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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  
Vaccinated:2021-09-27
Onset:2021-10-09
   Days after vaccination:12
Submitted: 0000-00-00
Entered: 2021-10-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (PFIZER-BIONTECH)) / PFIZER/BIONTECH - / 3 - / -

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

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
Allergies:
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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