Report #2881459

Received Jan 12, 2026

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: 11 yrs
State: CA
Recovered: Recovered
Vaccinated: Dec 19, 2025
Onset: Dec 1, 2025
Days to onset: —
Hospital days: —

Vaccines (1)

Type	Name	Manufacturer	Dose	Lot	Route / Site
COVID19	COVID19 (COVID19 (MODERNA))	MODERNA	1	3052668	IM / RA

Symptoms (1)

Wrong product administered

Symptom narrative

During system downtime. Provider ordered Moderna Spikevax 12yrs + on paper. The vaccine was prepared by Medical Assistant and cosigned by registered nurse. Incorrect vaccine for patients age administered . Error caught when the vaccine was entered into system. Patient and provider notified.

Current illness

N/A

Medical history

VSD, Asthma

Other medications

n/a

Allergies

NKDA

Lab data

n/a