Age: 73.0
Sex: M
Vaccine: LYME
Symptoms: Injection site pain
Clinical narrative: Within one hour post 3rd dose, this pt experienced local site pain, resolving in 2 days. One month later approximately (06/15), he experienced "sudden severe arthritic inflammation" of the left fingers, left hand and left wrist. 06/22, he had x-rays revealing "osteoarthritis in the thumb and a couple of fingers." He was treated with Vioxx - reportedly ineffective, diclofenac - reported ineffective and resulted in hypertension, naproxen - blood pressure remaining elevated.  Currently he is being treated with acetaminophen and propoxyphene napsylate. Primary care physician does not see events as related to vax. Outcome is unresolved.  A follow up report received 2/2/2001 adds: Follow up info was received from both the primary care physician and a rheumatologist. Concurrent medicatins included lovastatin (Mevacor), indapamide (Lozol), antenolol, and neproxen sodium. The pt had a history of mild polio in the mid-1940's affecting the right arm and leg (fully recovered), renal insufficiency, and slightly elevated prostate-specific antigen. Ten years ago, the pt had an accident with a power tool resulting in severing of the left fourth finger at the joint (casted for a long time). The pt reported having a "mild arthritic condition" for 10 years consisting of left hand middle finger joint swelling and stiffness (which he had prior to the power tool accident), but no significant pain. The rheumatologist noted that the pt had a history of osteoarthritis of the hands. Prior to the third injection, the pt had a deer tick bite but the tick was not infected (determined with unspecified testing). The pt denies history of gout, psoriasis, or Crohn's disease. The rheumatologist reported that the pt had a uric acid level of 8.9 mg/dl "in the past" (unspecified). The pt's father had severe gout, severe degenerative joint disease, arthritis in his hands and had a hip joint replaced due to arthritic degeneration. The pt has no family history of rheumatoid arthritis or lupus. The pt has 2 sons, both with high uric acid levels; one has had several severe gout attacks and is on preventative drug therapy. The pt "thinks" he has a family history of osteoarthritis. He has no previous history of Lyme disease. The pt received his first Lymerix injection in July 1999. One hour later, his arm was slightly sore at the injection site. He received his second injection in August 1999 and again experienced soreness in the arm (both times resolved in 2 days). The third Lymerix injection was given on 05/12/2000 and within one hour the pt developed slight local site pain, again resolving in 2 days. On 06/15/2000 the pt reportedly experienced a "sudden severe arthritic inflammation" of the left fingers, left hand and left wrist. He also developed pain in the left forefinger and arthropathy some time in June 2000. On 06/22/2000, the pt had a "full series of X-rays" of the left hand which reportedly revealed "osteoarthritis in the thumb and a couple of fingers". In addition, in approximately July 2000, the pt was noted to have increased serum creatinine (2.1 mg/dl) and uric acid (value not specified). The pt received the following treatment: refecoxib (Vioxx) from 06/22/2000 to 07/02/2000, which the pt reported was ineffective; diclofenac from 07/03/2000 to 07/15/2000 which pt reports was ineffective and also cuased hypertension (blood pressure was 212/110 mmHg but normally runs 145/85 mmHg); naproxen from 07/16/2000 to 07/25/2000 but blood pressure remained elevated so it was discontinued) acetaminophen (Tylenol arthritis); prednisone 10 mg daily frmo 09/02/2000 to 09/09/2000; and colchicine 0.6 mg daily since 07/29/2000. The pt is currently being treated with acetaminophen (extra strength Tylenol) and propoxyphene napsylate (Darvocet N-100). The pt reported having blood tests that showed a "decrease in kidney function" (as well as high blood pressure) so all anti-inflammatories were discontinued. The pt was seen by both his primary physician and a rheumatologist for the events. Follow-up info was received from the primary care physician who felt that the events had nothing to do with Lymerix. He stated, "The pt has osteoarthritis of the wrist exacerbated by over use and mild carpal tunnel syndrome". He added, "There was never any suspicion in my mind that this was related to the vaccine-it was strictly the pt's idea". However, the rheumatologist felt that the events were possibly related to Lymerix but also noted that they may have been associated with indapamide (Lozol). Relevant tests included sedimentation rate of 5 seconds and a rheumatoid factor, anti-nuclear antibodies and C-reactive protein which were normal. HLA-DR4 was negative. According to the primay care physician, warm and swollen joints were not documented on physical exam. However, the rheumatologist noted swollen joints of the right ankle, and left wrist and third and fourth fingers. As of 07/28/2000 the pt's serum uric acid was 8.9 mg/dl (although the rheumatologist noted that the pt's uric acid has been 8.9 mg/dl in the past) and his serum creatinine was 1.5 mg/dl. The most recent info received from the rheumatologist on 11/10/2000 reported that the events were ongoing. The events of "osteoarthritis, arthritic joint inflammatin, joint stiffness, swollen joints and warm joints" do not meet ICH serious criteria but are being submitted as an expedited report per the 06/28/2000 letter. The initial section of this report was submitted to VAERS on 08/11/2000.