Age: 43.0
Sex: F
Vaccine: LYME
Symptoms: Lymphadenopathy, Major depression, Mental impairment, Myalgia, Nausea
Clinical narrative: The pt reportedly received Lymerix; the number of injections administered was not reported. In a Statement of Injuries, her attorney alleged that the pt "has suffered from joint pain that migrates from her hips to knees and fingers to shoulders. She suffers daily from debilitating flare-ups of severe flu-like symptoms, nausea, headache, burning behind her eyes and numbness in her fingers, toes and lips. She feels unable to keep her eyes from closing and is forced to sit or lie "in a daze" for hours at a time. These episodes happened daily for 4 to 12 hours at a time at first, though they presently happen with less frequency and duration. (She) cannot stand for more than 10 minutes without feeling pain and exhaustion. At the same time, she cannot sit in one place or position for any length of time before feeling pain, thereby necessitating that she constantly move from chair to chair, or chair to bed. She attempts to walk each day, but overexertion can lead to a flare-up of symptoms that will confine her to chairs or bed for the remainder of the day. (The vaccinee), a mathematician, has noticed a marked failure of her mental skills and finds that she cannot do simple arithmetic. Reading can make her feel sick." Time to onset following immunization, treatment and outcomes of the alleged events were not reported. The events of flu-like symptoms, nausea, headache, burning behind her eyes, numbness, pain and exhaustion are considered disabling because they allegedly are "debilitating" and "confine her to chairs or bed". The follow up states Lyme disease in a 43 year old and the report was received as part of litigation proceedings, with forwarding of medical records. The medical history included allergies to codeine and red dye, "debilitating" chronic pelvic pain characterized by "severe dysmenorrhea and severe dyspareunia," uterine fibroids, chronic cervicitis, Nabothian cysts, fibrocystic breasts, incisional hernia, and antibiotic associated colitis. The surgical history included partial hysterectomy and incisional hernia repair. The following info wsa obtained from medical records. The vaccinee was evaluated by an infectious disease specialist on 11/19/99. She reported that she "developed symptoms over past months including night sweats, migratory joint pains-right hip pains, fingers/knees and complainted of discomfort behind eyes. Flare with period, fatigue, muscleache/neck stiffness, mental fogginess and word finding problems. Saw another physician, diagnosed LD and Ehrlichia. Doxy 100 BID twice daily for one week did have sweat last night." The physician made a diagnosis of "chronic Lyme/Ehrlichia probable. Babesia microti-no." The physician increased the doxycycline dosage to 200mg three times daily, and added Flagyl 250mg to 500mg three times daily, and Zithromax 600mg dialy. In the office records, the physician indicated on 11/24/99 that a Lyme titer was negative, human monocytic ehrlichiosia titer was positive at 1:80, complete blood count and electrolytes were normal, urine Lyme antigen test was negative, vitamin b12 and thyroid stimulating hormone concentrations were normal, and erythrocyte sedimentation rate and antinuclear antibody titer were negative. On 11/26/99, the physician prescribed hydrocodone 7.5mg/paracetamol 300mg, one or two tablets every four to six hours. The vaccinee returned to the infectious disease specialist on 12/3/99. The physician wrote, "On questioning, pt admits to two doses of LYMErix, then symptoms began. Presently on flagyl 500 TID three times daily, plus Zithromax 600mg QD daily, Doxy 100 TID with good response. Less knee pain. Positive flare tight hip. Still with neurocognitive deficits." The physician's plan was to "Continue current meds. Continue Acidophilus, add Diflucan 100 every week." On 12/10/99, the vaccinee telephoned the physician to report that she "has yeast infection in mouth." The physician prescribed Mycelex trochae five times daily for ten days. The vaccinee returned to the infectious disease specialist on 12/23/99. On a symptom checklist, she indicated that she was experiencing "Unexplained fevers, sweats, chills or flushing," "unexplained weight change-gain or less," "fatigue, tiredness, poor stamina," "testicular pain/pelvic pain." Eventhough th ept is a female, this was one of the listed complaints. "Unexplained menstrual irregularity," "sexual dysfunction or loss of libido," "chest pain or rib soreness," "shortness