Marine bivalves include species important globally for aquaculture and estuary ecology. However, epizootics of variable etiologies often pose a threat to the marine fishery industry and ecosystem by causing significant mortalities in related species. One of such diseases is larval vibriosis caused by bacteria of the genus Vibrio, which frequently occurs and causes mass mortalities in bivalve larvae and juveniles in hatcheries. During a mass mortality of razor clam, Sinonovacula constricta, juveniles in a shellfish hatchery in 2019, Vibrio mediterranei was identified as a dominant bacterial species in diseased animals and their rearing water. In this study, we selected and characterized 11 V. mediterranei isolates and studied their pathogenicity to the larvae and juveniles of S. constricta and Crossostrea sikamea. We found that V. mediterranei isolates showed various degrees of pathogenicity to the experimental animals by immersion. Injection of the extracellular products (ECPs) of the strains into clam juveniles resulted in similar pathogenicity with strain immersion. Furthermore, the measurements of enzyme activity suggested the existence of virulence factors in the ECPs of disease-causing V. mediterranei strains. Additionally, proteomic analysis revealed that more than 700 differentially expressed proteins were detected in the ECPs among V. mediterranei strains with different levels of virulence, and the higher expressed proteins in the ECPs of highly virulent strains were involved mainly in the virulence-related pathways. This research represented the first characterization of the V. mediterranei strains as causative agents for larval bivalve vibriosis. The mechanisms underlying the pathogenicity and related strain variability are under further study. IMPORTANCE In the marine environment, Vibrio members have a significant impact on aquatic organisms. Larval vibriosis, caused by bacteria of the genus Vibrio, often poses a threat to the marine fishery industry and ecosystem by causing the mortality of bivalves. However, the emerging pathogens of larval vibriosis in bivalves have not been explored fully. Vibrio mediterranei, the dominant bacterium isolated from moribund clam juveniles in a mortality event, may be responsible for the massive mortality of bivalve juveniles and vibriosis occurrence. Thus, it is necessary to study the pathogenic mechanisms of V. mediterranei to bivalve larvae. We found that V. mediterranei was the pathogen of larval bivalve vibriosis, and its extracellular products contributed a critical role for virulence in juveniles. This research is the first report of V. mediterranei as a causative agent for vibriosis in bivalve juveniles. Our results provide valuable information for understanding the pathogenic mechanism of V. mediterranei to bivalve larvae.