Prevnar 20

Last updated on RxList: 6/16/2021
Prevnar 20 Side Effects Center

Medical Editor: John P. Cunha, DO, FACOEP

What Is Prevnar 20?

Prevnar 20 (pneumococcal 20-valent conjugate vaccine) is a vaccine indicated for active immunization for the prevention of pneumonia and invasive disease caused by Streptococcus pneumoniae serotypes 1, 3, 4, 5, 6A, 6B, 7F, 8, 9V, 10A, 11A, 12F, 14, 15B, 18C, 19A, 19F, 22F, 23F, and 33F in adults 18 years of age and older.

What Are Side Effects of Prevnar 20?

Side effects of Prevnar 20 include:

  • injection site reactions (pain, swelling, and redness),
  • muscle pain,
  • fatigue,
  • headache,
  • joint pain, and
  • fever.

Dosage for Prevnar 20

Adults 18 years of age and older should receive a single dose of Prevnar 20.


Prevnar 20 In Children

The safety and effectiveness of Prevnar 20 in individuals younger than 18 years of age have not been established.

What Drugs, Substances, or Supplements Interact with Prevnar 20?

Prevnar 20 may interact with other medicines such as:

Tell your doctor all medications and supplements you use.


Prevnar 20 During Pregnancy and Breastfeeding

Tell your doctor if you are pregnant or plan to become pregnant before using Prevnar 20; it is unknown if it would affect a fetus. It is unknown if Prevnar 20 passes into breast milk. Consult your doctor before breastfeeding.

Additional Information

Our Prevnar 20 (pneumococcal 20-valent conjugate vaccine), Suspension for Intramuscular Injection Side Effects Drug Center provides a comprehensive view of available drug information on the potential side effects when taking this medication.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

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Prevnar 20 Professional Information

SIDE EFFECTS

In adults 18 through 59 years of age, the most commonly reported solicited adverse reactions >10% were pain at the injection site (>70%), muscle pain (>50%), fatigue (>40%), headache (>30%), and arthralgia and injection site swelling (>10%).

In adults 60 years of age and older, the most commonly reported solicited adverse reactions >10% were pain at the injection site (>50%), muscle pain and fatigue (>30%), headache (>20%), and arthralgia (>10%).

Clinical Trials Experience

Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a vaccine cannot be directly compared to rates in the clinical trials of another vaccine and may not reflect the rates observed in practice.

The safety of a single dose of Prevnar 20 in adults 18 years of age and older was evaluated in five randomized, active-controlled, multicenter clinical trials and one open-label, multicenter clinical trial. All of the trials were conducted in the United States and 2 of the trials also enrolled participants (N=172) in Sweden. Across the 6 trials, 4552 adults received Prevnar 20 and 2496 received active control vaccine.

Pneumococcal Vaccine Naive Adults 18 Years Of Age And Older

The safety of Prevnar 20 in adults 18 years of age and older with no history of pneumococcal vaccination was evaluated in five studies (Studies 1-5). In the main cohort of Study 1 (NCT03760146) and in Study 2 (NCT03313037), participants ≥60 years of age and participants 60 through 64 years of age, respectively, received a single dose of Prevnar 20 followed 1 month later with administration of saline placebo or received a single dose of Prevnar 13 followed 1 month later with a dose of PNEUMOVAX® 23 (PPSV23). The 2 other cohorts of Study 1, participants 50 through 59 years of age and participants 18 through 49 years of age, received a single vaccination with Prevnar 20 or Prevnar 13. In Study 3 (NCT03828617), participants 18 through 49 years of age received a single vaccination with Prevnar 20 or Prevnar 13. In Studies 4 (NCT02955160) and 5 (NCT03642847), which were smaller studies conducted early in the clinical development of Prevnar 20, participants 18 through 49 years of age received a single dose of Prevnar 20 or an active control (Tdap or Prevnar 13).

Adults ≥65 Years Of Age Previously Immunized With A Pneumococcal Vaccine

The safety of Prevnar 20 in adults 65 years of age and older with pneumococcal vaccination given as routine care prior to enrollment was assessed in Study 6 (NCT03835975). Participants were enrolled into 1 of 3 cohorts based on their prior pneumococcal vaccination history (PPSV23 only ≥1 to ≤5 years prior to enrollment, Prevnar 13 only ≥6 months prior to enrollment, or Prevnar 13 followed by PPSV23 [with PPSV23 given ≥1 year prior to enrollment]). Participants in 2 of the cohorts received a single vaccination with Prevnar 20 or control pneumococcal vaccine (Prevnar 13), and the other cohort received a single vaccination with Prevnar 20. only.

