One week post vax, the pt experienced malaise and tingling in ankles, feet, and legs with occasional shooting pain. An ER visit was required and she was treated with Rocephin for 4 weeks. The follow up states case reference number 1999024829-1, is a spontaneous report from a 52 year old female consumer, and a physician. No known drug allergies. Medical hisotry includes joint pain in hip and back, and memory loss. Tests for Lyme disease in the past were negative, per physician. Physician stated that pt has numerous medical hisotry problems. On approximately 4/5/99, the pt received her first dose of Lymeris. One week later, on 4/12/99, the pt experienced malaise and tingling in ankles, feet and legs with occasional shooting pain. An emergency room or doctor visit was required and she was treated with Rocephin x 4 weeks. Information, received on 9/14/99, reports the condition of th ept is worsening. On 10/18/99, physician opined that symptoms were unrelated to Lymerix. He no longer is following the pt.  Follow up 08/13/2002: "The patient was seen by an infectious disease specialist on 06/07/1999. He noted "a history remarkable for having maxillofacial surgery...with a plate placed for a mugging incident...years ago.  She ordinarily takes no medicines, doesn't smoke, and drinks one to two glasses of alcohol a night.  The patient has no known drug allergies.  The patient said that one year ago she started having right hip pain and then left shoulder pain...then the patient noted a small quarter size rash beneath the breast that was slightly itchy she thinks, but doesn't know for certain.  She started having kneee complaints.  She saw (a physician) who placed her on doxycycline 100mg per mouth twice daily for five weeks.  This did not really help her.  Her knee pain might have improved a little bit, but she still has a right hip pain and left shoulder pain.  (The vaccinee problems over the last week with further pain in her ankles and for the last week and a half she has been on doxycycline 200mg per mouth twice a day by another physician.  She says that her rheumatoid factor and ANA (antinuclear antobody) were negative, but she does not have copies of these.  She had an x-ray of the back that revealed narrowing at L5 S1.  The patient says she had an x-ray of her right hip, but she did not have a copy of that x-ray report."  On physical examination, "extremities were remarkalble for some redness over the MCP (metacarpophalangeal) joints of the index and middle fingers of the left hand.  Otherwise, her exam was negative.  She had slightly similar redness of the same two joints of the right hand, but barely visible.  She had no other joint abnormalitites or skin abnormalities on examination."  The physician's assessment was "As I explained to the patient, I think that after all this time with these joint complaints her Lyme serology should be positive if she has Lyme disease...The patient has had the symptoms too long to be able to pick up IgM antibody for perviews 919 infection, but this is a possibility.  It was my impression that this patient basically came in wanting to get a course of intravenous Rocephin for Lyme...If the Western Blot is positive she should get a course of Recephin.  If it is negative she really needs a rheumatologic evaluation to rule out other entities in addition to Lyme disease.  I also recommened she stop the doxycycline as she could be having a serum sickness reaction to this drug.  She certainly has redness of the face and with respect to this I wanted to repeat an ANA, but I do't know if she is going to do this when she goes down to the lab."  Erythrocyte sedimentation rate and creatine kinase concentration were within the reference ranges .  Rheumatoid arthritis screen, Lyme IgG Western Blot, and Lyme IgM by immunofluorescent assay were negative.  On 06/11/1999, the physician wrote," I called patient.  Lyme Western blot negative...Recommended she see a rheumatologist."  The vaccines was seen by her opthalmologist 12/28/1999.  She told the ophthalmologist that she had been "diagnosed with Lyme disease" joint pain, seiatic pain-inflammation...Lyme disease two years (2/99)....Took LYMErix-positive neurologic symptoms one week.  Negative RA (rheumatoid arthritis).  Negative ANA.  Positive genetic testing-positive RA gene."  At that time, medications included Plaquenil twice daily, tobremycin, and doxycycline.  During her annual gynecological examination on 06/20/2000, the patient reported that she was taking Plaquenil and penicillin "for Lyme and sequeles."  During her annual gynecological examination 06/20/2001, the patient reported that she was receiving penicillin for the treatment of Lyme disease.  The patient returned to the ophthalmologist on 10/18/2001, 'complaining of shooting pain under both eyes times three weeks."  The patient also reported that she had a history of Lyme disease-currently being treated.  On Plaquenil-for arthritis."  Medications at that time included Plaqnuenil and penicillin 1.2 million units intramuscularly every week for nine weeks.  The opthalmologist recorded the medical history as "RA, Lyme".  The memory loss, Lyme disease auto-antibody response, cognitive difficulties, and worsening joint pain in this report are considered medically serious."