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From the 9/17/2021 release of VAERS data:

This is VAERS ID 1369085



Case Details

VAERS ID: 1369085 (history)  
Form: Version 2.0  
Age: 13.0  
Sex: Male  
Location: Ohio  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-02
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0182 / 1 LA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Dizziness, Fall, Gait disturbance, Head injury, Headache
SMQs:, Peripheral neuropathy (broad), Anticholinergic syndrome (broad), Parkinson-like events (broad), Guillain-Barre syndrome (broad), Accidents and injuries (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (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:
Other Medications: N/A
Current Illness: None
Preexisting Conditions: None
Allergies: None
Diagnostic Lab Data: None that we are aware of at this time.
CDC Split Type:

Write-up: Patient became dizzy/started losing his vision fairly quickly after receiving the vaccine. He kept repeating he couldn''t see. He stumbled forward then fell down. Patient did hit his head. Store associate got him up and into a chair and started asking him questions. Mom stated he had just received vaccine. They were not told by the pharmacist on duty to stay to be monitored for 15 minutes after. He did say that he had a headache. Gave the patient some water, had him move his arm around, and monitored patient until pharmacy closed.


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