of breath, cough," "joint pain or swelling," "stiffness of the joints, neck or back," "muscle pain or cramps," "headache," "double or blurry vision, flosters, sensitivity," "lightheadedness, wooziness," "confusion, difficulty in thinking," "forgetfullness, poor short term memory," and "distrubed sleep (too much or too little," The physiican wrote "Starting to  notice shift in symptoms this past week with decreased knee pain, hip pain. Mind is clearer, sleeping less. Got bad rash after LYMErix with increased symptoms after second shot. Symptoms persisting; still with pains back. Positive yeast: vaginitis/tongue, on Diflucan QD for one week, four to five Acidophilus. Will decrease doxy to two every 12 hrs, increase Acidophilus three twice daily. FInish two more weeks Diflucan 200 per day, then switch to Nystatin 500,000 two twice per day (three times if possible). Decrease Flagyl to 500 twice per day for decreased body weight, decrease zithro 400mg per day." Babesia titers measured on 12/29/99 werer negative. On 1/7/00, the vaccinee telephoned the physician to report that after decreasing the zithromax dosage, she "has increased symptoms with headache, took it again and feels better (everything feels better)." The physician increased the Zithromax dosage to 600mg dialy. The vaccinee was seen by her gynecologist on 1/17/00. She reported that she was taking doxycycline, metronidarole, Zithromax, Mycalex, nystatin, and Diflucana. She stated that she had Lyme disease and ehrlichiosis. On 1/28/00, the vaccinee telephoned the physician to report that she had "yellow eyes." She was examined by the physician on 1/31/00. The physician noted, "Pt is feeling worse than last visit. Episode of jaundice-now much better." No icterus was noted.(Eventhough the terms jaundice and icterus denote the same event, this was what was transmitted through the litigation process). The vaccinee reproted "Constant right hip/knee pain." The physician's impression was "Chronic Lyme." He discontinued all antibiotics. Doxycycline 200mg twice daily was restarted on 2/3/00. Zithromax 600mg daily was restarted on 2/15/00. The vaccinee was seen by the physician on 3/3/00. "Overall much better. Less mental fogginess. Less chest pains. Less fatigue. Presently on Flagyl, Doxy plus Azithromax. Doing well. On Nystatin for yeast. Still with right hip pain." The physician's impression was "Chronic Lyme, ?Babesia." The vaccinee returned to the physician on 3/13/00. "Finishing up Doxy 100 TID plus Flagyl 500 BID twice daily plus Azithro 600 QD. Most significant symptom is fatigue, sleeps 10 to 12 hrs per dy. Still with night sweats. Positive trap tnderness." The physician's impression was "Chronic Lyme. Seronegative Babesia clinically." The physician discontinued doxycycline, metronidazole, azithromycin, and nystatin. He prescribed flucconazole 200mg, followed by 100mg daily. The seronegative babesicais was treated with Lariam 1250 mg single dose, then 250mg weekly. B. Burgdorferi and Babesia polymerase chain reaction (PCR) analyses were negative on 3/14/00. X-rays of the hips and pelvis, performed on 3/17/00, were normal. On 4/7/00, the vaccinee telephoned the physician to report that she "now feels worse." The physician prescribed amoxicillin 1000mg three times daily, probenecid 500mg three times daily, and azithromycin 600mg daily. White blood cell count was below the reference range on 4/14/00. On 4/17/00, Lyme IgG and IgM western blots were negative. On 5/2/00, the vaccinee began the receive benazathine penicillin million units by IM injection weekly. The last injection recorded was administered on 8/11/00. The vaccinee was seen by her gynecologist on 5/5/00. She reported that she was taking Ricillin, Zithromax, and Cipro 500mg twice daily "for chronic Lyme." On 8/8/00, the vaccinee indicated the following symptoms on a checklist: "Unexplained fevers, sweats, chills or flushing; fatigue, tiredness, poor stamina; swollen glands; testicular pain/pelvic pain; shortness of breath, cough; confusion, difficulty in thinking; forgetfulness, poor short term memory; and mood swings, irritability or depression." The physician wrote, "Still with night sweats, improved with Lariam, then worsened off." The vaccinee returned on 8/31/00, reporting "Unexplained fevers, sweats, chills or flushing; fatigue, tiredness, poor stamina; irritable bladder or bladder dysfunction; shortnes sof breath, cough; joint pain or swelling; stiffness of the joints, neck or back; muscle pain or cramps; headache; tingling, numbness, burning or stabbing pains; confusion, difficulty