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From the 5/7/2021 release of VAERS data:

This is VAERS ID 1147830



Case Details

VAERS ID: 1147830 (history)  
Form: Version 2.0  
Age: 31.0  
Sex: Male  
Location: California  
Vaccinated:2021-03-30
Onset:2021-03-30
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-03-30
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (UNKNOWN)) / UNKNOWN MANUFACTURER 1805025 / N/A LA / IM

Administered by: Other       Purchased by: ?
Symptoms: Condition aggravated, Fall, Loss of consciousness, Seizure
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), Accidents and injuries (narrow), 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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications: N/A
Current Illness: N/A
Preexisting Conditions: Hx of. Seizure
Allergies: N/A
Diagnostic Lab Data: N/a
CDC Split Type:

Write-up: At approximately 1238 patient was noted to be on floor, experienced fall from chair. 911 called. came to patient. Pt placed in recumbent position. noted to be having seizure regained consciousness. Airway not obstructed no s/s if respiratory destress noted. Regain consciousness after 2 seconds. Vs bp130/82, O298% on RA, HR 72, RR 28. Denies pain or discomfort. Pt alert and oriented able to state his name date location. Mae x34 l neurologically intact. did not give Epi . No s/s of anaphylaxis noted. please patient and become a position. Ambulance and fire department on site at this time.


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