This case was reported by a lawyer and described the occurrence of rheumatoid arthritis aggravated in a female subject in her late forties ore early fifties who was vaccinated with Lymerix for prophylaxis. The following information was received via medical records forwarded by the subjects attorney. The subjects medical history included Lyme disease with Hashimotos Thyroiditis. She was post menopausal and received hormone replacement therapy. In 1999, the subject was reportedly vaccinated with Lymerix (unk). Shortly thereafter, she developed arthritis in the hands and wrists which progressed gradually. At an unk time after vaccination with Lymerix, she was found to have a borderline positive rheumatoid factor and was diagnosed with fibromyalgia and probable rheumatoid arthritis. This diagnosis was reportedly confirmed by a second physician, who also believed there was an element of trochanteric bursitis. On 4/23/02, the pt complained of slight joint pain since vaccination with Lymerix vaccine, and noted that she had received tick bites sine that vaccination. Chronic conditions included stable osteopenia, which was initially diagnosed on an unspecified date. In May 2002, the pt was treated for Lyme disease with Ceftin, and reported feeling better or antibiotic therapy. Evaluation on 7/15/02 revealed continuing musculoskeletal complaints accompanied by fatigue. Assessment included fever, fatigue, myalgias, and arthralgias with a positive IgM Western Blot consistent with early Lyme disease followed by a two month course of antibiotic therapy. it was noted that the subject also had elevated liver function tests, possibly secondary to the infectious process. On 9/11/03, the subject was diagnosed with fibromyalgia evidenced by diffuse widespread body aches, arthralgias, and the presence of multiple fibromyalgia tender points. treatment included Ultram. On 11/18/03, she experienced chronic intermittent swelling in the medial aspect of the left ankle. Differential diagnoses included inflammatory arthropathy, consequences of fallen arch, and distal tibial stress fracture. In January 2004, the subject again had positive Lyme serology with reactive IgM antibodies and negative IgG antibodies, felt to most likely represent a false positive test rather than a reflection of acute Lyme disease. Impression included fibromyalgia and mild rheumatoid arthritis, and treatment included doxycycline. On 8/4/05, the subject was evaluated for complaints of right shoulder and arm pain, pain in the right biceps muscles that was worse with certain movements, and multiple joint pains through the body. At the time of examination, the pt noted that after receiving the Lymerix vaccine, her rheumatoid arthritis seemed to have come and flared and settled down again. The evaluating physician believed that the multiple joint pains may be rheumatoid arthritis, may be Lyme disease. She was treated with Naproxen sodium (Aleve) and treatment with Medrol dose pack. Upon rheumatologist evaluation on 9/7/05, she was assessed as most likely having rheumatoid arthritis, with fibromyalgia syndrome. In Nov 2005, rheumatoid arthritis symptoms were not optimally controlled on methotrexate alone. In Jan 2006, the subjects rheumatoid arthritis was improved on Humira. Cervical spine X ray on 2/28/06 showed mild osteroarthritic change and some associated evidence of paraspinal muscle spasm. Her rheumatoid arthritis was assessed by her rheumatologist to be fairly stable, with the exception of mild swelling and tenderness of the ankle with evolving valgus deformity. on 4/13/06 she was seen in follow up for rheumatoid arthritis which was described as fairly stable, with some stiffness and hand aching, but without joint swelling. At that time, medications included Flexeril and Ultram. This case was assessed as medically serious by manufacturer (OMIC). In 2003 the subject developed macrovesicular and microvesicular hepatic steatosis with chronically elevated liver function tests. In Oct 2005, the subject was recommended for breast reduction surgery in order to alleviate symptoms of neck and shoulder pain. In June 2006, the subject sustained a right biceps tendon rupture at work when lifting an object. At the time of her workers compensation evaluation, the orthopedist noted No definite history of previous shoulder difficulties, but she has a diagnosis of rheumatoid arthritis and has always described any aches and pains to that disease process. The described injury was considered to ban incidental finding on review of medical records.