Sex: M
Vaccine: LYME
Symptoms: Joint crepitation, Joint manipulation, Joint stiffness, Joint swelling, Knee arthroplasty
Clinical narrative: This case was received via medical records forwarded by a lawyer and described the occurrence of adverse event(s) in an adult male subject who was vaccinated with LYMErix (GlaxoSmithKline) for prophylaxis.  On an unspecified date the subject received unspecified dose of LYMErix (unknown).  Medical history included gastrocnemius tendon tear, shoulder dislocation/reconstruction, and back pain with laminectomy.  On 31 October 2000, the subject presented to an orthopedist with a complaint of left knee pain after feeling a "pop in his knee and intense pain in the left knee" on 27 October 2000.  Assessment included left knee bone bruise of the tibia on the medial tibial plateau, and underlying mild degenerative joint disease.  On 26 November 2000, he was advised that he could return to work without restriction.  On 28 December 2000, the patient presented with lower back pain radiating to the left leg, and assessment was of lumbar strain versus sciatica.  Medication at that time included Vioxx.  Upon follow up on 26 November 2001, he experienced continued pain in his left knee and right knee pain.  Assessment included left greater than right degenerative joint disease described as "severe bilaterally", and he was instructed to continue Vioxx.  Treatment also included a left knee interarticular injection of DepoMedrol and lidocaine.  On 25 February 2002, Hyalgan was prescribed for visco-supplementatoin, with some subsequent improvement of knee pain.  On 09 December 2002 he was fitted for a knee brace, and he also began receiving Synvisc injections.  Upon follow-up on 12 May 2003 he complained of increasing right knee pain, reporting that he had recently "heard a crack and felt some swelling and sharp pain in the knee".  He was diagnosed with right knee severe degenerative joint disease and possible tibial eminence fracture of "little added significance".  The subject was hospitalized on 17 June 2003, and on the same date underwent a total right knee replacement.  He did well postoperatively and the surgery was characterized as "successful".  Medications included Celebrex.  Surgical pathology findings included degenerative joint disease consistent with osteoarthritis.  He was discharged on 19 June 2003.  During an initial physical therapy consultation on 02 July 2003, the patient reported that he had "arthritis in both of his knees for a number of years".  On 26 August 2003, he presented for evaluation of knee stiffness, with failure of progression in obtaining range of motion in the preceding several weeks.  Mild erythema and warmth of the knee were noted, and aspiration of the knee was recommended to rule out infection.  He continued to experience some discomfort and stiffness of the knee, and on 06 September 2003 his orthopedist advised that manipulation of the knee would be appropriate.  On 30 September 2003, he was hospitalized and underwent aspiration and manipulation of the knee under anesthesia.  Secondary diagnoses included osteoarthritis.  He was discharged to home on 01 October 2003 in medically stable condition.  The patient underwent a left total knee replacement on 06 April 2004.  Postoperatively he experienced bradycardia, and was placed on Lovenox and heparin for deep vein thrombosis prophylaxis.  Pain management included Percocet.  He was transferred for orthopedic rehabilitation on 08 April 2004, and underwent physical and occupational therapy before his discharge on 10 April 2004.  At that time pain was improved and he was continued on Percocet, as well as outpatient physical therapy.  Upon follow up on 20 April 2004 was "doing very well in regards to his functional knee replacement".  On 06 April 2005, he was reportedly doing "exceptionally well" with functional recuperation.  On 15 November 2005, he was seen for follow up of left total knee replacement with complaints including crepitation, which was assessed to be self-limiting.  At the time of reporting the outcome of the events was unspecified.  Post-knee arthroplasty complications included deep vein thrombosis which required anticoagulation with Coumadin.  He was also diagnosed with depression secondary to "major surgery" and was treated with Effexor.  Additionally, he experienced postoperative bradycardia in April 2004 which resolved prior to his discharge from inpatient rehabilitation services.  These were assessed to be incidental findings based upon medical record review.