Age: 42.0
Sex: M
Vaccine: LYME
Symptoms: Testicular disorder, Visual disturbance
Clinical narrative: The pt received an injection of Lymerix (lot LY120F9) on 7/16/99. He presented to his physician on 4/2/00 with "paresthesias, numbness and weakness in both legs and right arm for the past several weeks. Also with numbness to right side of chest. Symptoms are worsening". The MD noted that there was "some injury to L-S during the 1989 MVA". The pt was referred to a neurologist. The pt was seen by the neurologist on 4/18/00. He presented with "numbness and tingling in bilateral lower extremities and right upper extremity for 5 weeks. Symptoms started as numbness in right leg, starting on ankle and going around to back of calf and ending in right knee posteriorly. Same symptoms started in left leg. Right and left knees started giving out and pt would lose his balance. Positive warmth or heat in right arm. Right flank numbness that spreads to anterior chest affecting right nipple. Had one episode, 2 weeks ago, where he was in so much pain that he stayed home from work. Right testicle pulled up into abdominal cavity and had right sided weakness at that time." The pt reported that he had headaches and chronic constipation. He reported no change in bladder or erectile function. On physical exam, the MD noted decreased sensation to pain in the C6, C7, C8 and L4 dermatome. The neurologist's assessment was "Sensory neuropathy versus sensory myelitis".   The pt was seen again by the neurologist on 5/2/00. He planned MRI and to consider infectious disease consult and also to consider psych consult. The pt returned to the neurologist on 5/23/00 and his assessment was "Myelitis/MS (multiple sclerosis). He also noted the possibly of an "underlying psych disorder".    The vaccinee presented to a new primary care physician on 6/8/00 with chief complaints of myalgia, arthralgia, and cephalgia. On 6/12/00, polymerase chaine reaction (PCR) analysis for Lyme disease was negative. On 13 June 2000, R. ricketsii IgG and IgM were negative. On 7/27/00, the vaccinee was "doing much better." However, based on LUAT results, a diagnosis of Lyme disease was made.   From January to June of this year his coordination and strength of the lower extremities were getting worse and he was experiencing difficulty focusing with his eyes, halos in night vision in both eyes, his head was dropping and generally he was feeling weak and confused. On 6/9/00, he was started on antibiotics, Ceftin 1000mg a day, due to the possibility of Lyme disease. On 6/16/00, serology was positive for Babesia microti IgM. Currently he is still on 1000mg of Ceftin, 400mg of doxycycline which was added in the first part of 7/00. He stated that his symptoms had gotten a lot better, such as eyes cleared, concentration improved, stiff neck improved and dental caries improved. At the end of August of this year, he started to get worse with greater difficulty in walking and balance. Around the end of 9/00, he started experiencing difficulty with bladder function, namely, inability to evacuate or incomplete evacuation, unable to hold it. He had constipation up until the start of the antibiotics, then became more regular. In the spring of 1991, he had a sudden onset of fever with rash in the left lateral abdomen. Exam showed multiple tick bites. Gait was impaired due to spastic weakness. Impression: Tetraparesis involving left upper extremity and both lower extremities with spinal cord lesion at C5 through T1 with multilevel herniated discs with evidence of spinal stenosis, accompanied by neurogenic bladder. He had (+) Lyme urinary antigen test and abrlichiosis and babesiosis and cervical-thoracic myelopathy of unclear etiology. The neurologist recommended a consult with a spine surgeon. I indicated that he was permanently disabled from the specific job as a tree surgeon at this point in time and recorded his dx as Lyme disease. The vaccinee returned to his primary phsyician on 1/16/01. At that time he reported "less numbness, increased dizziness; has not been able to work. Wants to increase treatment. Wants to discontinue doxy." The phsyician noted "staggering gait." The pt saw another physician on 2/1/01, who noted fasciculations, right-sided tongue numbness and vertigo. On 3/21/01, LUAT was negative on days 2, 3, and 10. ON 3/23/01, the vaccinee telephoned the physician "just to inform you that he is back on the job as of today." On 3/29/01, this physician noted that the pt was being treated with amoxicillin and clarithromycin. He recommended magnesium therapy. On 6/5/01, the MD reviewed Babesia protocol and noted that the pt was being treated with Mepron and Flagyl. He recommended clarithromycin 1000mg X 2 daily and penicillin G benzathine 2.4 million units weekly. On 9/14/01, **PCR analyses were positive for myoplasma and human herpes virus type 6 (variant-B). Serologies for Babesia microtti, chlemydia, cytomegalovirus, Enstein-Barr virus, and herpes simplex virus types 1 & 2 were negative. The primary physician prescribed Valtrex and continued Biaxin.