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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1404859



Case Details

VAERS ID: 1404859 (history)  
Form: Version 2.0  
Age: 86.0  
Sex: Male  
Location: Foreign  
Vaccinated:2021-06-01
Onset:2021-06-01
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-06-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EX3617 / 1 - / -

Administered by: Other       Purchased by: ?
Symptoms: Body temperature, Feeling hot, Heart rate, Vision blurred, Vital signs measurement
SMQs:, Anticholinergic syndrome (broad), Glaucoma (broad), Lens disorders (broad), Retinal 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:
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data: Test Date: 20210601; Test Name: KT; Result Unstructured Data: Test Result:36.3 Centigrade; Comments: before vaccination; Test Date: 20210601; Test Name: KT; Result Unstructured Data: Test Result:36.4 Centigrade; Comments: 10 minutes after the vaccination; Test Date: 20210601; Test Name: HR; Result Unstructured Data: Test Result:60; Test Date: 20210601; Test Name: Vital Sign; Result Unstructured Data: Test Result:104/60
CDC Split Type: JPPFIZER INC2021639087

Write-up: Hazy vision; feeling hot; This is a spontaneous report from a contactable Physician received from Medical Devices Agency. The patient was an 86-year and 2-month-old male. Body temperature before vaccination was 36.3 degrees Centigrade. There were no points to be considered on the vaccine screening questionnaire (primary diseases, allergies, vaccinations and illnesses within the last one month, medications the patient was taking, past adverse effect history, growth status). On 01Jun2021 at 11:10 (the day of vaccination), the patient received the first dose of BNT162B2 (COMIRNATY, Solution for injection, Lot number EX3617, Expiration date 31Aug2021) via an unspecified route of administration as a single dose for COVID-19 immunization. On 01Jun2021 at 11:25, the patient experienced adverse events. On 01Jun2021 (the same day after the vaccination), the outcome of the event was recovered. The course of the event was follows: On 01Jun2021 at 11:25 (the day of vaccination), about 10 minutes after vaccination, the patient experienced Hazy vision and feeling hot. Vital Sign 104/60, HR 60, KT 36.4 degree Centigrade. There were no issues that require special attention, but just in case, Adrenaline 0.3g was injected in the thigh. The reporting Physician classified the event as non-serious and assessed the causality between the event and BNT162B2 as unassessable. There was no other possible cause of the event such as any other diseases. The reporting Physician commented as follows: Although it is considered to be no problem at all, but I reported it because there was a person who complained of subjective symptoms for the first time in the 100 inoculations. Therapeutic measures were taken as a result of the events and included Adrenaline. The outcome of the events was recovered on 01Jun2021.


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