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From the 1/14/2022 release of VAERS data:

This is VAERS ID 903010

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Case Details

VAERS ID: 903010 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: West Virginia  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-17
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Confusional state, Slow response to stimuli, Visual impairment
SMQs:, Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Anticholinergic syndrome (narrow), Dementia (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Glaucoma (broad), Optic nerve disorders (broad), Lens disorders (broad), Retinal disorders (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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: yes.
Current Illness: UTI
Preexisting Conditions: yes
Allergies: kna
Diagnostic Lab Data: Pulse ox 100 no sob bp 125/67 Pulse 58
CDC Split Type:

Write-up: After receiving vaccine patient started complain of vision disturbance, confusion, nurses started he was slow to respond. Nurses also documented that he was acting the same way the day before due to UTI. No SOB . no signs of allergic reaction


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