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Report #2869188

Received Oct 28, 2025

A note on interpretation. VAERS reports are unverified and may be incomplete or coincidental. A report does not establish that a vaccine caused an event, and counts should not be used to calculate incidence or infer causation. Full disclaimer

Overview

Sex
Female
Age
3 yrs
State
WA
Recovered
Unknown
Vaccinated
Oct 22, 2025
Onset
Oct 22, 2025
Days to onset
0
Hospital days
—

Vaccines (1)

TypeNameManufacturerDoseLotRoute / Site
COVID19COVID19 (COVID19 (MODERNA))MODERNA13052668IM / LL

Symptoms (2)

Product lot number issueWrong product administered

Symptom narrative

pt came into the office to recive their covid vaccine, when vaccine was pulled the lot number did not match the system. vaccine was brought to LEAD staff, medication program coordinator and backup vaccine coordinator who reviewed the preflled syrigne and confirmed the vaccine was the correct one but that the lot may have been enetered incorrectly. lot was changed by them and i confired after entering lot number i was okay to amndinister to which the ressured me that i was okay. i return to the pt room with the vaccine, confirmed with mother pt information and vaccine and adminitered. shortly after administering medication program coordinator entered the room and informed me that the vaccine was inccorect, however vaccine had already been administrerd. pt mother spoke to individual one on one in regards to event.

Current illness

none

Medical history

none

Other medications

pedi multivit no.17 w-fluoride 0.5 mg tablet,chewable

Allergies

NKDA