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This is VAERS ID 69684

History of Changes from the VAERS Wayback Machine

Already in VAERS on 12/31/2003

VAERS ID: 69684
VAERS Form:
Age:73.8
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-23
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1994-1995 / PARKE-DAVIS 00374P / - LA / -

Administered by: Private      Purchased by: Unknown
Symptoms: HEMIPLEGIA, LAB TEST ABNORM, DYSPHAGIA, INFARCT CEREBR, CEREBROVASC ACCID

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     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': HBP-CVA rt hemiparesis; type II DM

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;


Changed on 12/8/2009

VAERS ID: 69684 Before After
VAERS Form:
Age:73.8
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-23 1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: FLUOGEN 1994-1995 INFLUENZA (SEASONAL) (FLUOGEN 94-95) / PARKE-DAVIS 00374P / - LA / -

Administered by: Private      Purchased by: Unknown Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal, HEMIPLEGIA, LAB TEST ABNORM, DYSPHAGIA, INFARCT CEREBR, CEREBROVASC ACCID

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     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': HBP-CVA rt hemiparesis; type II DM (blank)

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;


Changed on 8/31/2010

VAERS ID: 69684 Before After
VAERS Form:
Age:73.8
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN 94-95) INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     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;


Changed on 7/7/2013

VAERS ID: 69684 Before After
VAERS Form:
Age:73.8
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / - LA / -
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / - LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     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;


Changed on 2/14/2017

VAERS ID: 69684 Before After
VAERS Form:
Age:73.8 73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     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;


Changed on 5/14/2017

VAERS ID: 69684 Before After
VAERS Form:
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
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

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot; shot;~ ()~~~In patient
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;


Changed on 9/14/2017

VAERS ID: 69684 Before After
VAERS Form:(blank) 1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / - UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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;


Changed on 2/14/2018

VAERS ID: 69684 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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;


Changed on 6/14/2018

VAERS ID: 69684 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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;


Changed on 8/14/2018

VAERS ID: 69684 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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;


Changed on 9/14/2018

VAERS ID: 69684 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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;


Changed on 10/14/2018

VAERS ID: 69684 Before After
VAERS Form:1
Age:73.0
Sex:Male
Location:Pennsylvania
Vaccinated:1994-10-12
Onset:1994-10-30
Submitted:1994-12-09
Entered:1994-12-19
Vaccin­ation / Manu­facturer Lot / Dose Site / Route
FLU3: INFLUENZA (SEASONAL) (FLUOGEN) / PARKE-DAVIS 00374P / UNK LA / -

Administered by: Private      Purchased by: Private
Symptoms: Cerebral infarction, Cerebrovascular accident, Dysphagia, Hemiplegia, Laboratory test abnormal

Life Threatening? Yes
Birth Defect? No
Died? No
Permanent Disability? Yes
Recovered? No
Office Visit (V2.0)? No
ER or Office Visit (V1.0)? No
ER or ED Visit (V2.0)? No
Hospitalized? Yes, days: 14     Extended hospital stay? No
Previous Vaccinations: pt exp rt hemiparesis @A 72 y/o flu shot;~ ()~~~In patient
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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