in thinking; forgetfulness, poor short term memory; and mood swings, irritability or depresion." The physician wrote, "Having increased right hip pain/low back pain. These symptoms went away for a long time and then returned. Night sweats improved with lariam, no longer drenching, but has only taken two doses. On doxy for two weeks, and already had increased symptoms. Switch Lariam to Cleocin 300mg every eight hours for 14 days, quinine 325mg every eight hours. Stay with artemisia ODS every eight hours. Can try staying on doxy. Increased Acidophilus six per day. Back with paraspinal muscle spasm, no pain on palpation over spine. Ibuprofen 600 QID four times daily, as needed iwth Robaxin 750 QID. Do chiropractic trial. Renewed Diflucan 150 one time per week. Once done with Cleocin plus Quinine can go back to doxy-Larian. Ianax 0.25 TID as needed anxiety." On 8/9/00, red blood cell count, hemoglobin, and hematocrit were below the reference ranges. White blood cell count was within the reference range, but the percentage of basophils was increased. Mean platelet volume was above the reference range. On 8/10/00, Babesia IgG titer was negative. Babesia IgM titer was positive. On 9/11/00, the vaccinee telephoned the physician to report that she "broke out with rash from head/toe-on day 10 C plus Q-told to discontinue C plus Q-take Benadryl-when rash completely gone to start back on doxy/Lariam." The vaccinee returned to the physician on 9/29/00. Doxycycline and nefloquine were discontinued due to increased liver function tests. "Once LFTS normal, can restart bicillin 2.4 once per week with pulse flagyl three days per week 750 mg per  day, plus Zithro three days per week 600mg. Needs Diflucan 150mg twice per week. Pt has been unable to teach some days. Needs letter to take off for the semester. Will write letter for pt." On 10/4/00, total Lyme antibodies were elevated, Lyme IgG western blot was positive, demonstrating 23-25 and 31 kD bands; 18 and 28 kD bands were reported as "+/-." Lyme negative. On 10/5/00, PCR analyses for b. burgdorferi and Babesia DNA were negative. On 10/6/00, antinuclear antibody titer, hepatitis C antibody titer, Lyme IgM western blot, and RA latex were negative. Erythrocyte sedimentation rate was normal. White blood cell count was below the reference range. Cytomagalovirus IgM titer was negative; cytomegalovirus IgG titer was positive. epstein-Barr virus IgM titer was negative; Epstein-Barr virus igG titer was positive. The vaccinee returned to the infectious disease specialist on 10/19/00. The vaccinee has history of Lyme disease and was off of antibiotics for the last 30 days and has had recurrence of increasing severity of symptoms. Recall that she has been previously on Bicillin, pulse Flagyl and pulse Zithro. Pt refuses to do any homaopathy. She would rather go for IV medication and it was agreed by another physician in the group that we would start a course of IV Rocephin, doing 2mgs daily five days on, two days off for a total of 30 doses, along with doing pulse Zithromax 600mg daily three days on, four days off, with pulse flagyl 750mg daily, doing four days on three days off. She will continue with yeast free diet and acidophilum tablets. On 10/23/00, the vaccinee's husband telephoned the physician to report that the vaccinee had "decided not to do IV at this time."  On 11/2/00, the vaccinee's husband telephoned the family physician and reported taht the vaccinee had a pruritic rash on her lower back. The rash was characterized by "small raised areas". The vaccinee was seen by the family physician on 11/10/00. She reported that "all symptoms became much worse with po (er os) and first day of IV, but today much better, GI (gastrointestinal) symptoms seem to get better on antibiotic. Rash is decreasing, less pruritic. NO other new symptoms." The physician also noted that the vaccinne had Vicodin for pain relief and Difulcan 150mg ever third day. The vaccinee was seen by her gynecologist on 11/16/00. She reported that she was "on IV Rocephin for Lyme disease." She also reported that she had "increased mercury level-may be starting chelation therapy." On 12/11/00, the vaccinees' family physician prescribed tinidazole 500mg three times daily. On 1/22/01, the physician "mailed progress notes and labs to SS Disability." The vaccinee was seen by her family physician on 1/31/01. The physician's impressions were "chronic neurologic lyme disease, ADD (attention deficit disorder), tend toward OCD(obssevie-compulsive disorder)." The physician prescribed Congerta 18mg daily to "see if this might help her cognition".  