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This is VAERS ID 69684

(NOTE: This result is from the 7/7/2013 version of the VAERS database)

Case Details

VAERS ID: 69684 (history)  
Form: Version .0  
Age: 73.8  
Sex: Male  
Location: Pennsylvania  
Vaccinated:1994-10-12
Onset:1994-10-30
   Days after vaccination:18
Submitted: 1994-12-09
   Days after onset:40
Entered: 1994-12-19
   Days after submission:10
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / - LA / -

Administered by: Private       Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal
SMQs:, Anticholinergic syndrome (broad), Ischaemic cerebrovascular conditions (narrow), Haemorrhagic cerebrovascular conditions (narrow), Embolic and thrombotic events, vessel type unspecified and mixed arterial and venous (narrow), Guillain-Barre syndrome (broad), Noninfectious encephalitis (broad), Noninfectious encephalopathy/delirium (broad), Noninfectious meningitis (broad), Gastrointestinal nonspecific symptoms and therapeutic procedures (broad), Conditions associated with central nervous system haemorrhages and cerebrovascular accidents (broad)

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit? No
ER Visit? No
ER or Doctor Visit? No
Hospitalized? Yes, 14 days
   Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;
Other Medications: Micconas; Procardia
Current Illness: HBP type II Dm (old, no new disease)
Preexisting Conditions: HBP-CVA rt hemiparesis; type II DM
Allergies:
Diagnostic Lab Data: MRI: multifocal ischaemic disease involving matter basal ganglia;
CDC Split Type:

Write-up: acute CVA, lt hemiparesis; dysphagia post; pt had flu vax 12OCT94; CVA-30OCT94; pt has hx of CVA w/ rt hemiparesis on 13OCT93; 2 wkd prior to CVA in 1993 pt had a flu shot;


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