An 18-year-old boy was brought to the emergency with complaints of headache and recurrent vomiting for five days. His attendants also gave a history of excessive drowsiness for the last two days. He had no significant past medical or surgical history. There was a history of vaccination (Covishield, 1st dose) 17 days before the presentation. Clinically, he was afebrile, had a pulse rate of 80 bpm, and blood pressure 120/76 mm of Hg. He was drowsy but arousable. He was producing incomprehensible sounds and was able to localize the pain. He had gaze preference to the left side. Extensor plantar response was noted on the right side. An urgent computed tomography (CT) imaging of the head showed hyperdense lesions involving the left parieto-temporal region suggestive of intracerebral hemorrhage (Fig. 1 a). The patient was treated with mannitol, dexamethasone, phenytoin, and supportive care. His routine evaluation showed, hemoglobin 13.1 g/dL, WBC 17,250/cmm and platelet 85,000/cmm. His creatinine was 0.6 mg/dL and AST and ALT were 107 and 166U/L respectively. Coagulation parameters (PT, aPTT and fibrinogen) were normal with elevated D-dimer (8334.8 ng/mL). During the next 12-h, his neurological status continued to deteriorate and for airway protection, he was electively intubated. Because of progression on anti-edema measures and history of vaccination, and thrombocytopenia, clinical diagnosis of vaccine-induced thrombosis and thrombocytopenia (VITT) was considered. The patient was taken out for a computed tomography (CT) venography head and contrast enhanced CT (CECT) chest and abdomen. The venography images showed a filling defect in the superior sagittal sinus, andbilateral sigmoid sinuses (right [left)(Fig. 1 b). The CECT abdomen images showed a filling defect in the portal vein (Fig. 1 c). The Gel card test for Anti-PF4/heparin complex antibody was positive and the heparin-induced platelet aggregationbased functional assay for HIT antibodies was confirmative of the presence of heparin dependent platelet aggregation (Figure-1d-e). Following these results, the diagnosis was confirmed as VITT, and fondaparinux was started. However, the patient’s general condition continued to deteriorate, and he succumbed to his illness on day seven of hospitalization.