Information has been received from a licensed practical nurse concerning a 40 year old female with a history of frequent upper respiratory infections and no known drug allergies who on 02/01/2002 was vaccinated with pneumococcal vaccine 23 polyvalent. Concomitant therapy incuded minerals vitamins. On 02/25/2002 the pt presented to her physician's office with pneumonia. It was reported that the pt had been hospitalized with pneumonia sometime in the interim. At the time of this report, the outcome of the pneumonia was unknown. Additional info has been requested. The follow up states the pt reported that she experienced mild discomfort the evening of 2/1/02. On the morning of 2/2/02 the pt remained with discomfort, generalize dall over her body. The pt stated that it felt like the flu and she took Tylenol. On 2/3/02 at approximately 12pm, the pt started with pain to the left arm and chest area radiating to the left breast and under her left arm. The pt went to the ER at 6pm on 2/3/02 and was subsequently admitted on 2/4/02 with acute pleuritis and bronchitis, and diagnosed with pneumonia. In the ER the pt stated having chest pain for the last eight hours, more in the left axilla area, knife-like pain, with 10/10 pain scale radiating to the left shoudler, and some nausea, and vomiting were noted. Lab findings from 2/3/02 revealed a white blood cell count of 15.2. On 2/4/02 the pt's white blood cell count was noted at 17.6. On 2/5/02 the pt stated that her pain was easily reproducible with palpation, movement of the left arm over the head as well as deep breathing. The pt stated that the pain felt "like a stretching type pain" and every time she bent down or used the left arm, the chest pain increased. On 2/5/02 the pt had no complaints of shortness of breath, diaphoresis, fatigue, weakness, nausea, or vomiting or any other cardiovascular symptoms. On 2/5/02, the pt's vital signs revealed a blood pressure of 100/60 mmHG, pulse 92, respirations 18 and telemetry monitoring revealed sinus rhythm. An EKG revealed normal sinus rhythm, no acute ST changes, and nonspecific ST changes were noted. Lab finding revealed a WBC of 11.1. Chest x-ray from 3/2/02 was negative, as well as from 2/4/02. Myoglobin perfusion scan revealed a questionable small apical defect. The pt's lungs were clear to auscultation bilaterally, there was no rhonchi or wheezes. The pt's chest was tender over the left chest wall, more towards the left axilla area with reproducible chest pain with palpation. A cardiovascular review found S1 and S regular, no S3 or S4 gallop, no rubs or click, and PMI was not localized. Further evaluation of vital sings revealed a blood pressure of 110/50, pulse o f60/min, temperature of 98.8 and respiratory rate 20/min. The pt also was noted to have lymphocytopenia seocndary to neutrophilia(lymphocyte count 10% on 2/3/02; and 80% on 2/5/02); neutrophil count 84% on 2/3/02; 90% on 2/4/02; and 80% on 2/5/02. In addition, the pt was noted to have mild anemia with a drop in hemoglobin from 12.9 to 10.8 associated with chronic iron deficiency anemia secondary to acute inflamamtion and dehydration (incidental finding). The pt subsequently recovered from the pneumonia, lymphopenia, and neutrophilia and was diacharged on 2/6/02. No further info is expected.