Demographics Of Trial Participants

In the three main trials (Studies 1, 3, and 6), participants were predominantly female (52.0% to 65.9%) across groups defined by age and prior pneumococcal vaccination status within the Prevnar 20 and control vaccine groups. Across all 3 trials combined, 59.8% of participants were 60 years of age and older, 6.9% were 50 through 59 years of age, and 33.3% were 18 through 49 years of age. In Studies 1 and 3, participants were 80.7% White, 14.2% Black, 2.1% Asian, and 10.3% Hispanic. In Study 6, participants were predominantly White (92.4%). Participants were primarily from the United States; however a portion of participants 65 years of age and older were enrolled from Sweden in Study 1 (5.7% of participants 60 years of age and older in that study) and also in Study 6 (35.5% of participants with prior PPSV23 only).

In the three main trials, participants with pre-existing underlying diseases were enrolled if the medical condition was stable (did not require a significant change in therapy in the 6 weeks before receipt of study vaccine or any hospitalization for worsening disease within 12 weeks before receipt of study vaccine). In Study 1, approximately one-third of all participants had risk factors that placed them at increased risk for serious pneumococcal disease, including smoking (12.9%), stable medical conditions of chronic cardiovascular disease (5.5%), chronic pulmonary disease including asthma (8.7%), chronic liver disease (0.4%), and diabetes mellitus (13.9%).

Safety Monitoring

Solicited adverse reactions for Prevnar 20 in the three main trials were monitored in participants recording daily into an electronic diary their local adverse reactions for 10 consecutive days and systemic reactions for 7 consecutive days following vaccination. Across all trials, serious and nonserious adverse events were collected for 1 month after each vaccination. Safety follow-up of serious adverse events (SAEs) continued through 6 months after vaccination with Prevnar 20 or Prevnar 13 (or other appropriate control vaccine), as applicable. Newly diagnosed chronic medical conditions occurring within 6 months after vaccination were also collected via telephone contact.

Serious Adverse Events

Across all 6 clinical trials combined, performed in adults of all ages, naive to and with prior pneumococcal vaccination, the proportion of participants reporting 1 or more SAEs within 6 months after vaccination with Prevnar 20 was 1.5% (67 of 4552 participants). This was similar to the proportion of participants with SAEs after vaccination with Prevnar 13 or other applicable control vaccine (1.8%, 44 of 2496). The proportions of participants with SAEs occurring within 1 month after vaccination with Prevnar 20 or with Prevnar 13 or other applicable control vaccine were both 0.4% (19 of 4552 participants and 11 of 2496 participants, respectively). There were no notable patterns or imbalances between vaccine groups for specific categories of serious adverse events that would suggest a causal relationship to Prevnar 20.

Solicited Adverse Reactions

The frequency and severity of the local adverse reactions (redness, swelling, and pain at the injection site) prompted daily in the 10 days after Prevnar 20 vaccination in adults naive to pneumococcal vaccination (Study 1) and in adults with prior pneumococcal vaccination (Study 6) are shown in Table 1 and Table 2, respectively. The frequency and severity of the systemic adverse reactions (fever, fatigue, headache, muscle pain, and joint pain) prompted daily in the 7 days after Prevnar 20 vaccination in adults naive to pneumococcal vaccination (Study 1) and in adults with prior pneumococcal vaccination (Study 6) are shown in Table 3 and Table 4, respectively.

Table 1: Percentage of Participants With Solicited Local Adverse Reactions, by Maximum Severity, Within 10 Days After Vaccination in Pneumococcal Vaccine-Naive Adults - Study 1a

