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

This is VAERS ID 1231130

Case Details

VAERS ID: 1231130 (history)  
Form: Version 2.0  
Age: 77.0  
Sex: Male  
Location: Michigan  
   Days after vaccination:19
Submitted: 0000-00-00
Entered: 2021-04-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 1808609 / 1 AR / IM

Administered by: Private       Purchased by: ?
Symptoms: Computerised tomogram head abnormal, Echocardiogram normal, Electroencephalogram normal, Generalised tonic-clonic seizure, Laboratory test normal, Magnetic resonance imaging head normal, Scan with contrast, Ultrasound scan normal
SMQs:, Systemic lupus erythematosus (broad), Convulsions (narrow), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Generalised convulsive seizures following immunisation (narrow), Hypoglycaemia (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 9 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Losartan/Hctz, Lovastatin, Flomax, Prilosec, COq10, magnesium, zinc, D3, B12, aspirin 81mg, Flonase, MVI, Vit C
Current Illness: None
Preexisting Conditions: Elevated BP, controlled w/medication -- High cholesterol, treated with medication
Allergies: Shrimp
Diagnostic Lab Data: CT head w/contrast, MRI brain, EEG, echocardiogram, ultrasound of carotids, specific lab tests unknown. All tests were negative. All tests done between 4/11/21 and 4/19/21
CDC Split Type:

Write-up: Grand mal seizure while visiting daughter, length of duration unknown.

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