Can Shingrix and Pneumovax Cause Vomiting?
Vomiting is not a common adverse event with either Shingrix or Pneumovax 23, but it can occur rarely with pneumococcal vaccines in children, while data for adults are limited.
Shingrix (Recombinant Zoster Vaccine)
Vomiting is not listed among the common adverse reactions to Shingrix. The most frequently reported adverse reactions with Shingrix include injection-site reactions (pain, redness, swelling), myalgia, fatigue, headache, shivering, fever, and gastrointestinal symptoms 1. While gastrointestinal symptoms can occur, the available safety data from clinical trials and real-world effectiveness studies primarily document local injection-site reactions and mild systemic reactions such as fever and muscle pain, rather than vomiting specifically 1.
- Rare adverse events occurring in less than 1% of recipients include Guillain-Barré syndrome, but vomiting is not prominently featured in the documented adverse event profile 1.
- One case report documented prolonged neurological and musculoskeletal symptoms following Shingrix, but gastrointestinal symptoms like vomiting were not the primary concern 2.
Pneumovax 23 (Pneumococcal Polysaccharide Vaccine)
Vomiting occurs in approximately 1.8-2.0% of pediatric vaccine recipients but is not well-documented as a common adverse event in adults.
Pediatric Data
- In clinical trials involving pneumococcal conjugate vaccines (PCV13), vomiting was reported in 1.8% of PCV13 recipients compared to 2.0% of PCV7 recipients among infants and toddlers 3.
- Vomiting was classified among unsolicited adverse events occurring in >1% of infants and toddlers, alongside diarrhea and rash 3.
- These gastrointestinal symptoms are generally mild and self-limited 4.
Adult Data
- The most common adverse reactions in adults following PPSV23 are mild local reactions (pain, erythema, swelling) that typically resolve within 48 hours 3.
- A large survey of 1,006 adults (mean age 69.9 years) found that systemic symptoms including fever, rash, myalgias, fatigue, malaise, and headache occurred at similar or lower rates during the post-vaccination week compared to the comparison week, but vomiting was not specifically highlighted 5.
- Rare systemic reactions including high fever, headache, nausea, and photophobia have been reported in isolated case reports, with some patients requiring hospitalization 6, 7.
- Five adult patients who received both influenza and PS23 vaccines experienced fever, leukocytosis, and cellulitis-like reactions, but vomiting was not a prominent feature 7.
Clinical Implications
If vomiting occurs after vaccination, consider alternative causes first. Most respiratory or gastrointestinal symptoms occurring after vaccination represent coincidental illnesses unrelated to the vaccine 4. Inactivated vaccines like Pneumovax 23 contain no live virus and cannot cause the disease they prevent 4.
- Monitor patients for 15-20 minutes post-vaccination to identify immediate adverse reactions, though vomiting is not typically an immediate hypersensitivity reaction 4.
- Report any clinically significant adverse events to VAERS, even without certainty of causation 4.
- Reassure patients that while mild systemic symptoms can occur, vomiting is uncommon and typically represents coincidental illness rather than a vaccine-related adverse event 4, 5.