Al Simmons ends his life by blasting his head off. Just when he dies Jim Downing awakes from a coma in a hospital with no memory of who or where he is. As he tries to scream for help his life-supporting machines send a signal to the nurse Sara who then looks after him. This is a miracle for her, as she always prayed to God that he would awake one day, and the entire hospital crew so he immediately gets medical attention but is referenced to as "Patient 47". He passes his medical tests just perfect, the only unusual thing about him is that no one at the hospital knows anything about him because his file is missing. Only he seems to know that something is wrong when he starts seeing Hellspawns in his room that no else can see while his doctors believe they have stumbled upon a medical miracle because he is regenerating at an abnormally fast pace.
Understandably, they want to profit from Jim´s situation to make a name of themselves. Unfortunately, the conversation between the doctors is overheard by a caretaker who is supposed to report to an attorney about Jim´s condition. This particular attorney goes bananas when he hears that Jim is already awake for several hours because the caretaker actually had to report immediate changes in Jim´s state of health. When the caretaker threatens the attorney to sell this story to the newspapers, the attorney in return threatens the caretaker´s family and suggests that he should better leave town when he wants to live. Then the attorney has to report to somebody else. After the conversation is over he commits suicide. In the meantime, the Violator discovers the dead body of Al Simmons and goes on a search for the new Spawn.
While Jim is talking to Sara the Extractor attacks the both. Jim tells Sara to run outside if they get separated but as she tries to escape she gets stopped by a mysterious man who tells her to fall asleep and to forget all of this. In the meantime Jim tries to escape his follower who accidently sets of some oxygen tanks in the hospital because of his flaming skull. Firefighters arrive at the scene and are evacuating the hospital whereas the Extractor realizes that he can´t touch Jim without burning his own flesh. As Jim has no chance to flee from him he transforms into the new Spawn and kills the Extractor. With his last efforts Jim manages to escape the burning hospital. The firefighters managed to rescue Sara who was found unconscious on the floor.
Jim gets medical attention and is transferred to another hospital. On the way he touches a dying man who later is healed from his severe illness. At the hospital, he has to share his room with others while there. In the night he can´t control his powers and screams in agony but manages to stop just before the nurses show up. The next day he is again transferred to another hospital where is examined and proclaimed healthy. There he meets Sara again and she allows him to stay with her so that he can leave the hospital. But in the night he transforms into Spawn again and flees from Sara´s apartment. He then explores his new powers and runs into a gang war. As he is shot by both sides he uses his powers to brutally kill all members of both gangs. In the meantime, Sara prays to God that Jim comes home again and when he finally shows up she admits that she was worried sick.
Marc Rosen, who examines the weird hospital case, becomes interested in Jim after he talked to the man Jim healed, although he does not know that it is Jim at this point. So he starts asking further questions and finds out that there are even more patients that were entirely healed, all people Jim shared his room with when he was at the hospital.
At Sara´s apartment Jim gets really angry because he has no memories of the past and leaves her again. While wandering the streets, he meets Wanda Blake, who recognizes him as the man who once fainted in front of her house (Spawn # 3), Sara is visited by a man who is in search of Jim Downing. Wanda sees that Jim is a Hellspawn and sends him to Al´s throne where he meets an angel. While fighting her he gets a call from Sara who obviously is in danger. He thinks that the angel has sent someone to hurt her so he beats her up and flocks her to a wall to talk to her later. At Sara´s apartment he finds the man who is in search of him and makes his point to him clear that he will kill everybody who is after him or Sara.
Sara is relieved when she sees Jim but gets a little bit jealous when he says that he has to leave again to meet another woman (he means the angel). Unfortunately, the Violator has found the angel, tortures her and eventually removes her wings. By this all sanity is taken away from her. When Jim arrives and realizes that he will not get any answers he becomes very desperate just until the Violator shows up who wants to help Jim because he claims to know a lot of him. To get some answers Jim goes on a killing spree and finally meets a guy who could deliver some answers, but before they can get to business the house is blown up.
Marc Rosen has tracked down Sara as one of the possible informants for his story about the health miracles and eventually meets Jim who returns home and gets slapped by Sara for being absent without an explanation. For the interview, Sara invited a friend named Judy but after the quarrel between Jim and Sara, Marc suggests to leave the two alone. Judy leaves first with Sara´s jacket and is so wrongly accused of being Sara and gets kidnapped. This is witnessed by Marc who returns to Sara´s apartment to call the cops. Jim realizes the immediate danger and leaves to save Judy by transforming into Spawn. After saving her he wants a name from the attacker who survived but kills him after he got an answer.
After everything cooled down Marc realizes that he is cured from his severe cough and is finally aware that Jim has to be the one who can cure people from their illnesses. In the meantime, Jim explores his past by trying to find answers. In the course of the events he kills more people but eventually accepts his new role.
Later on in the story, it was revealed that Jim used to be an angel, who tried to assassinate God. And for his treachery, God banished him.