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From the 10/15/2021 release of VAERS data:

This is VAERS ID 1181735



Case Details

VAERS ID: 1181735 (history)  
Form: Version 2.0  
Age: 53.0  
Sex: Female  
Location: Rhode Island  
Vaccinated:2021-04-08
Onset:2021-04-08
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-08
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 041A21A / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye movement disorder, Glassy eyes
SMQs:, Ocular motility disorders (narrow)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Unknown
Preexisting Conditions: Unknown
Allergies: Unknown
Diagnostic Lab Data: Unknown
CDC Split Type:

Write-up: Observer noticed patient eyes glazed , Call pharmacist over - pharmacist spoke with patient, he noticed eyes rolling up and yelled to call 911 -then asked patient her name And where she was - did Not answer - pharmacist administered epi pen. Paramedics arrived


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1181735

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