18-49 Years of Age 50-59 Years of Age ≥60 Years of Age
Vaccine Group
Prevnar 20
(Nb=335) %
Prevnar 13
(Nb=112) %
Prevnar 20
(Nb=331) %
Prevnar 13
(Nb=111) %
Prevnar 20/Saline
(Nb=1505) %
Prevnar 13/ PPSV23
(Nb=1483) %
Local Reaction
Pain at injectionsitee
Anyd 81.2 82.1 72.5 69.4 55.4 54.1
Mild 42.7 52.7 53.5 52.3 45.3 44.6
Moderate 38.2 28.6 17.8 16.2 9.9 9.2
Severe 0.3 0.9 1.2 0.9 0.2 0.3
Swelling c
Any (>2.0 cm)d 11.6 12.5 8.8 10.8 7.5 8.0
Mild 7.2 8.9 5.7 7.2 4.8 4.9
Moderate 4.5 3.6 3.0 3.6 2.4 2.8
Severe 0 0 0 0 0.3 0.3
Rednessc
Any (>2.0 cm)d 9.0 9.8 8.2 5.4 7.3 6.2
Mild 3.0 5.4 5.1 2.7 3.7 3.8
Moderate 5.4 4.5 2.7 2.7 2.8 2.2
Severe 0.6 0 0.3 0 0.8 0.2
Any local reactionf 81.2 82.1 72.8 70.3 57.4 56.0
a Study 1 was conducted in the United States and in Sweden (NCT03760146).
b N = number of participants with any e-diary data reported after vaccination (after Vaccination 1 [Prevnar 20 or Prevnar 13] for Study 1 participants 60 years of age and older). This value is the denominator for the percentage calculations.
c Diameters were measured in caliper units of whole numbers from 1 to 21 or 21+. One caliper unit = 0.5 cm. Measurements were rounded up to the nearest whole number. Intensity of redness and swelling were then characterized as follows: mild is >2.0 to 5.0 cm; moderate is >5.0 to 10.0 cm; severe is >10.0 cm.
d “Any” includes all participants who reported a reaction as “mild”, “moderate”, or “severe” during Day 1 to Day 10 after vaccination.
e Mild = does not interfere with activity; moderate = interferes with activity; severe = prevents daily activity.
f “Any local reaction” includes all participants who reported any injection site reaction (pain, swelling, or redness) as “mild”, “moderate”, or “severe” during Day 1 to Day 10 after vaccination.

Table 2: Percentage of Participants With Solicited Local Adverse Reactions, by Maximum Severity, Within 10 Days After Vaccination in Adults 65 Years of Age and Older With Prior Pneumococcal Vaccination - Study 6a,b

Prior Pneumococcal Vaccination Statusc
PPSV23 Prevnar 13 Prevnar 13 and PPSV23
Vaccine Group
Prevnar 20
(Nd=253)%
Prevnar 13
(Nd=121)%
Prevnar 20
(Nd=245)%
PPSV23
(Nd=126)%
Prevnar 20
(Nd=125)%
Local Reaction
Pain at the injection siteg
Anyf 50.2 43.0 61.2 56.3 52.8
Mild 45.8 38.8 54.7 40.5 47.2
Moderate 4.3 3.3 6.1 14.3 5.6
Severe 0 0.8 0.4 1.6 0
Swelling e
Any (>2.0 cm)f 9.9 6.6 9.4 14.3 4.0
Mild 5.1 6.6 5.7 6.3 1.6
Moderate 3.6 0 3.7 7.1 2.4
Severe 1.2 0 0 0.8 0
Redness e
Any (>2.0 cm)f 7.9 2.5 8.6 12.7 4.8
Mild 3.6 1.7 2.9 4.8 1.6
Moderate 3.2 0.8 5.3 7.1 3.2
Severe 1.2 0 0.4 0.8 0
Any local reactionh 53.0 43.8 64.1 57.9 54.4
a Study 6 was conducted in the United States and in Sweden (NCT03835975)
b Open-label administration of Prevnar 20.
c Includes participants who previously received either PPSV23 ≥1 to ≤5 years before enrollment (PPSV23), Prevnar 13 ≥6 months before enrollment (Prevnar 13), or Prevnar 13 followed by PPSV23 ≥1 year before enrollment (Prevnar 13 and PPSV23) in the study.
d N = number of participants with any e-diary data reported after vaccination. This value is the denominator for the percentage calculations.
e Diameters were measured in caliper units of whole numbers from 1 to 21 or 21+. One caliper unit = 0.5 cm. Measurements were rounded up to the nearest whole number. Intensity of redness and swelling were then characterized as follows: mild is >2.0 to 5.0 cm; moderate is >5.0 to 10.0 cm; severe is >10.0 cm.
f “Any” includes all participants who reported a reaction as “mild”, “moderate”, or “severe” during Day 1 to Day 10 after vaccination.
g Mild = does not interfere with activity; moderate = interferes with activity; severe = prevents daily activity.
h “Any local reaction” includes all participants who reported any injection site reaction (pain, swelling, or redness) as “mild”, “moderate”, or “severe” during Day 1 to Day 10 after vaccination.