** On 10/10/01, this MD prescribed rifampin 600mg daily and Bactroban and on 1/17/01, noted the pt was "getting better". On 2/11/02, in a Statement of Injuries, the pt's attorney alleged that the pt "suffers from spondyloarthropathy and oligoarthritis post Lymerix, along with radiculopathy and cervical thoracic myelopathy with multiple neurologic and CNS symptoms. The most recent information received on 5/17/02, did not provide the outcomes of the reported events.  *Follow-up report on 8/22/02: Following the reported onset of cervical tharacic myelopathy, the vaccinee experienced a dental abscess, hypercholesterolemia, hypertriglyceridemia, hyperkalesia, increased concentrations of alanine aminotransferase and increased concentrations of aspartate aminotransferase."... The vaccinee presented to a new primary care MD on 6/8/00 w/chief complaints of myalgia, arthralgia, and cephalgia. On 6/12/00, polymerase chain reaction (PCR) analysis for Lyme disease was negative. On 6/13/00, R. rickettaii IgG and IgM were negative. On 6/16/00, serologias for babesiosis, human granulocytic ehrlichiosis (HGE), and human monocytic ehrlichiosis (HME) were positive. On 6/17/00, Lyme IgG and IgM Western blots were neg. Lyme genomic and plasmid PCR analyses in serum and whole blood were negative. On 6/27/00, the MD made diagnoses of HGE, HMe, and babesiosis, and prescribed cefuroxime (Ceftin) and doxycycline. Lyme urine antigen test (LUAT), performed beginning on 6/30/00, was pos. On 7/27/00, the vaccinee was "doing much better." However, based on LUAT results, a Dx of Lyme disease was made"... The most recent information received 5/17/02, did not provide the outcome of the reported events.** Info. received on 2/15/02 indicated that as of 1/17/02, the vaccinee was "getting better". The follow up received on 3/20/03 states the vaccinee was referred to a second neurologist on 11/2/00. At that time, the vaccinee reported that he "was relatively well until January 2000 when he started having numbness in the right foot which later moved up to the knees, thigh, torso, to the mid chest and since April he started having numbness and weakness of the left leg, also numbness of both upper extremities, particularly forearms and hand.s From January to June of this year his coordination and strength of the lower extremities were getting worse and he was experiencing difficulty focusing with his eyes, halos in night vision in both eyes, his head was dropping and generally he was feeling weak and confused. On 6/9/00 he was started on antibiotics, Ceftin 1000mg a day on the basis of possible LYme disease which was diagnosed on the basis of clinical findings including multiple tick bites, skin rashes in the neck and right lateral abdomen and the profession that he is in. On 6/16/00 serology was positive for Babesia microtti IgM in a titre of 1:16 and IgG was negtive with a titre of less than 1:40 but human moocytic ehrlichiosis IgM was positive in the titre of 1:40 and IgG positive at 1:80 and LUAT on 6/30/00 was positive for all three specimens nalely 49, 136, 85 respectively. Currently he is still on 1000mg of Ceftin, 400mg of doxycycline which was added in the first part of July 2000. He expressed that his symptoms have gotten a lot better, such as eyes cleared, concentration improved, stiff neck improved, dental abscess improved. Findings that have not changed include numbness in upper extremities and weakness of lower extremities, balance problems. At the end of August of this year he started to get worse with greater difficulty in walking and balance. Around the end of September of this year he started experiencing difficulty with bladder function, namely inability to evacuate or incomplete evacuation, unable to hold it. For the last two weeks it got somewhat better to the point where he can control it. As far as bowel function goes, he had constipation up until the start of antibiotics, then became more regular. he has never lost control of his bowels. Around August he began to notice soem change in sexual function. Around June or July of this