The vaccinee was seen by her gynecologist on 2/1/01. Medications at that time included Rocephin, nystatin and Diflucan. At this visit, the vaccinee reported that she was allergic to codeine and red dye. She also reported that she was "status post intestinal fungal infection, still having loose stools." The gynecologist's impression was "chronic Lyme disease." The most recent info, received 4/3/02, did not provide the outcomes of the Lyme disease, ehrlichiosis, or babesiosis. These events are considered disabling because their corresponding symptoms allegedly are "debilitating" and "confine her to chairs or bed." The follow up states on February 2001, white blood cell count was below the referrence range; percentage of lymphocytes was also below the reference rrange, while percentages of monocytes and basophils were above the reference ranges. ? kinase concentration was elevated. Concentrations of thyroid stimulating hormone, serum protein, serum ? and C-reactive protein were within the reference ranges. Erythrocyte sedimentation rate was within the reference range. Serologies for hep B, hep C, and antinuclear antibody were negative. Lyme IgG/IgM serology was "equivocal." On 4/23/01, the vaccinee was seen for "rheumatologic evaluation and consultation" at a tertiary care. The rheumatologist indicated that the vaccinee was in excellent health and was very athletic until 1998-1999 when she noted the onset of increasing fatigue. The pt was seen by a physician in 1999 and diagnosed to have Lyme disease after a series of serologies. She was referred to another physician who treated her with multiple antibiotics. Pt did not believe that she felt better despite the oral antibiotics. Around November 2000, she developed worsening of her symptoms with increasing fatigue, fever, night sweats as well as arthralgias and arthritis. About the same time, pt was noted to have cognitive ? associated with memory loss as well as paresthesias and numbness in the lower extremities associated with the weakness. She was seen by three physicians. Apparently, everyone confirmed that the pt indeed has Lyme disease. In November 2000, she was started on ceftriaxile antibiotics which improved her symptoms subsequently. However, her symptoms relapsed after discontinuation of the antibiotics fo rthree weeks. She is on Cefotaxine for the past three weeks. She believes that the fever has improved and her overall symptomatolgy has also improved slightly. Her last infusion was approximately two days ago. However the pt had a recurrence of her fever last evening. In addition, she developed new onset of right lower calf and foot pain. In addition, she still continued to complain of right hip discomfort. The pt describes good days and bad days. However, overall she has chronic fatigue. Some days she can walk two miles or less. However, after walking she becomes severely fatigued for the rest of the day. In addition, she has nonspecific myalgias, arthralgias, paresthesias and numbness involving both extremities. She also describes sudden onset of extreme weakness and pain which require her to sit down quickly. Otherwise, she feels like she will collapse. The only medication at the time of the evaluation was cefotaxime. On review of systems, "she recalls an erythema chronicum migrane rash over her thigh in 1993. She describes Raynaud's phenomenon involving both her fingers and her toes. She describes the onset of rash over her face more recently. She does describe urinary frequency." On physical examination, "She walks very slowly however and appers quite tired. She also appears to have difficulty relating information and the history actually was obtained with a lot of prompting from her husband. Musculoskeletal examination revealed good range of motion of the neck, although on extension and right and left rotation she complained of some cervical tenderness. However, on palpation the muscles, particularly over the trigger points, were not tender. There is good range of motion of her shoulders. Her elbows, wrists, MCPs, PIPs, and DIPs are normal. There is no evidence of synovitis. There is good range of motion of all her joints. Examination of both hips revealed good range of motion. She had some tenderness on palpation over the right sacroiliac area and the L4-5 lumbosacral area as well. Lumbar spine flexion is full. Examination of both knees is normal. Ankles and MTPs are normal. On neurological examination, "it appears that the pt is grossly weak? in the proximal musculature in both the upper and lower