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This is VAERS ID 266376

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History of Changes from the VAERS Wayback Machine

First Appeared on 12/30/2006

VAERS ID: 266376
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (UNKNOWN MFR) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER VACCINE LIVE (OKA/MERCK) (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk facto"rs were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years


Changed on 12/8/2009

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (UNKNOWN MFR) INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER VACCINE LIVE (OKA/MERCK) (ZOSTAVAX) ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk facto"rs factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 7/31/2010

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 1/4/2011

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 4/13/2011

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 5/13/2011

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 6/11/2011

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 7/7/2013

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 12/14/2016

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 5/14/2017

VAERS ID: 266376 Before After
VAERS Form:
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Chest X-ray normal, Computerised tomogram abnormal, Disturbance in attention, Electroencephalogram abnormal, Facial palsy, Mental impairment, Nuclear magnetic resonance imaging brain abnormal, Speech disorder, Carotid artery occlusion, Carotid artery dissection, Cognitive disorder, Hyperlipidaemia

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 9/14/2017

VAERS ID: 266376 Before After
VAERS Form:(blank) 1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / - UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / - UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 2/14/2018

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 6/14/2018

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 8/14/2018

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 9/14/2018

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 10/14/2018

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 8/14/2019

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER (ZOSTAVAX) ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 12/10/2020

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Unknown Pennsylvania
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 12/24/2020

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Pennsylvania
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 12/30/2020

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Pennsylvania
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 5/7/2021

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Pennsylvania
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.


Changed on 5/21/2021

VAERS ID: 266376 Before After
VAERS Form:1
Age:60.0
Sex:Male
Location:Pennsylvania
Vaccinated:0000-00-00
Onset:2006-11-05
Submitted:2006-11-06
Entered:2006-11-09
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLUX: INFLUENZA (SEASONAL) (NO BRAND NAME) / UNKNOWN MANUFACTURER - / UNK UN / -
VARZOS: ZOSTER LIVE (ZOSTAVAX) / MERCK & CO. INC. - / UNK UN / -

Administered by: Unknown      Purchased by: Unknown
Symptoms: Cerebrovascular accident, Nuclear magnetic resonance imaging brain abnormal, Carotid artery occlusion

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? No
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? Yes
ER or ED Visit (V2.0)? No
Hospitalized? No
Previous Vaccinations:
Other Medications:
Current Illness:
Preexisting Conditions: No hypertension, no diabetes no comorbidities except for hyperlipidemia well controlled with statin Zocor therapy for years.
Allergies:
Diagnostic Lab Data: Normal lab. Normal vital signs. MRA/MRI findings above for complete R internal carotid artery occlusion involving an MCA stroke. CXR: Normal, MRA of brain acute infarct in the distribution of right middle cerebral artery. MRA of carotids impaired flow in right internal carotid artery. Repeat MRA showed improved flow. CT cineangiography showed dissection of right middle cerebral artery with intact blood flow. EEG abnormal slow activity on right. Sylvian area is consistent with recent right middle cerebral artery distribution stroke.
CDC 'Split Type':

Write-up: This pt my brother received Zostavax and a flu vaccine on the same visit approx 7-10 days prior to developing a stroke. The stroke by MRI MRA was a complete occlusion of his R internal carotid artery with the MCA arterial distribution affected. Risk factors were hyperlipidemia but this was well controlled with statin Zocor 40 for years. No hypertension. No diabetes. Healthy life style, occasional daily cocktail, non smoker ever. Only prior medical history otherwise was a urethral stone two or three years ago. 02/27/07-records received and reviewed for DOS 11/5-11/8/06 DC DX: cerebrovascular accident secondary to carotid dissection on the right side. hyperlipidemia. Admitted with left sided facial droopiness. He had a right internal carotid artery dissection is hole. He still has cognitive impairment (mild), R facial droop. He wil never be able to believe Per 60 day follow up: Pt had a right internal carotid artery dissection. He had a large R MCA stroke. He has regained most use of left hand. He still has a large left lip droop. He has difficulty with speech, of math calculations and difficulty concentrating.

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