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

This is VAERS ID 1415874



Case Details

VAERS ID: 1415874 (history)  
Form: Version 2.0  
Age:   
Sex: Male  
Location: Foreign  
Vaccinated:2021-05-23
Onset:2021-06-04
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-06-21
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 2 - / -

Administered by: Other       Purchased by: ?
Symptoms: SARS-CoV-2 test, Thrombosis
SMQs:, Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Thrombophlebitis (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:
Current Illness:
Preexisting Conditions: Medical History/Concurrent Conditions: Surgery (Blood clot in the left side of his brain, surgery was done.)
Allergies:
Diagnostic Lab Data: Test Name: COVID-19 virus test; Test Result: Negative
CDC Split Type: GBPFIZER INC2021657891

Write-up: Clot blood; This is a spontaneous report from a contactable consumer received from the regulatory authority. The regulatory authority report number is GB-MHRA-WEBCOVID-202106051110087220-NMRJT. Safety Report Unique Identifier GB-MHRA-ADR 25426106. A male patient of an unspecified age received BNT162B2 (PFIZER-BIONTECH COVID-19 VACCINE), dose 2 via an unspecified route of administration on 23May2021 (Batch/Lot number was not reported) as SINGLE DOSE for COVID-19 immunization. Medical history included, surgery from an unknown date and unknown if ongoing, Blood clot in the left side of his brain, surgery was done. The patient''s concomitant medications were not reported. The patient experienced clot blood (thrombosis) (hospitalization) on 04Jun2021 with outcome of recovering. The patient underwent lab test included COVID-19 virus test: negative on an unspecified date. Additional Information: Blood clot in the left side of his brain, surgery was done, all his vital signs were normal, patient in ICU, doctor asking information like they don''t have clear the what causes the problem. Patient has not tested positive for COVID-19 since having the vaccine. Patient has not had symptoms associated with COVID-19. Patient is not enrolled in clinical trial. No follow-up attempts are possible; information about lot/batch number cannot be obtained. No further information is expected.


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