. On 26-AUG-2013, patient presented to a physician who acknowledged that some people did have respiratory illness following the pneumonia vaccine, but that she had not seen a reaction in a number of years (see MARRS# 1310USA001739). Patient underwent a chest x-ray and a CT scan with contrast. Both were clear, but patient noted she was sicker than ever. On 30-AUG-2013, physician gave patient another prescription for prednisone but felt that another antibiotic was not needed after reviewing the CT scan and chest X-ray. On 07-SEP-2013, patient's husband took her to the coast in a desperate effort to help her respiratory condition. They spent a week there with a bit of improvement in the breathing effort, but little change in the cough or improvement in patient's ability to sleep. Patient noted she wakes up strangling and coughing despite 80mg of prednisone a day. On the morning of 09-SEP-2013, patient woke up with a real feeling of constriction in the lower part of her lungs. She realized that she was no longer normally breathing. Patient was not breathing from the diaphragm, but only from her upper chest. It was a very shallow and difficult breathing pattern. When patient tried to take deep breaths to the diaphragm, she could make the air go there, but it hurt. That day, the patient began doing deep breathing exercises multiple times a day while sitting in the ocean breeze. On 16-SEP-2013, patient stood up, got dizzy and fell. Patient broke her foot in two places. Patient reported that now she cannot breathe, talk, sleep or walk. It was not patient's belief that the vaccine caused her illness. She reported that she knew it did. Following these events, patient had come to realize that serious reactions and pulmonary infection were more common than the vaccine information implied. The patient reported several people that she had met have had similar reactions (see MARRS# 1310USA001269). Patient noted it appeared a live virus had infected her in the bronchial tube and throat area. Nothing helped to improve the condition and the patient claimed she needed help. Upon internal review, lost her voice and could not really speak without extreme effort/cannot talk was considered to be medically significant. Additional information has been requested.