I realized that the PDF engines of modern desktop browsers (PDFium and PDF.js) support JavaScript with enough I/O primitives to make a basic game like Tetris.
It was a bit tricky to find a union of features that work in both engines, but in the end it turns out that showing/hiding annotation "fields" works well to make monochrome pixels, and keyboard input can be achieved by typing in a text input box.
All in all it's quite janky but a nice reminder of how general purpose PDF scripting can be. The linked PDF is all ASCII so you can just open it in a text editor, or have a look at the source code here: https://github.com/ThomasRinsma/pdftris/blob/main/gengrid.py
Despite what people say in the comments here, both browsers really do not let you execute PDF JavaScript willy nilly. Outside of browser environments you are mostly safe anyway because JavaScript is rarely supported, with the big exception being Acrobat. The cleverness of pdftris is not so much Tetris in PDF but how it found its way around the restrictions that browser environments have put up to protect us.
From what I understand pdftris also only works because of user interaction. I think there is no way to run JavaScript in a PDF without user interaction.
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