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From the 4/30/2021 release of VAERS data:

This is VAERS ID 1137019



Case Details

VAERS ID: 1137019 (history)  
Form: Version 2.0  
Age: 22.0  
Sex: Male  
Location: New York  
Vaccinated:2021-03-26
Onset:2021-03-26
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-26
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1805025 / 1 LA / IM

Administered by: Work       Purchased by: ?
Symptoms: Loss of consciousness, Seizure, Tonic clonic movements
SMQs:, Torsade de pointes/QT prolongation (broad), Hyperglycaemia/new onset diabetes mellitus (broad), Neuroleptic malignant syndrome (broad), Systemic lupus erythematosus (broad), Anticholinergic syndrome (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Hypotonic-hyporesponsive episode (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? Yes
Office Visit? Yes
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: Keppra
Current Illness:
Preexisting Conditions:
Allergies:
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient passed out and began seizing within 5 minutes of vaccine administration sitting down on chair. Tonic, clonic motions for 5 seconds. No foaming at the mouth. Patient was taken off chair, held on the ground until seizure ended. Patient gained consciousness after a minute. Given water, snacks, air and EMS was called. EMS assessed situation, and allowed patient''s girlfriend to pick him up from site and drive back home.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1137019


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