Received Oct 27, 2025
| Type | Name | Manufacturer | Dose | Lot | Route / Site |
|---|---|---|---|---|---|
| COVID19 | COVID19 (COVID19 (MODERNA)) | MODERNA | 1 | 3053238 | IM / LL |
| DTAPIPVHIB | DTAP + IPV + HIB (PENTACEL) | SANOFI PASTEUR | 3 | UK364AA | IM / RL |
| PNC20 | PNEUMO (PREVNAR20) | PFIZER\WYETH | 3 | MA2506 | IM / LL |
| RV5 | ROTAVIRUS (ROTATEQ) | MERCK & CO. INC. | 3 | Y019505 | PO / MO |
Patient was receiving their 6 month vaccines. Patient received 3 injections without incident. When the 4th injection, for the Pentacel vaccine was being administered, the syringe separated from needle during vaccine administration causing the vaccine to spill out. Unknown amount failed to be administered to patient. Unknown what amount was administered to patient. At the time of the incident there was no bruising, no redness, no sign of injury. The needle was removed from patient intact. Patient left the office before provider could do physical evaluation of patient after incident. Provider gave father instructions of what to monitor for. Dr. followed up with mom via phone call in the afternoon as well as a second phone call on Saturday 10/25/25 and offered to have the patient come in for an evaluation.
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