year he started having difficulty using his left hand and fingers. He was bitten numerous times by a tick. In the fall of 1999 he had thick, raised rashes in the left lateral abdomen and many rashes in the back of his neck and most recently as late as last week he was bitten by ticks, one in the right anterior axilla, another over the lateral chest at the eleventh rib, slightly behind the axillary line and one in the right medial thigh, one in themedial scrotum on the right. In retrospect he recalled he always had swollen glands in the neck and also had very large swollen glands in the right groin, abscesses and cuts from the wrok in the spring time of 1991 he had sudden onset of fever with rash in the left lateral abdomen." On physical examination, "Skin reveals tick bite in the upper axilla and right thigh and scrotum. Joints were not swollen. Muscle strength is normal in right upper extremity, particularly distally fingers and hand. Mild weakness is noted in both lower extremities with brisk knee jerks and ankle jerks with a weakly positive Babinski on the left and on the right. Gait was impaired due to spastic weakness. A sensory level was noted at T4-T5 on the right anteriorly and T7-T8 on the left posteriorly, T5 and 6 on the right and T7 and 8 on the left. Impression: 1) Tetraparesis involving left upper extremity and both lower extremities with spinal cord lesion at C5 through T1 with multi level herniated discs involving C3-C4, C4-C5, C5-C6, C6-C7 with evidence of spinal stenosis, accompanied by neurogenic bladder. 2) Positive Lyme urinary antigen test and also positive ehrlichiosis and babesiosis. 3) Status post fracture of the left femur and pelvis as a result of an MVA in August 1989. 4) Cervical-thoracic myelopathy of unclear etiology. It appears that he might have had initial injury from herniated disc pressing on the spinal cord even though myelopathy secondary to Lyme disease and/or MS cannot be ruled out at this point in time." The neurlogist recommended consultation with a spine surgeon, continuation of Ceftin and doxycycline therapy, and addition of Mepron. The neurologist wrote, "I indicated that he was permanently disabled from specific job as a tree surgeon at this point in time." He recorded his diagnosis as "Lyme disease."   The vaccinee returned to his primary physician on 1/16/01. At that time, he reported "Less numbness. Increased dizziness. Hasn't been able to work. Wants to increase treatment. Wants to discontinue doxy." The physician noted "Staggering gait." The vaccinee was seen by another physician on 2/1/01, who noted fasciculations, right-sided tongue numbness, and vertigo. On 3/21/01, LUAT was negative on days 2, 3, and 10. On 3/23/01, the vaccinee telephoned the physician "just to inform you that he is back on the job as of today." On 3/29/01, this physician noted that the vaccinee was being treated with amoxicillin and clarithromycin. He recommended magnesium therapy. On 6/5/01, the physician "reviewed Babesia protocol." He noted that the vaccinee was was being treated with Napron and Flagyl. He recommended Biaxin 1000mg twice daily and penicillin G bonzathine 2.4 million units weekly. On  6/12/01, testing for the HLA-DR4 antigen was negative.   On 9/14/01, PCR analyses were positive for M. fermentans and human herpex virus tyype 6. Serologies for Babesia microtti, Chlemydia, Cytomegalovirus, Epstein-Barr virus, and herpes simplex virus type 1 and 2 were negative. The primary physician prescribed Valtrex and continued Biaxin.   On 10/10/01, the other physician prescribed rifampin 600mg daily and Bactroban. On 1/17/02, the physician oted that the vaccinee was "getting better," and that he was receiving psychotherapy.   On 2/11/02, in a Statement of Injuries, the vaccinee's attorney alleged that the vaccinee "suffers from spondyloarthropathy and oligoarthritis post LYMErix, along with radiculopathy and cervical thoracic myelopathy with multiple neurologic and CNS symptoms." At the request of his attorney, the vaccinee was evaluated by a third neurologist at a tertiary care center on 8/8/02. At that time, he reported that "his neurological problems began in about August 1999. He had previously recieved the LYMErix in June 1999. In the fall of 1999, he developed numbness and tingling in the feet. Within weeks he developed clumsiness of the leg. The symptoms were gradually progressive. Within   six weeks to two months after the onset of symptoms, he sought medical attention. He noted that he was tripping over the tiniest tings. He had falls. He had a heat sensation in