Report #2858401

Received Sep 12, 2025

ER / ED visit

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: 62 yrs
State: VA
Recovered: Recovered
Vaccinated: Sep 9, 2025
Onset: Sep 10, 2025
Days to onset: 1
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
PNC21	PNEUMO (CAPVAXIVE)	MERCK & CO. INC.	1	Z006889	IM / LA

Symptoms (4)

Anaphylactic reactionLip swellingPharyngeal swellingUrticaria

Symptom narrative

anaphylactic reaction, hives, sensation swollen lips and throat, denies SOB or chest pain seen in ER

Current illness

Essential hypertension Generalized anxiety disorder Hypercholesterolemia Vitamin D deficiency Hypothyroidism Idiopathic urticaria Perennial allergic rhinitis with seasonal variation Mild intermittent asthma

Medical history

Reviewed Problems Dysuria - Onset: 04/06/2025 Anaphylaxis Sprain of right knee Mild intermittent asthma - Onset: 12/02/2022 Adenomatous polyp of colon - Onset: 03/18/2018 Essential hypertension - Onset: 07/08/2020 Generalized anxiety disorder - Onset: 09/06/2016 Hypercholesterolemia Vitamin D deficiency Hypothyroidism

Other medications

albuterol sulfate 2.5 mg/3 mL (0.083 %) solution for nebulization USE 1 VIAL VIA NEBULIZER 3-4 TIMES A DAY AS DIRECTED albuterol sulfate HFA 90 mcg/actuation aerosol inhaler INHALE 1-2 PUFF(S) 4 TIMES A DAY AS NEEDED FOR WHEEZING Align (B

Allergies

Atorvastatin (muscle pain) 12/2023, pitavastatin (joint pain) 7/2024, rosuvastatin (muscle pain) 12/2023, pneumococcal vaccine-Capvaxcive- anaphylaxis/hives 9/2025

Lab data

Epi -drip in Emergency department, Discharged with Epi-pen auto-injector, prednisone20mg tablet (60 mg) daily # 12