Age: 46.0
Sex: M
Vaccine: LYME
Symptoms: Synovitis, Tendonitis, Tinea infection, X-ray with contrast upper gastrointestinal tract
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 for prophylaxis. A physician or other health care professional has not verified this report. The following information was received via a statement of injuries forwarded by the subject's attorney: On an unspecified date the subject received unspecified dose of Lymerix (unknown). At an unspecified time after vaccination with Lymerix, the subject "suffers and has suffered from joint pain, flu-like symptoms, headaches, gastrointestinal disorders, possible memory loss, and decreased activities of daily life". He also reportedly experienced "rheumatologic, neurologic and/or cognitive impairment of an autoimmune, immune mediated, or other mechanism, all caused by vaccination with LYMErix, including but not limited to those set forth above". At the time of reporting the outcome of the events were unspecified. Follow up information was received on 04 December 2007 via medical records. In October 2001, the subject was evaluated by a chiropractor for complaints including low back pain, pinched nerve in low back, pain in buttocks, hips, and leg, and leg numbness. At that time, the patient was 48 to 49 years old. According to billing records, he remained in chiropractic treatment through as recently as June 2007. Follow up information was received on 07 January 2008 via medical records. The subject had a twenty or more year history of Crohn's disease/Crohn's colitis, and had undergone two small bowel resections in the 1980s. He also had a history of abnormal liver function tests "for years", gout, remote joint pain, "profound" allergies, and hypertension. On 20 March 1999, the subject was evaluated for right shoulder pain and Crohn's disease, and on the same date received his first vaccination with LYMErix. The second dose of LYMErix was administered on 19 April 1999 (0.5 mL in the left deltoid). Concurrent medication included allopurinol for uric acid renolithaisis. On 20 July 1999, three months after administration of LYMErix, the subject presented to a podiatrist for acute pain and swelling of the right great toe. Assessment was synovitis of the right first metatarsophalangeal joint, "probable gouty crystalline synovitis". Treatment included corticosteroid infiltration of the affected joint. The third dose of LYMErix was administered on 23 September 1999 (intramuscular, left deltoid). On 01 April 2000, the subject complained of increased right shoulder pain especially with repetitive motion. He was also noted to be experiencing metatarsal pain associated with gout. Diagnoses include 1) "quiet Crohn's, 2) possible acromioclavicular separation/osteoarthritis, as well as possible ringworm and/or gout. Treatment included Vioxx. On 07 August 2000, the subject was evaluated by an orthopedist for "difficulty" with his right shoulder including pain which sometimes radiated to his elbow and hand. Examination revealed pain and point tenderness in the shoulder area, and the subject also related some transient nerve symptoms. The subject reported that he was an avid sport, clay, and skeet shooter and used to shoot regularly, but at the time of evaluation had decreased shooting to once or twice weekly. Evaluation showed trace intrinsic weakness consistent with recurrent injury to the brachial plexus, and impression was "anterior choricoid pain from direct trauma and brachial plexus irritation or contusion secondary from direct trauma from skeet shooting". Previous treatment with Vioxx had been unsuccessful, and ibuprofen was recommended. In April 2002, the subject reported that he had been treated for sciatica by a chiropractor; at that time, Crohn's disease was assessed to be stable. On 18 November 2002, the subject was assessed for complaints of left elbow pain which had been aggravated by recent use of a leaf-blower. Assessment was of tendonitis of the extensor tendons, and treatment included Aleve. On 03 March 2003, he complained of gastroenteritis with diarrhea, describing the symptoms as "flu-like" not activation of Crohn's". On the same date, he received an injection of DepoMedrol in the left lateral epicondyle for a diagnosis of epicondylitis. On 22 July 2005, the subject was evaluated for ongoing Crohn's colitis, with chronic active ileitis. Medications at that time included Pentasa, allopurinol, and Metamucil, as well as Cozaar. According to a letter dated 14 October 2005, the subject's digestive disease specialist indicated that the subject was "doing fairly well with occasional loose bowels and some gas but no other symptoms". He was placed on Pentasa, then was switched to Purinethol in an effort to stop the subject's progression of Crohn's disease. On 14 June 2007, the subject was evaluated for unspecified knee complaints. Medications at that time included Celebrex and Advil. A note from the subject's digestive disease specialist dated 10 August 2007 indicated that the subject was receiving Humira and was "doing well". The case was assessed to be medically significant based upon follow up information. In 2000, the subject was evaluated for eczema of the buttocks, possible ringworm, and metatarsal pain attributed to gout. In approximately November 2003, the subject developed increased arthralgias, and approximately five days later was hospitalized on 28 November 2003 with a vesicular rash. He was diagnosed with "most likely first episode" of chicken pox, and was reported to have "no immune deficiencies". He was discharged on 02 December 2003. These were assessed to be incidental findings upon review of medical records.