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From the 6/4/2021 release of VAERS data:

This is VAERS ID 1185450



Case Details

VAERS ID: 1185450 (history)  
Form: Version 2.0  
Age: 28.0  
Sex: Female  
Location: Illinois  
Vaccinated:2021-04-09
Onset:2021-04-09
   Days after vaccination:0
Submitted: 0000-00-00
Entered: 2021-04-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 201A21A / 1 LA / IM

Administered by: Private       Purchased by: ?
Symptoms: Fall, Seizure
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Accidents and injuries (narrow), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? No
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: Depakote, ativan, valtrex
Current Illness: "anxiety seizures"
Preexisting Conditions: N/A
Allergies: neosporin, sunscreen
Diagnostic Lab Data:
CDC Split Type:

Write-up: Patient with previous hx of seizure disorder started convulsing within 10 minutes of vaccination, fell to the ground and convulsed for approximately 7 minutes. Convulsions reduced significantly and patient was coherent without post-ictal state. EMS was called and she was taken to nearby hospital for further evaluation. Patient had reportedly taken ativan and depakote this morning prior to arrival.


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