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

This is VAERS ID 1426127



Case Details

VAERS ID: 1426127 (history)  
Form: Version 2.0  
Age: 57.0  
Sex: Female  
Location: North Carolina  
Vaccinated:2021-06-03
Onset:2021-06-04
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-06-25
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EW0178 / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Eye swelling, Visual impairment
SMQs:, Anaphylactic reaction (broad), Angioedema (narrow), Anticholinergic syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (broad), Hypersensitivity (narrow), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), Hypoglycaemia (broad)

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

Write-up: Pt complains of eye swelling and altered vision. States she has been seeing black spots in her vision and has some swelling around her right eye. Refrained from giving second shot due to these effects


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