Age: 48.0
Sex: M
Vaccine: LYME
Symptoms: Pain in extremity, Paraesthesia, Rash, Red blood cell sedimentation rate normal, Rheumatoid factor negative
Clinical narrative: This case was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified age who was vaccinated with LYMERIX.  A physician or other health care professional has not verified this report.  On an unspecified date the subject received unspecified dose of LYMERIX (unknown).  At an unspecified time after vaccination with LYMERIX, the subject experienced joint pain, flu-like symptoms, cardiovascular disorder, fatigue, eye disorder, rash, shooting pains, weakness, nerve injury, numbness, headache, memory loss, autoimmune disease and activities of daily living impaired.  At the time of reporting the outcome of the events was unspecified.  This information was received via a Statement of Injuries.  Follow up information was received on 30 April 2008 via medical records.  On 07 May 1999, the subject was evaluated for diffuse arthralgias and a scattered itchy rash.  At that time, the subject asked "about Lyme vaccine" noting that he lived in an area populated by deer.  Magnetic resonance imaging results were consistent with radiculopathy in approximately February 1999, and on 17 May 1999 the subject underwent electromyography and nerve conduction studies due to "winging of the scapula" (onset approximately July 1998); findings were abnormal, but there was no indication of polyneuropathy or brachial plexopathy.  On 18 June 1999, the subject complained of pain in the neck and right upper back that was attributed to cervical disc disease and long thoracic nerve injury.  On 27 August 1999, the subject reported exacerbation of visual floaters.  The subject was evaluated by an internist on 05 May 2000 for complaints including lightheadedness (seemingly related to job stress).  He reported that his hips had been bothering him for two years and that he had been diagnosed with degenerative joint disease, and he had a history of ocular migraines with multiple vision since December 1997.  According to a summary prepared by the subject, medications taken as of 11 October 2005 included Vioxx, Celebrex, Bextra, glucosamine, chondroitin, Skelaxin, APAP plus codeine, Lidoderm patch, Mobic, and methylprednisolone.  On 07 November 2002, the subject underwent chest x-rays as part of screening prior to hip surgery, with no acute findings.  On 13 December 2002, x-rays were performed due to hand pain and possible arthritis, knee pain, and foot pain with possible ankylosing spondylitis, with unremarkable findings.  X-rays of back due to back pain showed facet arthropathy with no acute abnormality.  On 16 June 2005, magnetic resonance imaging of the cervical spine was performed due to neck pain radiating to the arms, knee pain, and hip pain.  Findings included slight progression of canal narrowing at C5/6, with "now mild to moderate stenosis" as well as stenosis of the neural foramen, right greater than left at C6/7.  On 19 August 1995, the subject was evaluated for left leg pain and swelling.  According to an initial evaluation by a physical medicine and rehabilitation specialist on 11 October 2005, performed as a consequence of a back and neck injury sustained on 14 September 2005, the subject had been diagnosed with "reactive arthritis in 2000 as a result of a series of three Lyme disease vaccinations over the preceding year".  He had been treated by orthopedic surgeons and rheumatologists "over the years", and treatment included Vioxx, Celebrex, Bextra, Mobic, codeine, Skelaxin, Relafen, and Lidoderm.  The subject noted that his use of Lidoderm had increased since the 14 September 2005 injury.  On 14 September 2005, the subject was evaluated after a "malfunctioning elevator caused him to fall and injure neck/ back".  As a result of this injury he was diagnosed with a contusion to the neck and back, cervical and lumbosacral strains with underlying cervical/ lumbar disc degeneration, herniation, spondylosis, and stenosis.  He was followed for neck and lower back pain, and medications included Skelaxin and Relafen.  On 27 October 2005, electrodiagnostic testing was performed.  At that time he reported a 40 percent improvement in neck pain, no change in low back pain, pain in the left wrist, with paresthesias in the left thumb, index, and middle fingers, "muscle jumping" in the right proximal arm, sensitivity and paresthesias over the balls of the feet extending into the great and second toes bilaterally, and increasing anterior knee pain bilaterally.  Events were referenced to his injury on 14 September 2005 which resulted in muscular strain and myofascial pain, superimposed on multilevel degenerative disc disease and spondylosis with disc herniation (C5/6) causing stenosis and C6/7 degenerative changes causing severe bilateral foraminal stenosis.  He had discontinued Relafen approximately one week prior to this study, and was receiving Skelaxin and ginger.  Electrodiagnostic testing was within normal limits without evidence of left cervical radiculopathy, median or ulnar neuropathy, peripheral polyneuropathy, or inflammatory myelopathy.  The subject also received physical therapy three times per week between 18 October 2005 and 14 October 2005, then reduced to a frequency of twice weekly through at least 06 December 2005.  Treatment included connective tissue mobilization, muscle energy techniques, and therapeutic exercise, and responded well to treatment with pain that was more localized in his neck and low back, with relief of radicular pain.  These findings were assessed to be incidental findings based upon medical record review.  Follow up information was received on 10 December 2008 via an interview between the subject and attorney(s).  The subject was vaccinated with LYMERIX in May 1999, August 1999, and May 2000.  In November 1999 the subject developed joint pain (hip pain, lower back, knees, hands, left foot, wrists, elbows).  He reported difficulty walking and stated that he had been advised by a physician that he had lost half of the cartilage in his hips and had inflammation".  Treatment included Celebrex, Bextra, Vioxx, prednisone, APAP/codeine, Nabumetone, "Avinza" (described as "a derivative of morphine), Lexapro, Paxil, Cymbalta, and Lyrica (due to anxiety/ depression associated with chronic pain), sulfasalazine, and Skelaxin.  In 2002 or 2003 he developed eye floaters accompanied by blurred vision.  The events were unresolved at the time of this report.  Follow-up information was received on 16 January 2009 in the form of medical records.  The subject was evaluated on 18 December 2000 and found to have floaters, migraines with aura, episodes of double vision causing imbalance and coordination problems.  An evaluation dated 05 June 2001 indicated that the subject clearly had arthritic changes of his hip.  X-rays (dates not given) showed osteoarthritis of the hip.  Review of an undated MRI indicated that the subject more than likely did not have avascular necrosis.  On 10 October 2001 the subject had a rheumatology evaluation.  At that time it was noted that the subject may have a severe degenerative disease at the hip level.  The physician also noted that the subject could have an ischemic necrosis process.  Surgical intervention was suggested.  The subject was in a lot of pain and it was reported that his hips lock.  The subject was continuing treatment with Vioxx.  Follow-up information was received on 08 April 2009 via medical records.  The subject was hospitalized from 17 April 2007 to 19 April 2007 due largely to increasing groin pain and bilateral bursitis of the hips.  Follow-up information was received on 01 May 2009 via medical records.  Physician records from 2001 to 2008 indicated that the subject was treated with Marcaine and Kenalog for hip pain.  On 06 November 2001, medical notes indicated that the subject could no longer function with the bilateral hip pain and that the subject was losing motion of his hips.  On 20 December 2001, the subject underwent surgery for removal of left hip bursa and for left hip resurfacing.  The subject was hospitalized.  Final diagnosis was osteoarthritis of the left hip.  At the office visit on 20 August 2002, the subject required a cane to walk and experienced bilateral hip pain.  Medical notes from 27 July 2004 indicated that the subject had a right hip replacement.  Medical notes from 14 January 2005 indicated that the subject took a bad fall and injured his lower back area, since then he has had tingling in both legs.  As of December 2008, the subject continued to have severe cervical spine and lumbar spine disease and pain.