With the rapid development of the Vision-Language Model (VLM), significant progress has been made in Visual Question Answering (VQA) tasks. However, existing VLM often generate inaccurate answers due to a lack of up-to-date knowledge. To address this issue, recent research has introduced Retrieval-Augmented Generation (RAG) techniques, commonly used in Large Language Models (LLM), into VLM, incorporating external multi-modal knowledge to enhance the accuracy and practicality of VLM systems. Nevertheless, the RAG in LLM may be susceptible to data poisoning attacks. RAG-based VLM may also face the threat of this attack. This paper first reveals the vulnerabilities of the RAG-based large model under poisoning attack, showing that existing single-modal RAG poisoning attacks have a 100\% failure rate in multi-modal RAG scenarios. To address this gap, we propose Spa-VLM (Stealthy Poisoning Attack on RAG-based VLM), a new paradigm for poisoning attacks on large models. We carefully craft malicious multi-modal knowledge entries, including adversarial images and misleading text, which are then injected into the RAG's knowledge base. When users access the VLM service, the system may generate misleading outputs. We evaluate Spa-VLM on two Wikipedia datasets and across two different RAGs. Results demonstrate that our method achieves highly stealthy poisoning, with the attack success rate exceeding 0.8 after injecting just 5 malicious entries into knowledge bases with 100K and 2M entries, outperforming state-of-the-art poisoning attacks designed for RAG-based LLMs. Additionally, we evaluated several defense mechanisms, all of which ultimately proved ineffective against Spa-VLM, underscoring the effectiveness and robustness of our attack.