injection site reaction; significant injection site reaction there is redness and erythema; blister; injection site reaction...tenderness; swelling; significantly indurated; Arm is hard; This is a spontaneous report received from a contactable reporter(s) (Physician) from medical information team.  A 71-year-old female patient received pneumococcal 20-val conj vac (dipht crm197 protein) (PREVNAR 20), on 13Sep2023 as dose number unknown, single (Batch/Lot number: unknown) for immunisation. The patient's relevant medical history and concomitant medications were not reported. The following information was reported: LIMB DISCOMFORT (non-serious) with onset Sep2023, outcome "unknown", described as "Arm is hard"; VACCINATION SITE VESICLES (non-serious) with onset Sep2023, outcome "unknown", described as "blister"; VACCINATION SITE REACTION (non-serious) with onset Sep2023, outcome "unknown", described as "injection site reaction"; VACCINATION SITE PAIN (non-serious) with onset Sep2023, outcome "unknown", described as "injection site reaction...tenderness"; VACCINATION SITE ERYTHEMA (non-serious) with onset Sep2023, outcome "unknown", described as "significant injection site reaction there is redness and erythema"; VACCINATION SITE INDURATION (non-serious) with onset Sep2023, outcome "unknown", described as "significantly indurated "; VACCINATION SITE SWELLING (non-serious) with onset Sep2023, outcome "unknown", described as "swelling".  Additional information: The physician administered Prevnar 20 to a patient yesterday. The patient comes in today with significant injection site reaction. There was redness and erythema that the physician has seen over the years with Pneumovax. It was significantly indurated and wraps around her arm and there was blister. The physician always worries about E. multiforme and sees a blister. The physician just don't know if that was typical and when to get concerned or what degree of an injection site reaction is expected. Further stated that it was wrapped around the patient's entire arm. It's red and think of the upper arm a little below the elbow, posteriorly where the injection was given in the deltoid, wraps around underneath the arm.it doesn't quite meet around the arm and goes from the upper arm all the way down to the elbow, right below the elbow. It was red, hot, indurated and can feel it. It was thick through and through and there is one single blister, 2 to 3 mm. Reported that the patient had swelling, redness, tenderness, induration around the circumference of her arm and a blister. The physician has seen a lot of injection site reactions over time, never such significant induration or even a blister. So, the physician was not sure if this was standard and expected. Further described that it was significant induration. It was hard, the arm was hard. The physician just wanted to be able to take care of his patients in time sensitive fashion. The physician was calling for an urgency, like a medical assessment with an anticipated side effect.   The information on the batch/lot number for pneumococcal 20-val conj vac (dipht crm197 protein), pneumococcal 20-val conj vac (dipht crm197 protein)  has been requested and will be submitted if and when received.