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

This is VAERS ID 1290426

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Case Details

VAERS ID: 1290426 (history)  
Form: Version 2.0  
Age: 17.0  
Sex: Male  
Location: Utah  
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-05-05
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Activated partial thromboplastin time, Angiogram cerebral abnormal, Anticoagulant therapy, Arteriogram carotid abnormal, Blood fibrinogen, Body temperature increased, C-reactive protein normal, Computerised tomogram abnormal, Computerised tomogram head abnormal, Computerised tomogram neck, Deep vein thrombosis, Epstein-Barr virus antibody, Full blood count, Gene mutation identification test, Headache, Influenza A virus test, Influenza virus test, Intensive care, International normalised ratio normal, Localised oedema, Lymphadenitis bacterial, Malaise, Metabolic function test, Neck pain, Prothrombin time normal, SARS-CoV-2 test negative, Scan with contrast, Thrombophlebitis, Transverse sinus thrombosis
SMQs:, Angioedema (broad), Neuroleptic malignant syndrome (broad), Embolic and thrombotic events, arterial (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (narrow), Extravasation events (injections, infusions and implants) (broad), Haemodynamic oedema, effusions and fluid overload (narrow), Central nervous system vascular disorders, not specified as haemorrhagic or ischaemic (narrow), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad), Hypersensitivity (broad), Arthritis (broad), Drug reaction with eosinophilia and systemic symptoms syndrome (broad), COVID-19 (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? Yes, ? days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lexapro, Gabapentin
Current Illness: Previously healthy
Preexisting Conditions: Previously healthy
Allergies: NKDA
Diagnostic Lab Data: CT Head and Neck - 4/26: Significant diffuse right-sided deep spatial neck edema. Right-sided adenopathy is present and there is a right level 2 1.8 cm suppurative lymph node or abscess. CTA Head and Neck - 5/4: 1. Deep venous thrombosis involving the left internal jugular vein from the skull base to approximately the level of the hyoid bone. Of note CT of the brain performed the same day shows extension of this thrombus into the transverse sinus. 2. Suppurative lymphadenopathy in the right side of the neck. This was present on the previous study and has decreased slightly in size. 3. No evidence of embolic disease in the visualized portions of the lungs on today?s study. CBC, BMP, PTT, PT, INR, CRP, covid-19, RSV and influenza A+B PCR, EBV Ab, Fibrinogen, Factor V liden, Prothrombin 20210 G/A mutation Neurology Consult Hematology Consult Admitted to ICU
CDC Split Type:

Write-up: 17-year-old male who presents with 8 days of headache. He received his first dose of the Pfizer vaccine on 4/21. He felt like he had the flu after getting the vaccine and developed right-sided neck pain and a temperature to 100. The patient did endorse being elbowed in the neck playing basketball during this time as well, as he played in a basketball tournament in right after this. He got his Covid vaccine in his right deltoid. He saw his pediatrician on 4/26 and a CT scan of his neck with IV contrast was done and this showed significant diffuse right-sided deep spatial neck edema and right-sided adenopathy. The pediatrician discussed the findings with ENT who recommended augmentin and a medrol dosepak. The patient developed a headache several days after this and went to urgent care for evaluation. There was concern that the augmentin and steroids had caused the headache, so the steroids were stopped and he was switched to keflex on 4/30. He was given phenergan and toradol at Urgent Care and discharged home. His mom notes that several days ago he had fevers of 101-104. He has not had a fever for several days now. His headache continued and he felt unwell at basketball practice so he returned to urgent care on 5/4. A CT scan of his head was done which showed right sigmoid and transverse sinus thrombosis as well as thrombophlebitis of the right IJ. He was sent to ED for further management at that time. In the ED, the patient was hemodynamically stable and well-appearing. The CTs were overread by our radiologists here. The patient had some labs done at the outside urgent care but PT/PTT/INR and a CRP were drawn here, which were unremarkable. A Covid PCR is negative. Neurosurgery, neurology, and hematology were consulted. Neurology recommended heparin and a hypercoagulable workup and hematology agreed with this plan. The patient was admitted to the ICU for neuro checks and monitoring during initiation of heparin.

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