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The Sentinel Distributed Database (SDD) is a large database of patient-level medical and prescription records, primarily derived from insurance claims and electronic health records, and is sponsored by the U.S. Food and Drug Administration for drug safety assessments. In this chart validation study, the authors report on the positive predictive value (PPV) of inpatient International Classification of Diseases, Ninth Edition, Clinical Modification (ICD-9-CM) codes for acute ischemic stroke (AIS) and administrative diagnosis codes (433.x1, 434.xx, and 436) in the SDD.