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From the 11/19/2021 release of VAERS data:

This is VAERS ID 1783203

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Case Details

VAERS ID: 1783203 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Female  
Location: Kansas  
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Magnetic resonance imaging, Transient global amnesia

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? Yes, 1 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Calcium, magnesium, multivitamin, CoQ10, Vit D, Vit B12
Current Illness:
Preexisting Conditions: Osteoarthritis
Diagnostic Lab Data: 10/9/2021 CT scan Multiple blood tests 10/10/2021 MRI
CDC Split Type:

Write-up: Transient Global Amnesia

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