Sex: M
Vaccine: LYME
Symptoms: Red blood cell sedimentation rate normal, Retinal vein occlusion, Rheumatoid arthritis, Rotator cuff syndrome, Swelling
Clinical narrative: This case was reported by a lawyer and described the occurrence of arthralgias in an adult male subject who was vaccinated with LYMERIX, GlaxoSmithKline.  A physician or other health care professional has not verified this report.  On an unspecified date the subject received unspecified dose of LYMERIX (unknown).  On an unspecified date after vaccination with LYMERIX, the subject experienced joint pain and swelling, flu-like symptoms, headaches, fatigue, rashes, possible memory loss, tingling in extremities, vision problems, ocular disorders, dizziness, and decreased activities of daily life.  In addition, the subject suffers from rheumatologic, neurologic, and/or cognitive impairment of an autoimmune, immune-mediated or other mechanism, all reported to be caused by vaccination with LYMERIX.  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 03 November 2008 via medical records.  The subject had a history of sudden onset of vertigo in 1997, with occasional ongoing dizziness.  On an unspecified date, he was diagnosed with a branch retinal vein occlusion, and underwent laser surgery to the right eye.  On 02 December 1999, he was evaluated for severe bilateral knee pain with limitation of ambulation that had been ongoing for over a year, and was treated with Celebrex.  In August 2000, he experienced a recurrence of these symptoms accompanied again by diplopia.  The subject was diagnosed with Lyme disease that he "reports was secondary to the LYMERIX resulting in need for bilateral knee replacements, bilateral shoulder replacements".  On an unspecified date, the subject was diagnosed with rheumatoid arthritis and osteoarthritis.  On 17 January 2003 he presented with severe pain and restricted motion in the left shoulder that had been progressive over the last few years, and noted that "many years ago" he sustained a shoulder injury.  He was diagnosed with advanced left shoulder osteoarthritis confirmed with magnetic resonance imaging and x-rays.  On 26 February 2003, he underwent left shoulder arthroscopy with extensive debridement of labral tear and partial biceps tendon rupture, arthroscopic removal of loose bodies, chondroplasty, subacromial decompression, and acromioplasty Postoperative diagnoses included left shoulder degenerative arthritis, extensive degenerative labral tear, multiple loose bodies, and impingement syndrome.  He then underwent physical therapy, and upon follow up on 01 May 2003 he continued to have severe shoulder pain with only minimal improvement following arthroscopy.  He underwent left total shoulder arthroplasty on 16 June 2003 for a pre- and post-operative diagnosis of extensive rheumatoid arthritis.  According to a physician's note on 23 December 2003, the subject's degenerative arthritis had been ongoing for greater that 15 years.  The subject was hospitalized on 01 March 2004, and on the same date the subject underwent left total knee replacement.  On 03 March 2004 he underwent right total knee replacement.  On 08 March 2004, the subject was discharged from the hospital to a rehabilitation facility where he was evaluated for gait dysfunction after a "greater than ten year history of severe progressive bilateral knee pain increased with weight bearing".  He was admitted to an inpatient rehabilitation facility on 08 March 2004 for an anticipated stay of ten days with impressions of gait/activities of daily living disturbance, polyarthritis/rheumatoid arthritis, status post bilateral total knee replacements and left total shoulder arthroplasty.  Medications included prednisone and methotrexate.  He was discharged on 16 March 2004.  On 28 September 2004, the subject reported various "subtle aches and pains but overall is doing well".  On 07 July 2005, he was seen after a minor fall exacerbated ongoing symptoms of severe shoulder pain, and he was recommended as a candidate for shoulder arthroplasty.  On 31 October 2005, he underwent right shoulder total joint arthroplasty with humeral and glenoid component as well as an excisional biopsy of a lipomatous mass on the left shoulder.  Post-operative diagnoses included right shoulder inflammatory arthritis and large lipomatous mass on the anterior aspect of the right shoulder.  On 16 January 2001, he was evaluated by a neurologist who commented that the subject had a history of hypertension with risks for cardiovascular disease and "I am concerned that he may have vertebrobasilar insufficiency with the recurrent episodes of vertigo, diplopia, and vomiting".  In approximately August 2006, the subject fell and experienced "most likely strain and contusion" of both knees/legs.  These were considered to be incidental findings upon medical record review.