his right foot. Later in November or December, he started noting that his knees would give out and he would drop, initially sore to the right side and then bilaterally. He had a sensation as if he had a haridryer on his leg, which would occur intermittently for hours at a time also. He also had shooting pains. Later, he developed double vision with his eyes crossing in the year 2000 and floaters. Within 48 hrs of starting doxycycline and Ceftin, he started having improvement in his visual symptoms, and within weeks, those all resolved except for the floaters. He still occasionally gets a star pattern around his eyes from lights. After receiving the antibiotics, however, he did progress in other ways such aws he had spastic muscles and at times his abdomen would tighten up and he could not straighten out. His hands became tight, initially on the left. Within a year, this symptom eventually improved. He also has forgetfulness. He notes that he did not receive the second planned Lyme vaccine, not because of side effects related to it but because he forgot. At some point, he was unable to finish a sentence. In the last year, this has been bette. He hasbeen diagnosed with chronic Lyme disease.   He has had multiple tick bites and has had multiple bulls-eye rashes; the earliest one he can remember is in 1999. He has lived in Lyme endemic areas He was treated with the oral antibiotics I mentioned. Later, he received 10 months of IM Bicillin, an dhe is now on his one-hundredth day of Rocephin for a planned six-month course. He thinks he has had some improvement sin ethe Recephin is started." Medications at the time of the evaluation included IV ceftriaxone, clarithromycin, co-enzyme Q10, omega-3 fatty acids, and garlic. On review of systems, the vaccinee reported joint pains, fecal incontinence that resolved in 2001, urinary incontinence that resolved five months prior to evaluation, difficulty initiating his urinary stream, episodes of urinary urgency, sexual dysfunction wiht poor erections, and poor digestion that improved with antibiotics. On physical examination, "He walks with an unsteady gait. He is alert and attentive with fluent and prosodic speech and normal comprehension. He had no paraphasic erros. On the modified mini-mental status exam, he scored 54 out of a possible 57, missing one point for the date and two points for memory though he was able to recall both of other objects with clues. He did well with tasks of attention, consturction, language, arithmetic, and fund of knowledge." Extraocular motion was "intact without nystagmus." Motor testing revealed 4/5 opponens strength with give-away weakness. Strength in the tibialis anterior muscles were 4+/5. Strength in the extensor longus muscles "was at least 4/5, though he had give-away weakness." NO fasciculation was seen. The vaccinee was "able to walk on his toes. His irregular gait notes spasticity more severely in the right leg. He does have spasticity in both legs. Tone was normal in both arms. He could not walk on his heels. He was able to walk tanden. He swayed slightly but did nto fall on testing the Romberg. He could hop on his left foot slowly. He could not hop on his right foot. Rapid alternating movements were normal in the hands and slow in the foot, though with increased slowness in the right side. On sensory testing, he had mildly diminished vibration in the feet and normal vibration in the hands. He had decreased cold sensation distally in the hands, which was normal in the feet. He had preserved pin sensation in both the fingers and the toes. He had diminished light touch sensation in the fingers, which was normal in the toes. His reflexes were normal in biceps, brachioradialis and right tricepts, though hyperactive in the right triceps and hyperactive at the knees and ankles with approximately five beats of clonus in both ankles. He had bilateral Babinski sings. He had a left Hoffmann sign." The neurologist reviewed previous MRIs and "numerous other records" including "limited" clectromyelography of the legs, performed on 5/2/00, "which was reported as normal." The neurologist's impression was "The vaccinee has symptoms and signs of cervical myelopathy with numbness, weakness, urinary symptoms, impaired gait and pasticity in the legs, as well as on neurological examination, spasticity in the legs, hyperactive reflexes and bialteral Babinski signs. His MRI of the cervical spine does show degenerative cervical spine disease with prominent spinal cord signal abnromalities. He also has other symptoms that have occurred int he pact