If a patient ends up with a different item than you pictured, it's usually because the recommendation allowed a choice.
Why it happens
You allowed a variant or filtered choice. The patient selected a different size, pack, or product from the set you permitted.
The patient swapped in an alternative. At checkout, patients can browse and choose a similar Walmart product.
How to check
Open History and view the recommendation's cart details. It shows the patient-selected options and any alternatives they chose.
To prevent it
If the exact product matters, recommend it as an exact product rather than a variant or filtered option. See "Choosing a recommendation type."