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Acute COVID-19 infection typically results in mild disease in children, but can lead to several immune manifestations. One such severe manifestation is immune-mediated thrombotic thrombocytopenia (iTTP). It is exceedingly rare in children, and only a few cases have been reported worldwide. We report a case of severe iTTP in a 17-year-old girl. She was positive for COVID-19 infection by reverse-transcription polymerase chain reaction at presentation and had received a Covaxin injection two weeks earlier. She responded to therapeutic plasma exchange, corticosteroids, and rituximab. Early recognition of this complication and prompt initiation of therapeutic plasma exchange and corticosteroids is paramount to achieving a good outcome in this rare, life-threatening complication.