Candidates deemed suitable for further evaluation after review of medical records from the referring physician and an initial visit in the Lung Transplant Clinic are scheduled for a 3-day, formal evaluation process. Results of this evaluation and the initial visit are consolidated into a Lung Transplant Evaluation Summary, which is available electronically and in hard copy in each patient’s individual chart. In general, patients referred for formal evaluation are < 64 years old with advanced, nonmalignant diseases of the lungs who are at high risk of death in the subsequent several years. Information included in the evaluation summary includes basic demographic information, history of present illness, medical history, medications, social history, family history, physical examination, and results of pulmonary, cardiac, gynecologic, dental, laboratory, and immunologic evaluations, as well as consultations and special tests as deemed necessary. A subsection devoted to immunization history is included in the medical history portion of the evaluation summary form. Information regarding types and timing of vaccination against influenza, S pneumoniae, and other immunizations are recorded according to patient self-report and/or available medical records. Evaluation summaries were reviewed in order to ascertain the S pneumoniae vaccination status for all patients undergoing evaluation during the study period and to identify predictors of vaccination.