The purpose of this study was to determine the incidence, risk factors, and significance of adverse symptoms occurring in pilots more than 24 hours after completion of flight simulator training. This continued occurrence or recurrence of symptoms is termed by the author as “Long Term Simulator Aftereffects” (LTSA). Information was gathered by multi-part, anonymous, and voluntary questionnaire. Nine (4.6%) of 196 pilots studied reported LTSA. Several pilots reported symptoms up to one week and one three weeks post simulator training. Symptoms reported included: recurrent visual flashbacks, continued disturbance in balance, difficulties in concentrating and hand-eye discoordination. Three pilots (1.5%) reported difficulties in flying aircraft. There was no statistically significant association between LTSA and: total flight time, total simulator time, length of simulator training, self-determined motion sickness susceptibility, and sex. Simulator training can result in the occurrence of long term (1 day) adverse symptoms which poses flight safety concerns.