Report #2873401

Received Nov 18, 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: 44 yrs
State: OR
Recovered: Unknown
Vaccinated: Nov 17, 2025
Onset: Nov 17, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	4	3052859	IM / RA

Symptoms (1)

Underdose

Symptom narrative

CCMA grabbed pediatric moderna vaccine that was placed in the adult moderna vaccine basket and vaccine was then documented on vaccine worksheet and then administered to pt. Pt left clinic ambulatory.

Current illness

N/A

Medical history

Left ovarian epithelial cancer, Malignant neoplasm of peritoneum, unspecified, Moderate episode of recurrent major depressive disorder,Chondromalacia of patella, Prediabetes, Hepatic steatosis, Essential hypertension, Posttraumatic stress disorder, Binge eating disorder, Erosive esophagitis, BRCA gene mutation positive,S/P hysterectomy with oophorectomy

Other medications

tirzepatide, weight loss, (ZEPBOUND) 2.5 mg/0.5 mL, buPROPion HCL (WELLBUTRIN XL),ondansetron HCL (ZOFRAN) 8 mg tablet (PRN), olaparib 150 mg tab and losartan-hydrochlorothiazide (HYZAAR)

Allergies

NONE

Lab data

N/A