such as double vision, halos, and also bulll's eye rashes, which he says have responded to antibiotics. He does not have abnormalities on his neurological exam that correspond to these other complaints and I would be hesitant to recommend a lumbarpuncture at this time for fear of worsening the cervical spine compression. He has not had serologic evidence of Lyme disease though he has had other serological abnormalities of other tick bourne, illnesses, as well as he did have a Lyme urine antigen. If he does also have neurological Lyme disease; he likely has had adequate treatment for neurological Lyme disease with 100 days of IV ceftrizxone." "Repeat MRI fo the cervical, thoracic, and lumbar spine revealed abnormalities. The vacinee was referred to a physician at another tertiary care center closer to his home.   The vaccinee was under the care of a physician practicing acupuncture and chinese herbal therapy from 7/26/02 to at least 2/27/03. Ona questionnaire at the time of the intiial visit, the vacinee wrote "weakness in my legs, muscle spasms and spasticity, constipation, balance, motor control" under "description of problem." He indicated that he had pain and described it as "cramps from muscles that don't relax." He indicated that standing and reaching upward increased the pain. The physician noted that symptoms had been present for three years. He also noted numbness in the ulnar side of the hands and little fingers.The vaccinee received acupuncture and herbal therapies. During this time, the vaccinee reported that he was "slowly getting better." He also reported that one of his physicians "suggests to get surgery to relieve the pressure in the spinal cord." He also reported "mineral imbalance. High copper level of 13.50. Low zinc of 9.0." On 8/20/02, the acupuncurist noted, "He didn't use anti-bacterial for three to four days last week, which made him very uncomfortable and weak. Now he's good after taking the medication." On 1/2/03, the acupuncturist noted, "The pt stated he has spasticity in legs. He has stopped antibacterial medication for two weeks." As of 2/27/03, the vaccinee continued to report weakness and lower leg pain. The most recent info, received on 3/20/03, indicated that the vaccinee continued to experience weakness and leg pain as of 2/27/03.  Follow up on 01/08/03: "On 04/03/03, approximately ten days after initiation of a new unspecified antibacterial, the pt experienced improvement.  By 05/01/03 the pt reported that he felt more energy and less spascicity.  Lab results indicated that a Lyme IgM Western Blot test performed on 01/21/03 was positive.  The most recent information, received on 12/29/03 did not provide the outcome of the reported events." Follow up: The vaccinee underwent serum protein electorphoressis on 25April2000. No abnormalities noted and no monoclonal proteins were seen. On 25 April 2000, thryroid stimulting horomone and vitamin B12 concentraions were normal. Rapid plasma reagin was non-reactive. The vaccinee was seen again by the neurologist on 02MAY2000. The neurologist's plan included MRIs as ordered. To consider ID consult secondary to patient's serious concernin regarding Lyme. To consider psych consult. The vaccinee underwent MRI of the brain, cervical spine and thoracic spine on 11MAY2000. Brain MRI, with and without contrast, revealed "no significant abnormaility". cerval spine MRI with and without contrast, demonstrated Prominent degenerative changes at C5-6 with a lesser degree of degenerative change at C6-7. Abnormal increased signal within the spinal cord form the level of C5 through that of T1 on the T2 and proton density weighted images with enhancement in the cord at the level of C6. Low signal within the C5 and C6 vetebral bodies on the non enhanced T1 weighted images perhaps degenerative, although other etiology including infection cannot be excluded and conceivably the abnormalities inte cord could be related to extension of infectiion intot the cord." No epidural abscess was seen. Thracic spine MRI, with and without contrast, shoed "multiple relatively small disc protursion in the throacic rgion withoiut evidence of throacic cord compression. The spinal cord inferior to T1 is free of significatn abnormal signal." Although not specifically requested screeing of the lumbar spine was performed. the radiologist noted evidence of at least Grade I and II anteriro spondylolisthesis of L5 relative to S1 proably secondary to bilteral L5 spondylolysis. Theere appears to be a broad disc herniation at L5-S1 and there may be degenerative posterior