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From the 11/12/2021 release of VAERS data:

This is VAERS ID 1694990

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Case Details

VAERS ID: 1694990 (history)  
Form: Version 2.0  
Age: 62.0  
Sex: Male  
Location: Georgia  
Vaccinated:2021-05-11
Onset:2021-09-12
   Days after vaccination:124
Submitted: 0000-00-00
Entered: 2021-09-13
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
COVID19: COVID19 (COVID19 (JANSSEN)) / JANSSEN 205A21A / 1 LA / -

Administered by: Private       Purchased by: ?
Symptoms: Blood test, Computerised tomogram, Electroencephalogram, Loss of consciousness, Lumbar puncture, Magnetic resonance imaging, Neurological examination, Positron emission tomogram, Seizure, Single photon emission computerised tomogram
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), 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? Yes
Hospitalized? No
Previous Vaccinations:
Other Medications: none
Current Illness: none
Preexisting Conditions: none
Allergies: none
Diagnostic Lab Data: All tests on May 11, 2021- Neurological exam Blood tests Lumbar puncture EEG, MRI, CT scan, PET, SPECT
CDC Split Type:

Write-up: Seizures and loss of consciousness


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