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From the 9/10/2021 release of VAERS data:

This is VAERS ID 1394950

Case Details

VAERS ID: 1394950 (history)  
Form: Version 2.0  
Age: 51.0  
Sex: Female  
Location: Washington  
   Days after vaccination:26
Submitted: 0000-00-00
Entered: 2021-06-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Anticoagulant therapy, Blood test, Cerebral venous thrombosis, Computerised tomogram head abnormal, Headache, Intensive care, Nausea, Vertigo, Vomiting
SMQs:, Acute pancreatitis (broad), Ischaemic central nervous system vascular conditions (narrow), Embolic and thrombotic events, venous (narrow), Thrombophlebitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (narrow), Vestibular disorders (narrow)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 3 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: norethindrone-ethinyl estradiol 1-20 MG-MCG per tablet
Current Illness: NA
Preexisting Conditions: NA
Allergies: NA
Diagnostic Lab Data: CT scan on June 9 and June 9 Numerous blood tests June 8, 9, 10, and 11
CDC Split Type:

Write-up: On Tuesday, June 8 I was diagnosed through a CT scan with Cerebral Venous Thrombosis. I was sent to the ICU where I stayed for 3 days and luckily never had a stroke. I am now on blood thinners and seem to be recovering fully. i was initially thinking this was oral contraceptive related, but having been on the pill for 6 years with no adverse results, wonder if the Moderna vaccine or a combination of the vaccine and the oral contraceptive, caused it. I would like my info to help outcomes for others as this was one of the most frightening weeks of my life. I had headaches, 1 incident of vomiting , nausea and vertigo before heading to urgent care, where I was diagnosed.

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