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From the 7/23/2021 release of VAERS data:

This is VAERS ID 1330996



Case Details

VAERS ID: 1330996 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Female  
Location: Texas  
Vaccinated:2021-05-15
Onset:2021-05-19
   Days after vaccination:4
Submitted: 0000-00-00
Entered: 2021-05-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0175 / 1 RA / IM

Administered by: Private       Purchased by: ?
Symptoms: Crying, Headache, Pain, Visual impairment
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Depression (excl suicide and self injury) (broad), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations: Syncope after HPV vaccine. Age 11 years. 2018.
Other Medications: None
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None
CDC Split Type:

Write-up: Patient developed changes in her vision that she reported as black dots on the left side of her vision that lasted roughly 2 minutes. She said she could not see out to the left side of her eye. This went away after 2 minutes and within 20-30 minutes she developed a severe headache and was in tears from the pain. She has no history of headaches and this has never happened before. She did not report light or sound sensitivity. She did not have any vomiting, but did not want to eat. We consulted her Optometrist and Pediatrician. I gave her Naproxen and caffeine and within 3 hours her headache resolved.


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