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

This is VAERS ID 1475008

Case Details

VAERS ID: 1475008 (history)  
Form: Version 2.0  
Age: 15.0  
Sex: Male  
Location: Ohio  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-07-15
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Pharmacy       Purchased by: ?
Symptoms: Anxiety, Blindness transient, Dizziness, Fear of injection, Pallor, Presyncope, Vomiting
SMQs:, Acute pancreatitis (broad), Anticholinergic syndrome (broad), Embolic and thrombotic events, arterial (narrow), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Glaucoma (broad), Optic nerve disorders (broad), Retinal disorders (broad), Vestibular disorders (broad), Hypotonic-hyporesponsive episode (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: Mother claimed he typically has a fear of needles and sometimes passes out with vaccines or blood draws.
Other Medications:
Current Illness:
Preexisting Conditions:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient had a vagal response caused by an anxiety attack due to fear of needles. Technician, gave the vaccine and then immediately called me in. The mother and son were worried about the needle disappearing due to the retraction mechanism. The son was loosing color in his face and becoming dizzy. I had him sit upright, talked with him for a few minutes, gave him Benadryl as a precaution, and checked his blood pressure. He was having no difficulty breathing and blood pressure was WNL. His mother said that he has passed out with needles before and that he had not eaten today. Eventually the patient claimed to lose his sight, and within 30s passed out. He was still sitting in the chair, bent over, vomited, and then immediately came back to consciousness. The patient then said that he felt fine and wanted to leave. I talked with him and his mother for around 20 minutes, had him eat a banana, and drink a full bottle of water. After the time, he felt fine and him and his mother left.

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