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

This is VAERS ID 1213171



Case Details

VAERS ID: 1213171 (history)  
Form: Version 2.0  
Age: 67.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-03-22
Onset:2021-03-26
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-04-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye disorder, Injection, Magnetic resonance imaging, Tremor, Vision blurred
SMQs:, Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Noninfectious encephalopathy/delirium (broad), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Unknown
Current Illness: Answered: Yes to "Do you have a weakened immune system caused by something such as HIV infection or cancer or do you take immunosuppressive drugs or therapies?"
Preexisting Conditions: Unknown
Allergies: Non listed on consent
Diagnostic Lab Data: MRI without contrast , possibly on 3/26/21 (pt could not remember dates). Scheduled for an MRI with contrast. Received "injections" in her left eye 4/15/21.
CDC Split Type:

Write-up: 4/15/21 Pt called stating that she has had some of the symptoms that everyone is talking about with the vaccine. She stated that Friday after her shot on Monday she had severe tremors, so bad it shook the car, and she went to the ER. They ordered an MRI without contrast and she is scheduled for an MRI with contrast soon. She cannot remember the date, but she began having blurry vision in her left eye. She went to her eye doctor and he stated she had an "eye stroke". She had injections in her eye today. I asked her to please call her primary physician as well and she agreed. I told her I was going to report her symptoms.


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Link To This Search Result:

https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1213171

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