Report #2874101

Received Nov 21, 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: Male
Age: 71 yrs
State: IL
Recovered: Not recovered
Vaccinated: Nov 10, 2025
Onset: Nov 10, 2025
Days to onset: 0
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052859	IM / LA

Symptoms (2)

No adverse eventUnderdose

Symptom narrative

Pulled out covid vaccine from VFC stock and gave the patient a pediatric dose. Injection of the immunization to patient went normal with no negative reactions during appointment. Noticed while doing inventory that pediatric VFC dose was given instead of adult private pay dose. VAERS report completed. Consulted with state and they recommended to administer a repeat dose with the correct dose. Calling and rescheduling patient for another covid immunization.