Table 3: Percentage of Participants With Solicited Systemic Reactions, by Maximum Severity, Within 7 Days After Vaccination in Pneumococcal Vaccine-Naive Adults - Study 1a

18 through 49 Years of Age 50 through 59 Years of Age ≥60 Years of Age
Vaccine Group
Prevnar 20
(Nb=335) %
Prevnar 13
(Nb=112) %
Prevnar 20
(Nb=331) %
Prevnar 13
(Nb=111) %
Prevnar20/ Saline
(Nb=1505) %
Prevnar13 /PPSV23
(Nb=1483) %
Systemic Reaction
Muscle painc
Anyd 66.6 74.1 49.8 49.5 39.1 37.3
Mild 36.4 42.0 33.8 31.5 28.9 26.8
Moderate 29.0 31.3 15.4 17.1 9.8 10.0
Severe 1.2 0.9 0.6 0.9 0.4 0.5
Fatiguec
Anyd 42.7 43.8 39.3 36.0 30.2 30.7
Mild 18.8 20.5 21.1 18.0 16.1 17.5
Moderate 22.1 19.6 17.2 15.3 12.8 11.9
Severe 1.8 3.6 0.9 2.7 1.2 1.2
Headachec
Anyd 38.8 33.9 32.3 36.0 21.5 23.3
Mild 21.5 16.1 20.5 21.6 15.5 17.0
Moderate 14.6 17.0 10.9 13.5 5.4 5.9
Severe 2.7 0.9 0.9 0.9 0.7 0.3
Joint painc Anyd 13.4 17.9 15.4 20.7 12.6 13.7
Mild 6.3 8.9 10.6 12.6 6.9 7.1
Moderate 7.2 8.0 4.8 7.2 5.4 6.3
Severe 0 0.9 0 0.9 0.3 0.2
Fever
≥38.0°C 1.2 1.8 1.5 0.9 0.9 0.8
≥38.0°C to 38.4C 0.6 0 0.6 0.9 0.3 0.4
≥38.4C to 38.9C 0.3 0 0.3 0 0.3 0.2
≥38.9°C to 40.0C 0.3 1.8 0.3 0 0 0
≥40.0°C 0 0 0.3 0 0.3 0.2
Any systemic reactione 79.4 83.0 69.5 67.6 55.2 55.4
Use of antipyretic or pain medicationf 25.7 23.2 24.5 27.9 18.5 20.4
a Study 1 was conducted in the United States and in Sweden (NCT03760146).
b N = number of participants with any e-diary data reported after vaccination (after Vaccination 1 [Prevnar 20 or Prevnar 13] for Study 1 participants 60 years of age and older). This value is the denominator for the percentage calculations.
c Mild = does not interfere with activity; moderate = some interference with activity; severe = prevents daily activity.
d “Any” includes all participants who reported a reaction as “mild”, “moderate”, or “severe” during Day 1 to Day 7 after vaccination.
e “Any systemic reaction” includes all participants who reported any fever ≥38.0°C or any other systemic reaction (fatigue, headache, joint pain, or muscle pain) as “mild”, “moderate”, or “severe” during Day 1 to Day 7 after vaccination.
f Severity was not collected for use of antipyretic or pain medication. The numbers listed reflect “yes” responses (i.e., number of reactions reported).

Table 4: Percentage of Participants With Solicited Systemic Reactions, by Maximum Severity, Within 7 Days After Vaccination in Adults 65 Years of Age and Older With Prior Pneumococcal Vaccination - Study 6a,b

