This is a spontaneous report from a contactable consumer reporting for herself and from a contactable physician. A 78-year-old female patient received the first dose of PREVNAR 13 on 06Oct2015 at 10:30, at 0.5 ml single, for pneumonia prevention. Medical history included myasthenia gravis ongoing from 2006 (it started out primarily ocular, with double vision), osteonecrosis from 2015 (she believed this has healed, she just needed to check with her dentist to make sure), dermatomyositis ongoing from May2004, bronchiectasis ongoing from 2007, bronchiolitis obliterans with organising pneumonia from 2007 to 2008 (they thought it returned in 2013, but there was no way to prove it without a lung biopsy), ongoing chronic lung infections, ongoing bone loss, ongoing sleep disorder, ongoing fatigue due to her myasthenia gravis, ongoing sinus infection. Past drugs included prednisone 4 mg, 1x/day causing bone loss, felt antsy, hyper and like she was crawling on the walls due to taking the prednisone for long (she has taken up to 60mg a day, her dose changed when she every got a flare up, pneumonia like), PROLIA in 2012 for a year and a half which caused osteonecrosis, and FOSAMAX before denosumab. Concomitant medications included influenza vaccine in Sep2015 for immunisation, oral prednisone 2 mg, 1x/day, for the past 3 years and then at unknown dose from May2004 and ongoing for dermatomyositis and myasthenia gravis, oral ongoing CELLCEPT from Feb2006, 1000 mg, 2x/day (two 500 mg tablets twice a day) for dermatomyositis and myasthenia gravis, oral ongoing lorazepam tablets, 0.5 mg once a day in the evening, from May2004, oral ongoing MESTINON tablets, 90 mg, 4x/day (one half 60 mg four times a day), from 2008, for myasthenia gravis, ongoing FORTEO from Apr2015, 600 ug/2.4 mg injection in the stomach once a day for bone loss, ongoing FLONASE from Aug2014, 2 sprays 50 ug nasal spray each nostril twice a day for bronchiectasis and chronic lung infections, ongoing PULMICORT 2 puffs 180 ug inhaler twice a day, from Aug2014, for bronchiectasis and chronic lung infections and PERIDEX swish and spit 15ml twice a day, from Jan2015 to Jun2016, for osteonecrosis (she now just has to pat the spot because it has healed, as soon the bottle runs out she will check with the dentist to see if she needs to continue).   The patient underwent pneumococcal antibody test (23 types) on an unknown date after vaccination which did not respond to the vaccine and another one that did not do well on it on 30Nov2015. The low response to the initial dose of vaccine was discovered as part of a series of tests for hypogammaglobulinemia. The patient stated two different doctors prescribed pneumococcal 13-val conj vac (dipht crm197 protein). The second doctor was an immunologist. Her doctor was trying to determine if she had an immune system disorder and that was why she had pneumococcal 13-val conj vac (dipht crm197 protein). They were trying to get her intravenous immunoglobilin infusions. The reporting physician stated that was not aware of the adverse event experienced by the patient since she/he did not administered the vaccine. Follow-up (15Aug2016): Additional information received from the same contactable consumer includes information on concomitant drugs. Follow-up (06Sep2016): New information from a contactable physician includes: clarification that the reporter was not aware of the adverse events experienced by the patient since she/he did not administered the vaccine.