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

This is VAERS ID 1185909



Case Details

VAERS ID: 1185909 (history)  
Form: Version 2.0  
Age: 39.0  
Sex: Female  
Location: Unknown  
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 042A21A / 1 RA / IM

Administered by: Unknown       Purchased by: ?
Symptoms: Seizure, Syncope
SMQs:, Torsade de pointes/QT prolongation (broad), Systemic lupus erythematosus (broad), Arrhythmia related investigations, signs and symptoms (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Cardiomyopathy (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? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness: NO
Preexisting Conditions: NO
Allergies: PCN
Diagnostic Lab Data:
CDC Split Type:

Write-up: PATIENT FAINTED AND HAD A 20SEC SEIZURE SEVERAL MINUTES AFTER RECIEVING VACCINE. PATIENT HAD EXTREME ANXIETY ABOUT BEING VACCINATED BEFORE HAND AS WELL AS HAD NOT EATEN DAY OF. PATIENT SYMPTOMS SUBSIDED AND HSOPITLIZATION WAS NOT REQUIRED.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1185909


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