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Report #2874604

Received Nov 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
Male
Age
9 yrs
State
SD
Recovered
Recovered
Vaccinated
Nov 4, 2025
Onset
Nov 1, 2025
Days to onset
—
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
PNC21PNEUMO (CAPVAXIVE)MERCK & CO. INC.1Z005765IM / LA

Symptoms (3)

No adverse eventProduct administered to patient of inappropriate ageWrong product administered

Symptom narrative

no adverse event for patient. Patient was not to receive this vaccine but either PSV23 or PCV20. Nurse (myself) ordered PCV21 as we don't carry PCV20. Received no warnings or hard stops noting this is only for adults. scanned med and gave, again no warnings or errors noted. Was only found to be the wrong vaccination when our health maintenance didn't update saying it wasn't due anymore. When I looked it showed the PCV21 did not satisfy the series. Reviewed with our staff and they determined we should complete a VAERS but will count toward patient series.

Current illness

ear infecftion

Medical history

Cardiac and Vasculature Partial AV canal (HHS-HCC) Complex cyanotic congenital heart disease (HHS-HCC) Congenital hypoplasia of aortic arch (HHS-HCC) Right pulmonary artery stenosis (HHS-HCC) Ventricular septal defect with posterior malaligned outlet septum with overriding pulmonary valve (HHS-HCC) S/P VSD repair SBE (subacute bacterial endocarditis) prophylaxis candidate Conduit failure in patient with reconstruction for congenital heart disease Chromosomal and Congenital Noonan's syndrome (HHS-HCC) Eye Ptosis of both eyelids Exotropia, intermittent Infectious Disease At risk for Mycobacterium chimaera infection associated with extracorporeal circulatory equipment Musculoskeletal and Injuries Hindfoot varus, acquired, left Neuro Subdural hematoma (HCC) Hydrocephalus (HCC) S/P VP shunt Scoliosis Tethered spinal cord (HCC) Neuromuscular scoliosis Pulmonary and Pneumonias Diaphragm paralysis Reactive airway disease without asthma Sleep Sleep-disordered breathing

Other medications

cetaminophen (TYLENOL) 160 MG/5ML oral suspension Take 10.22 mL (327.04 mg) by mouth Every 6 hours acetaminophen (TYLENOL) 325 mg tablet Take 1 tablet (325 mg) by mouth Every 6 hours Instructions here albuterol HFA (VENTOLIN HFA) 10

Allergies

Adhesives, ibuprofen, ketamine, seasonal, hydrocodone

Lab data

none