extremities. Testing of the ballus extensor tibialis revealed motor strength to be about 5/5 symmetrically. Straight leg raising; however, seems to be positive on the right at 30 degrees. She appears to have decreased pinprick sensation over the L5 distribution on the right. However, she is able to walk on the toes comfortably. Walking on her heels appears slightly more difficult. The pt is unable get out of the chair unaided. Femoral stretch test was negative. Examination of her skin revealed changes suggestive of Raynaud's phenomenon in both the hands and the toes. She has livedo reticularis changes over the trunk as well as her thighs. In addition, she has a fine diffuse papular rash around her neckline. She has a malar rash not sparing the labial fold as well. Impression:The pt's overall histoy of the ECM, fatigue, fever as well as memory loss and cognitive dysfunction is very consistent with that of Lyme disease. The question is whether she also has other underlying autoimmune diseases including systemic lupus, vasculitis, polymyositis and thyroid diseases. I do believe in this instance that these illnesses should be ruled out. In addition, unrelated to her constitutional symptoms. It is important to rule out a herniated Lf-S1 disc with corresponding radiculopathy." The vaccinee returned to her family physician on 4/27/01, "presently on Claforan 4mg every eight hours biweekly. Also on concerte 30mg daily, helps with flucuating focus/concentration. Symptoms seem gradually improving (less flare of symptoms), but still with monthly flare and always has myalgieas and cognitive dysfunction. Has sweats. The physician's assessemtn was "Lyme-seems steadily improving. Consider possible Babesiosis." The plan was to continue Claforan therapy. The vaccinee was sen by the family phsician on 5/25/01. She had 'moderate mid back pain in monrings' (had an MRI) mild DDD(degenerative disc disease). On 6/6/01, the physician prescribed Percocet. On 6/25/01, the vaccinee was seen by a psychiatrist. Medications at that time included Xanox .5mg at bedtime. The psychiatrist made diagnosis of "Dementia due to Lyme Disease" and "Mood disorder due to Lyme disease."  The vaccinee saw her family physician on 6/26/01. She reported 'some flare of symptoms about two weeks ago. Having increasing night sweats - occurring most nights. No changin in GI symptoms. Recent flare ? secondary to stress. Sensation is returning to feet but hand symptoms persist. Has been more fatigued. The physician's assessment was "lyme clearly imporved but still symptomatic and some suggestion of Babesiosis. Continue medication for five weeks more and observe."  The vaccinee returned to the psychiatrist on 7/2/01. The psychiatrist noted, "has flare-up of flu-like symptoms - feels like dying and paralyzed. Told is a ? (reaction) (die-off)."The vaccinee returned to the family physician on 7/5/01. At that time, she "has had significant increase in neuro symptoms - especially paresthesias and cognitive symptoms. Sweats resolved again. Claforan therapy was continued. The vaccinee returned to the family phyisican on 7/19/01 and reported that "foot paresthesias are gone. Some increase in burning behind eyes and increased facial paresthesias. Energy and cognitive ? was unchanged. ?. Sweats have resolved." On 7/20/01, a neuropsychologist wrote a letter to the vaccinee's medical insurance carrier stating, "I have completed a comprehensive neuropsychological evaluation of the vaccinee in December 2000. There is clear ? bothh on interview and examination of severe and diffuse cerebral dysfunction, consistent with Lyme encephalopathy. She has had a clear positive response to IV antibiotic treatment, which I have? She also lhas a clear relapse in response to cessation of treatment at this time, presumably because the length of treatment has thus far been inadequate." The vaccinee saw her family physician on 8/15/01. At that time she has ongoing diffuse pain - often worse with sitting and standing and is worse in back and lower extremities. No clear pattern, but seems to be reduced when walking. Energy and cognitive no change. Back on Nystatin for vaginitis. On examination, the physician noted "stifness/pain with motion in upper extremities and lower extremities. No joint inflammations." The physician's assessment was "patient's overwhelming symptoms of fatigue and dysfunction/neuro are improved on Claforan/tinidazole. But patient may be more aware of pain now - doesn't fit any pattern of arthritis, radiculopathy. Try Neurontin 300mg tid." On 8/17/01, the family