Slack marking from Italy allowed defender Antolin Alcaraz to head the South Americans in front on 39 minutes.
Daniele De Rossi poked home after a goalkeeping howler by Justo Villar to bring Italy level 17 minutes after the second-half restart.
Marcello Lippi’s 2006 winners pressed for a winner but, in keeping with what was a dreary affair, they failed to create any genuine chances as the game petered out to a dry draw.
Lippi will not be too overly concerned by the performance - Italy are traditionally slow starters at World Cups - but has a major worry over the fitness of keeper Gianluigi Buffon, who came off injured at half-time.
Albirroja boss Gerardo Martino will now feel his side have a chance to win the group, with convincing wins against Slovakia and New Zealand the clear targets for both teams.
Both sides were extremely well organised but largely negative, with Italy having more of the possession but only forcing Valladolid keeper Villar into first-half action when Riccardo Montolivo shot weakly from range.
Paraguay lined up with two banks of four and proved incredibly difficult to break down and - Simone Pepe aside - the Azzurri’s lack of pace allowed the Albirroja to contain their attacking threat.
Nelson Valdez and Luca Barrios were a touch isolated and responded by cleverly trying to win free-kicks whenever long balls went their way.
Oddly though, this current Italy team look vulnerable from set pieces and Paraguay took the lead six minutes before the break, when ageing skipper Fabio Cannavaro failed to challenge Alcaraz at a corner.
The new Wigan defender, who looked composed at the back in his first World Cup finals, easily stepped above the static 36-year-old Cannavaro to power a header inside the near post that Buffon could only watch bounce in.
Paraguay were happy to slow the game down, and Italy offered few answers, with midfielder Enrique Vera missing from close range when a misplaced Giorgio Chiellini clearance played him in.
That should have put Martino’s team two up and Italy made them pay.
An unchallenged Villar flapped at a 63rd-minute corner by Pepe, missing his one-handed punch to allow a tap-in for De Rossi, the Roma midfielder’s eighth international goal.
It was yet another dreadful goalkeeping error at this World Cup to add to those by Robert Green of England and Faouzi Chaouchi of Algeria, although it was one that could be partly blamed on the new ball, which was at least in flight this time.
Paraguay were not finished though, and three minutes Jonathan Santana missed a superb chance to get a second, smashing the ball well wide a superb cut-back from Lucas Barrios with inexperienced Cagliari keeper Federico Marchetti watching on stranded.
The introduction of Antonio Di Natale boosted Italy in the closing stages as they pushed hard for a winner but Paraguay, despite looking fatigued, stayed solid and determined, with Villar seemingly unflustered by his error and pulling off a smart stop to deny a low drive by Montolivo.
Paraguay were effectively down to 10 men by the end, with all three subs used and Santana limping around injured, but they held on manfully to frustrate the Azzurri into their 20th World Cup finals draw - a tournament record.
Match facts:
Italy v Paraguay
Goals 1-1
1st half goals 0-1
Shots on Target 5-1
Shots off Target 1-6
Blocked Shots 4-0
Corners 8-4
Fouls 15-14
Offsides 3-5
Yellow Cards1-1
Red Cards 0-0
Passing Success 69.9%-63.2%
Tackles 31-23
Tackles Success 83.9%-69.6%
Possession 57%-43%
Territorial Advantage 58.2%-41.8%
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