Prior Pneumococcal Vaccination Statusc
PPSV23 Prevnar 13 Prevnar 13 and PPSV23
Vaccine Group
Prevnar 20
(Nd=253)%
Prevnar 13
(Nd=121)%
Prevnar 20
(Nd=245)%
PPSV 23
(Nd=126)%
Prevnar 20
(Nd=125)%
Systemic Reaction
Muscle paine
Anyf 32.0 31.4 33.9 46.0 37.6
Mild 26.1 24.0 25.3 31.7 28.0
Moderate 5.5 5.0 8.6 11.9 8.8
Severe 0.4 2.5 0 2.4 0.8
Fatiguee
Anyf 28.9 22.3 31.0 33.3 32.8
Mild 17.8 9.9 19.6 19.8 19.2
Moderate 11.1 9.9 10.2 13.5 12.0
Severe 0 2.5 1.2 0 1.6
Headachee
Anyf 17.8 18.2 13.5 21.4 19.2
Mild 12.6 12.4 9.8 20.6 12.8
Moderate 4.7 5.8 3.7 0.8 5.6
Severe 0.4 0 0 0 0.8
Joint paine
Anyf 6.7 10.7 11.8 15.9 16.8
Mild 4.7 5.0 7.8 10.3 12.8
Moderate 2.0 5.0 4.1 5.6 4.0
Severe 0 0.8 0 0 0
Fever
≥38.0°C 0.8 0 0 1.6 0
≥38.0°C to 38.4C 0.8 0 0 0.8 0
≥38.4C to 38.9C 0 0 0 0.8 0
≥38.9°C to 40.0C 0 0 0 0 0
≥40.0°C 0 0 0 0 0
Any systemic reactiong 51.8 43.8 50.2 59.5 52.8
Systemic Reaction
Use of antipyretic or pain medicationh 15.8 14.9 17.1 19.8 17.6
a Study 6 was conducted in the United States and in Sweden (NCT03835975).
b Open-label administration of Prevnar 20.
c Includes participants who previously received either PPSV23 ≥1 to ≤5 years before enrollment (PPSV23), Prevnar 13 ≥6 months before enrollment (Prevnar 13), or Prevnar 13 followed by PPSV23 ≥1 year before enrollment (Prevnar 13 and PPSV23) in the study.
d N = number of participants with any e-diary data reported after vaccination. This value is the denominator for the percentage calculations.
e Mild = does not interfere with activity; moderate = interferes with activity; severe = prevents daily activity.
f “Any” includes all participants who reported a reaction as “mild”, “moderate”, or “severe” during Day 1 to Day 7 after vaccination.
g “Any systemic reaction” includes all participants who reported any fever ≥38.0°C or any other systemic reaction (fatigue, headache, joint pain, or muscle pain) as “mild”, “moderate”, or “severe” during Day 1 to Day 7 after vaccination.
h Severity was not collected for use of antipyretic or pain medication. The numbers listed reflect “yes” responses (i.e., number of reactions reported).

Postmarketing Experience With Prevnar 13

The postmarketing safety experience with Prevnar 13 is relevant to Prevnar 20 since the vaccines are manufactured and formulated similarly and contain 13 of the same polysaccharide conjugates. These adverse reactions are included based on one or more of the following factors: severity, frequency of reporting, or strength of evidence for a causal relationship to Prevnar 13 vaccine in adults. Because these reactions are reported voluntarily from a population of uncertain size, it is not always possible to reliably estimate their frequency or establish a causal relationship to product exposure. The following adverse reactions have been spontaneously reported during postapproval use of Prevnar 13 and may also be seen in postmarketing experience with Prevnar 20. Reactions reported in the postmarketing experience and which pertain only to pediatric populations are not included in this listing.

  • Immune System Disorders: Anaphylactic/anaphylactoid reaction, including shock
  • Skin and Subcutaneous Tissue Disorders: Angioneurotic edema, Erythema multiforme
  • Blood and lymphatic system disorders: Lymphadenopathy localized to the region of the injection site
  • General Disorders and Administration Site Conditions: Vaccination-site dermatitis, vaccination-site pruritus, vaccination-site urticaria

DRUG INTERACTIONS

Prior Vaccination With PNEUMOVAX 23

Receipt of PPSV23 1 to 5 years prior to Prevnar 20 resulted in diminished OPA geometric mean titers (GMTs) to Prevnar 20 compared to OPA GMTs in recipients who received Prevnar 13 at least 6 months previously, and compared to OPA GMTs in recipients who received Prevnar 13 followed by PPSV23, with the last dose of PPSV23 given at least 1 year prior to Prevnar 20 [see Clinical Studies].

Immunosuppressive Therapies

Individuals with impaired immune responsiveness due to the use of immunosuppressive therapy (including irradiation, corticosteroids, antimetabolites, alkylating agents, and cytotoxic agents) may not respond optimally to Prevnar 20.

Read the entire FDA prescribing information for Prevnar 20 (Pneumococcal 20-valent Conjugate Vaccine for Injection)

© Prevnar 20 Patient Information is supplied by Cerner Multum, Inc. and Prevnar 20 Consumer information is supplied by First Databank, Inc., used under license and subject to their respective copyrights.

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