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

This is VAERS ID 903591

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Case Details

VAERS ID: 903591 (history)  
Form: Version 2.0  
Age: 41.0  
Sex: Female  
Location: West Virginia  
Vaccinated:2020-12-17
Onset:2020-12-17
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2020-12-18
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH EH9899 / UNK RA / IM

Administered by: Work       Purchased by: ?
Symptoms: Chills, Feeling jittery, Lacrimation increased, Malaise, Ocular hyperaemia, Pain, Photophobia, Vision blurred
SMQs:, Anaphylactic reaction (broad), Anticholinergic syndrome (broad), Noninfectious meningitis (narrow), Glaucoma (broad), Lens disorders (broad), Corneal disorders (broad), Retinal disorders (broad), Lacrimal disorders (narrow), 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: Benicar. Allegra. Estrogen Hormone Cream
Current Illness: COVID 19 November 2020
Preexisting Conditions: HTN. Asthma. Interstitial cystitis. Gastritis
Allergies: Norco. Tofranil. Danocrine
Diagnostic Lab Data: N/A
CDC Split Type:

Write-up: Patient reports 1 hour post vaccination symptoms: jittery, feeling lousy. 12/18/20 Am reported bodyaches, red/watery eyes, chills, and blurred vision. States she can see better in dark than in bright lights. Previously hx of COVID 19 illness November 2020. Took Tylenol and Allegra 12/18/20. Reports improvement in symptoms 12/18/20 12:40pm but continues to report mild blurred vision. Advised to seek immediate medical care if condition not improved or worsens.


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