physician prescribed Vicodin as needed at bedtime for pain relief. The vaccinee returned to her family physician on 8/23/01, reporting that she 'has felt sick' this week since root canal. All pains decreased shortly after Claforan dose - now has residual wrist pain and usual hip/back pain. Night sweats have become severe. Energy and cognitive symptoms were worse until one to two days agao. GI symptoms decreased'. On examination, ;mentation seems slow.' The physician's assessment was "lyme - profound sweasts suggest possible Babesiosis. On 8/24/01, the physician prescribed Percocet at bedtime. On 8/29/01, the vaccinee returned to the psychiatrist. She reported "revewi by independent MD medical doctor...rejection fo diagnosis, medication treatment and supplies...needs a)legal advice, b) more Xonax. The family physician saw the vaccinee on 9/5/01. Medications included Xanax .5mg every 12 hours as need, Concerta 18mg twice daily, Mepron 750mg twice daily and Zithromax 600mg daily. she "has period of mental clarity after starting M+I., now not as good. Sweats are less. Nocturia is decreased. No GI symptoms. Foot paresthesias are gone." Slight thrush was noted on examination. The physician's assessment was "lyme/babesia". They physician prescribed Diflucan 100mg every other day for four doses. The vaccinee retured to her family physician on 9/12/01, and reported that she was "seein in emergency room earlier in week for abdominal and bilateral low back pain and vomiting. Had negative x-rays and negative ultrasound and negative labs. Given Demeraol and discharged. Pain has persisted but is decreased. Was eating increased fatty food for Mepron. Lyme symptoms with severe malaise and cognitive symptoms returned on Mepron/ off Claforan. Feels increased syptoms due to stress. Seeing psych every two weeks. The physician's assessemnt was "dyabiosis". The physician recommeded decreased intake of fatty food, increased fluid intake, and a laxative every other day. The vaccinee developed epigastric pain, nausea, and vomiting after three weeks of Mepron therapy. It was discontinued. On 9/20/01, she reported 'some flare of lyme symptoms since being off medication with diffuse pain. Paresthesias and poor cognitive function. Sweats stopped over past one to two weeks. Claforan therapy was resumed. Diflucan therapy was resumed on 9/26/01 and percocet therapy was resumed on 9/28/01. On 10/9/01, a urine specimen contained an elevated level of mercury.  On 10/16/01, multiple serologies for Lyme disease revealed "No evidence of seroeactivity beyond that expected from the Lyme vaccine." The vaccinee telephoned her family physician on 11/15/01 and reported taht "sweats, myalgias worse." The physician suggested that she "try artemisia/astragluc while on mercury medication. The vaccinee retured to her family physician on 11/30/01. At that time, she reported that she "has noted burning senstation near eyes/nose - especially when in downstairs of home. Has had similar problems with exposure to fumes in past (perfumes, gas station etc.). Develops associated nausea and respiratory symtpoms. Recently saw neurologist with spin MR and told missing disc and cyst. Told possible cause of pain to legs. That and back pain have never improved. Uses percocet every three hours over night. Pain is better lying down and walking. Has had very little claforan over past tow months, and arthralgieas are generally stable. Cognitive symptoms are also unchanged. Has had no sweats when using salt on lips and gums - also on Artemisia and Astragalus. Feels cold all the time." The physician's assessment was 1. Lyme - no significant deterioration off Claforan, continue Artemisia/astragals intermittent. 2. Mg (mercury) toxicity. 3. Back/leg. On 12/18/01, the family physician prescribed ? 250mg four times daily for three days, then 250mg once daily. ON 12/21/01, the physician prescribed Zithromax 250mg daily. The vaccinee retured to her family physician 12/27/01. She reported that "sweats have stopped after four days of ?. Some insomnia due to recurrence of right hip pain (had at onset of Lymes (sic) Symptoms of pain, cognitive symptoms and energy are flucuating. The physician's assessment was "1. Lyme  resolution of Habesia symptoms. Contineu Malarone for one week. 2. Mg overload. Continue DMPS (dimercaptropropasulphonets) until <10. Then may do DMCA (dimercaptesueeinic acid) of 'Metal Free.' The vaccinee was seen by her family physician on 2/8/02. She states having real hard time. Many symptoms seem to be verbal/emotional. States she's "much more sensitive to