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

This is VAERS ID 1233515



Case Details

VAERS ID: 1233515 (history)  
Form: Version 2.0  
Age: 76.0  
Sex: Male  
Location: New York  
Vaccinated:2021-04-10
Onset:2021-04-11
   Days after vaccination:1
Submitted: 0000-00-00
Entered: 2021-04-20
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 RA / IM

Administered by: Pharmacy       Purchased by: ?
Symptoms: Chills, Seizure
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? No
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 8 days
   Extended hospital stay? No
Previous Vaccinations:
Other Medications: Lisinopril 5mg Levetiracetam 75mgx4 Amlodipine 10g Gabapentin 600 mg Folic Acid 1mg Hydralazine 25mgx2 omeprazole 20mg Calcium 600-200 Thiamine 100mg OTC : Vitamin C 1000mg
Current Illness: no issues at time of vaccine
Preexisting Conditions: High Blood pressure pre diabetic seizure disorder high cholesterol
Allergies: nka
Diagnostic Lab Data: UNKOWN
CDC Split Type:

Write-up: Patient starting feeling chills on Sunday, patient stayed home then had a seizure 4-12-21. They were admitted to the hospital on the evening/ night of 4-12-21 . Still in hospital as of 4-20-21.


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https://medalerts.org/vaersdb/findfield.php?IDNUMBER=1233515


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