her arm was beet red from her elbow up to her shoulders/arm was a mild red; flu like symptoms; her arm was killing her, she had no red spot it was just very sore/shot itself was extremely painful it hurts; arm was very painful and swollen; This is a spontaneous report received from a contactable reporter(s) (Consumer or other non HCP). The reporter is the patient.  A 71-year-old female patient received pneumococcal 20-val conj vac (dipht CRM197 protein) (PREVNAR 20), on 13Aug2022 at 11:00 as dose number unknown, single (Batch/Lot number: unknown) at the age of 71 years, in arm for immunisation. The patient's relevant medical history was not reported. There were no concomitant medications. Vaccination history included: pfizer (Covid Vaccine: Pfizer, Dose #1: Date: 15Mar2021  , Lot: EN6201, Expiry: 30Jun2021, NDC: unknown, sore arm after the First Covid Vaccine), administration date: 15Mar2021, for COVID-19 immunization, reaction(s): "Sore arm"; pfizer (Dose #2: sore arm was mild nothing really, Date: 30Jun2021 , Lot: EN6207, Expiry: 31Jul2021, NDC: unknown), administration date: 30Jun2021, for COVID-19 immunization, reaction(s): "sore arm"; pfizer (Dose #3: , Date: 02Oct2021 , Lot: unknown but it says, Pfizer 301558A), administration date: 02Oct2021, for COVID-19 immunization; Pneumonia (She has had previous pneumonia and a skindex), for Immunization; Skindex (She has had previous pneumonia and a skindex), for Immunization. The following information was reported: VACCINATION SITE SWELLING (non-serious) with onset 13Aug2022, outcome "not recovered", described as "arm was very painful and swollen"; INFLUENZA LIKE ILLNESS (non-serious) with onset 13Aug2022, outcome "unknown", described as "flu like symptoms"; VACCINATION SITE PAIN (non-serious) with onset 13Aug2022, outcome "not recovered", described as "her arm was killing her, she had no red spot it was just very sore/shot itself was extremely painful it hurts"; VACCINATION SITE ERYTHEMA (non-serious) with onset 15Aug2022, outcome "not recovered", described as "her arm was beet red from her elbow up to her shoulders/arm was a mild red". The events "flu like symptoms", "her arm was killing her, she had no red spot it was just very sore/shot itself was extremely painful it hurts", "arm was very painful and swollen" and "her arm was beet red from her elbow up to her shoulders/arm was a mild red" required emergency room visit. Therapeutic measures were taken as a result of vaccination site pain, vaccination site swelling, vaccination site erythema. Additional information: On Saturday, 13Aug2022, the patient started having flu like symptoms and her arm was killing her. She had no red spot it was just very sore. She was in bed all day Saturday to Monday afternoon. Her arm was killing her early in the morning. Her arm was very painful and swollen. She noticed her arm was beet red from her elbow up to her shoulders, 2.5 days after shot on Monday, 15Aug2022. Her arm was a mild red, she went to the ER on 15Aug2022 because she thought she was having a reaction to shot and thought what if it turns into an anaphylaxis reaction. The ER told her to put ice on it and take Benadryl, and they gave her a prescription for steroids. The patient stated it was prednisone but she is not taking that prescription, and stated that you don't take steroids unless you need them. The patient then clarified that it was methylprednisolone 4 mg tablets, there are 20 tablets. She added that you don't want to take them unless you have to because they can wreck you. The redness is fading but her arm is sore but it is still there. She is pro vaccine, she then asked her pharmacist and was told once you get a severe reaction you are more prone to a bad reaction to another shot. The patient stated that she has never had a reaction in her life to anything, she is extremely worried for covid booster, she is still working. She teaches young kids who are full of germs, she plays at concerts in halls, she needs to get that booster. She still wears a mask when she goes into stores. She stated that she has not gotten covid but she bought a covid test and tested herself when this happened. She was negative. She is still congested but just had to be in bed. The shot itself was extremely painful this hurts. She has never had a shot that hurt her before. She filled the prescription but is not going to take it.   The information on the batch/lot number for pneumococcal 20-val conj vac (dipht CRM197 protein) has been requested and will be submitted if and when received.