spurring at this level, as well. Ther is impingement upon the ventral aspect of the thecal sac centrally and to both sides of midline and there appears to be narrowing of the neuroforamine bilaterally." The vaccine returned to neurologist on 23MAY2000. The neurologist's assessment was Myelitis/ ? MS (multiple sclerosis)". The neurologist also noted the possiblity of an "underlying psych disorder". On 16June 2000, serologies for babesiosis, HGE and MME were postive. On 17JUN2000, lyme IgG and IgM Western blots were negative. Lyme genomic and plasmic PCR analysis in seruma nd whole blood were negative. On 27JUNE2000, the physician made the diagnosis of HGE, HME and babesiosis and prescribed CEFTIN. The vaccinee was referred to a second neurologist on 02Nov00. At that time, the vaccinee reported taht he was relatively well until Jan2000 when he started having humbness in the right foot which later moved up to the knee, thigh, torso, to the midchest and since April he started having numbness and weakness of the left leg, also numbness of both upper extremities, particularly forearms and hands. From January to June of this year his coordination and strength of the lower extremities were getting worse and he was experiencing difficulty focusing with his eyes, halos in night vision in both eyes, his head was dropping  and generally be was feeling weak and confused. On June 9,2000 he was started on antibiotics, Ceftin 1000 mg a day...on the basis of possible Lyme disease which was diagnosed on the basis of clinical findings including multiple tick bites, skin rashes in the neck and right lateral abdomen and the profession that he is in (arborist). On June16,2000 serology was positive for Babesia microtti IgM in a titre of 1:16 and IgG was negative with a titre of less than 1:40 but human granulocytic ehrlichiosis (HGE) IgM was negative with a titre of less than 1:40 but IgG was positive in a titre of 1:40 and human monocytic ehrlichiosis (HME) IgM was positive in a titre of 1:40 and IgG positive at 1:80 and LUAT (Lyme urinary antigen test) on June30,2000 was positive for all three specimens, namely 49, 136, 85 respectively (normal below 32 mg/ml). Currently he is still on 1000mg of Ceftin, 400mg of doxycycline which was added in the first part of July 2000. He expresses that his symptoms have gotten a lot better such as eyes cleared, concentration improved, stiff neck improved, dental abscess improved. Findings that have not changed include numbness in upper extremities and weakness of lower extremities, balance problems. At the end of August of this year he started to get worse with greater difficulty in walking and balance. Around the end of September of this year he started to expriencing difficulty with bladder function, namely inability to where he can control it. As far as bowel function goes, he had constipation up until the start of antibiotics, then became more regular. He has never lost control of his bowels. Around August he began to notice some change in sexual function. Around June or July of this year he started having difficulty using his left hand and fingers. He was bitten numerous times by a tick...In the fall of 1999 he had thick, raised rashes in the left lateral abdomen and many rashes in the back of his neck and most recently as late as last week he was bitten by ticks, one in the right anterior axilla, another over the lateral chest at the eleventh rib, slightly behind the axillary line and one in the right medial thigh, one in the medial scrotum on the right. In retrospect he recalled he always had swollen glands in the neck and also had very large swollen glands in the right groin, right axilla and was on a short course of antibiotics by different physicians because he was having pimple abscesses and cuts from the work...in the springtime of 1991 he had sudden onset of fever with rash in the left lateral abdomen. On physicial examination, skin reveals tick bite in the right upper axilla and right thigh and scrotum. Joints were not swollen...Muscle strength is normal in right upper extremity and mildly weak in the left upper extremity, particularly distally fingers and hand. Mild weakness is noted in both lower extremities and with brisk knee jerks and ankle jerks with a weakly positive babinski on the left and on the right. Gait was impaired due to spastic weakness. A sensory level was noted at t4-t5 on the right anteriorly and t7-t8 on the left posteriorly, t6 and 6 on the right and t7 and t8 on the left. Impression: 1) Tetraparesis involving left upper extremity and both lower extremities with spinal cord lesion at c5 through t1 with multilevel herniated discs involving c3-c4,c4-c5,c5-c6, c6-c7 with evidence of spinal stenosis, accompanied by neurogenic bladder. 