chemicals now, including chlorine in the water. Husband reports her feeling suicidal lately - called the suicide hotline this week." The vaccinee also reported insomnia. The physician's impression were "chronic lyme disease, Mg overload. Depression with suicidal ideation." The physician prescribed Celexa 20mg daily and Sonata 20 mg at bedtime as needed for sleep. The vaccinee returned to her family physician on 3/4/02. She reported "some recurrence of right hip pain, then with nightly bouts of palpitations, paresthesia, low grade fever - all similar to previous symptoms when lyme was active. Left lower quadrant symptoms recurs intermittently. Sleep is erratic - exacerbated by nocturia times up to 12. Always hungry and thirsty. No weight change. Cognitive function about the same and depression better. The assessement was "fairly stable - still with sleep disorder. DI (diabetes insipidus) secondary to Mg. Depression reduced.   The most info received 4/16/02, indicated that LYme disease persisted as of 7/20/01. ? of the ehrlichiosis and bebesiosis were not provided. The most recent information received 4/29/02, indicated that the symptoms of Lyme disease and deprression persisted as of 3/4/02. Mercury was undectable in urine. Outcomes of the ehrlichiosis and babesiosis were not provided. The lyme disease, ehrlichiosis, and babesiosis in this report are considered disabling because their corresponding symptoms allegedly are "debilitating" and "confine her to hairs or bed". The follow up states following the reported onset of Lyme disease there were also low back pain, right hip pain, involvement in a motor vehicle accident. Serologies performed on 4/23/01 were negative for Lyme disease, anti-double-stranded DNA antibody, anti-myaloparoxidase antibody, anti-RWP antibody, anti-smooth muscle antibody, and antinuclear antibodies. Erythrocyte sedimentation rate was within the referance range. The follow up stats the vaccinee completed a system checklist in which she noted she had experienced all of the following: unexplained fevers, sweats, chills or flushing, fatigue, tiredness, pelvic pain, unexplained menstrual irregularity, irritable bladder or bladder dysfunction, sexual dysfunction or loss of libido, upset stomach, change in bowel function, chest pain or rib soreness, joint pain or swelling, stiffness of joints, neck or back, muscle pain or cramps, headache, tingling, eyes/vision-double, blurry, pain, increased floaters, lightheadedness, wooziness, poor balance, difficulty walking, confusion, difficulty in thinking, difficulty with concentration or reading, forgetfulness, poor short term memory, disorientation, getting lost, going to wrong places, mood swings, irritability, depression and disturbed sleep-too much, too little, early awakening. On 12/4/99, the vaccinee indicated she had experienced, "Unexplained fevers, sweats, chills or flushing," "fatigue and tiredness," "testicular pain/pelvic pain," "unexplained menstrual irregularity," "irritable bladder or bladder function," "upset stomach," "joint pain or swelling," "headache," "forgetfulness, poor short term memory," and "disturbed sleep." Positive night sweats, Bab likely even if negative: no paresthesia on flagyl because of high succentibility to yeast, will try and decrease longer course of antibiotics." On 1/13/02 babenesia IPA was noted as negative. It was noted on 1/19/00 that the infecitous disease specialist spoke with her gynecologist-fibroids and endometriosis-will need surgery, will try to get her better before considering surgery. On the same date 1/19/00 the vaccinee phoned her MD complaining of increased night sweats. A Lyme symptom follow up sheet dated March 2000 stated, "fatigue came back. Must sleep 12-16 hrs, in bed most of day. Hip and knee better today." On 3/20/00, the vaccinee called to report oral white material, questionalbe thrush. Diflucan and cystatin help the sinus and symptoms. On 3/24/00, "PCR's negative, x-rays negative and LFT's negative." On 3/29/00 the vaccinee's husband was told for her to continue with her medications and go for FNA of breast." On 4/5/00, the vaccinee's surgery was cancelled. It was noted, "changed doctors, Benadryl was prescribed. On 4/7/00, the vaccinee telephoned the physician to reprot that she "now feels worse." She had been off antibiotics for three days. On 4/14/00, the vaccinee saw the infectious disease specialist who noted, "very ill with headaches, fatigue and joint pains, unable to concentrate. Impression: chronic Lyme. Plan discontinue Lariam. Bicillin 2.4 one time todya, Fflagyl 250mg