After narrowly missing the podium in the 100m butterfly S10, Pearse scored silver in the 200m individual medley SM10 final, held at 1.30am AEST on Sunday.
Pearse entered the final as the fastest qualifier with a time of 2.16.19, but when medals were on the line, it became clear the eight-man field had more to give.
Italian Stefano Raimondi and Ukrainian Ihor Nimchenko, the top two finishers in the 100m butterfly, went out quickly in the opening butterfly leg, Nimchenko leading the pack at the first turn with Pearse lurking in third
Raimondi overtook the Ukranian in the backstroke portion, while Pearse remained on the heels of Nimchenko.
A decisive breaststroke leg proved the difference as while Raimondi started to slip out of reach, Pearse burst past Nimchenko, swimming a full three seconds faster than the Ukranian over the leg.
Pearse held his nerve over the final freestyle portion of the race to secure his second Paralympic medal in a time of 2.12.79.
Raimondi (2.10.24) took home his fourth gold at the games, improving to five hours later, while Nimchenko (2.13.73) held on for bronze.
Last Wednesday, Pearse was edged out of the bronze medal in the 100m butterfly S10 by fellow Australian Alex Saffy, who swum an Oceania record in the event.
Pearse was a bronze medallist in the 100m butterfly S10 at Tokyo 2020.