2) Positive Lyme urinary antigen test and also positive ehrlichiosis and babesiosis. 3) Status post fracture of the left femur and pelvis as a result of an MVA (motor vehicle accident) in August 1989. 4) Cervical-thoracic myelopathy of unclear etiology. It appears that he might have had initial injury from herniated disc pressing on the spinal cord even though myelopathy secondary to Lyme disease and/or MS (multiple sclerosis) cannot be ruled out at this point in time. The neurologist recommended consultation with a spine surgeon, continuation of Ceftin and doxycycline therapy, and addition of atovaquone (Mepron). The neurologist wrote, I indicated that he was permanently disabled from the specific job as a tree surgeon at this point in time. He recorded his diagnosis as Lyme disease. The vaccinee returned to his primary physician on 16Jan01. At that time, he reported Less numbness. Increased dizziness. Hasn't been able to work. Wants to increase treatment. Wants to discontinue doxy. The physician noted staggering gait. The vaccinee was seen by another physician on 01Feb01, who noted fasciculations, right sided tongue numbness, and vertigo. On 21Mar01, LUAT was negative on days 2,3, and 10 on 23Mar01 the vaccinee telephoned the physician just to inform you that he is back on the job as of today. On 29Mar01, this physician noted that the vaccinee was being treated with amoxicillin and clarithromycin. He recommended magnesium therapy. On 05Jun01, the physician reviewed Babesia protocol. He noted that the vaccinee was being treated with Mepron and Flagyl (metronidazole). He recommended clarithromycin (Biaxin) 1000mg twice daily and penicillin G benzathine (Bicillin LA) 2.4 million units weekly. On 12June2001, testing for the HLA-DR4 antigen was negative. On 14Sept01, PCR analyses were positive for mycoplasma and human herpes virus type 6 (variant B). Serologies for Babesia microtti, chlamydia, cytomegalovirus, epstein barr virus, and herpes simplex virus types 1 and 2 were negative. The primary physician prescribed valaciclovir (Valtrex) and continued Biaxin.  On 10Oct01, the other physician prescribed rifampin 600mg daily and mupirocin (bactroban). On 17Jan02, the physician noted that the vaccinee was getting better, and that he was receiving psychotherapy. On 11Feb02, in a statement of injuries, the vaccinee's attorney alleged that the vaccinee suffers from spondyloarthropathy and oligoarthritis post Lymerix, along with radiculopathy and cervical thoracic myelopathy with multiple neurologic and CNS (central nervous system) symptoms. On 11July2002, the pt was evaluated for complaints of a lot of cramping, no bladder control, fatigue, problems with balance, sweating , shocks, at that time, spasticity was improved. At the request of his attorney, the vaccinee was evaluated by a third neurologist at a tertiary care center on 08Aug02. At that time he reported that his neurological problems began in about Aug1999. He had previously received the Lymerix in June99. In the fall of 1999, he developed numbness and tingling in the feet. Within weeks, he developed clumsiness of the leg. The symptoms were gradually progressive. Within six weeks to two months after the onset of symptoms, he sought medical attention. He noted that he was tripping over the tiniest things. He had falls. He had a heat sensation in his right foot. Later in November or December, he started noting that his knees would give out and he would drop, initially more to the right side and then bilaterally. He had a sensation as if he had a hairdryer on his leg, which would occur intermittently for hours at a time also. He also had shooting pains. Later, he developed double vision with his eyes crossing in the year 2000 and floaters. Within 48 hours of starting doxycycline and Ceftin, he started having improvement in his visual symptoms, and within weeks, these all resolved expect for the floaters. He still occasionally gets a star pattern around his eyes from lights. After receiving the antibiotics, however, he did progress in other ways such as he had spastic muscles and at times his abdomen would tighten up and he could not straighten out. His hands became tight, initially on the left. Within a year, this symptom eventually improved. He also has forgetfulness. He notes that he did not receive the second planned Lyme vaccine, not because of side effectsrelated t