Report #2847085

Received Jun 24, 2025

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex: Female
Age: 0.6 yrs
State: NJ
Recovered: Unknown
Vaccinated: Jun 24, 2025
Onset: Jun 24, 2025
Days to onset: 0
Hospital days: —

Vaccines (2)

Type	Name	Manufacturer	Dose	Lot	Route / Site
DTAPIPVHIB	DTAP + IPV + HIB (PENTACEL)	SANOFI PASTEUR	3	UK228AB	IM / RL
PNC20	PNEUMO (PREVNAR20)	PFIZER\WYETH	3	LG5578	IM / LL

Symptoms (1)

Circumstance or information capable of leading to medication error

Symptom narrative

There were two sets of Pentacel, Prenvar20, and Rota ordered. Two staff members were preparing vaccines next to one another. Nurse looked over at second staff member and saw her inject the Prevnar20 into the Pentacel vial. Nurse immediately stopped what she was doing and alerted staff member of what she witnessed. Nurse took those vaccines from staff member and set them aside not to use. Nurse then retrieved a new Pentacel set and Prevnar20, and prepared and administered the correctly mixed vaccines. The VFC program was notified of the wasted Pentacel and Prevnar20. The staff member was placed on a safety pause while she receives re-education on the vaccines and the immunization workflow.