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

This is VAERS ID 1470331

Case Details

VAERS ID: 1470331 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Female  
Location: North Carolina  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-14
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Blindness, Cyanosis, Discomfort, Ear discomfort, Hypotonia, Malaise, Pallor
SMQs:, Anaphylactic reaction (broad), Peripheral neuropathy (broad), Acute central respiratory depression (broad), Guillain-Barre syndrome (broad), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (broad)

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

Write-up: After we left pharmacy and was in the car at a stoplight, my daughter starting feeling very uncomfortable. She complained that she did not feel well, she could not see and that her ears were "foggy". When I looked over at her, her face was pale as can be and her lips had bluish tinge to them and she looked limp laying in the passenger seat of the car. It came on very quickly and lasted about a minute or so and was extremely scary. It took close to 30 minutes for her to regain her color. We sat in a parking lot for thirty minutes to make sure she was stable and gave her water. Went home and gave her benadryl. She slept through the night fine and this morning so far is ok.

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