The patient reported that she received her 1st dose of Lymerix on 03/18/99. She stated, "Within days I began to have terrible pain in my right knee. The pain was accompanied by swelling and heat in my knee. It felt to me like arthritis". The patient stated that she reported her symptoms to her physician on 04/15/99. She reportedly received her 2nd dose of Lymerix on 04/15/99. The knee pain and swelling persisted, and she was referred to another physician, who prescribed physical therapy. The patient reported no relief with physical therapy. The patient reported that she received had 3rd injection of Lymerix on 04/06/00. She stated " My pain and swelling continued to escalate and on 04/22/00, I had arthroscopic surgery on my right knee. [The physician] found that the cartilage in my knee had been destroyed. I went through another course of physical therapy and an extended recovery period but now find that I must have a total knee replacement. In the meantime, I have developed pain in the little finger of my right hand, my right shoulder, my left knee and elbow and both my hips. Life as I knew it was over and my pain has become almost intolerable. I am taking various pain medications and am facing surgery and a long recovery. I believe that my condition has been caused by your product." The patient also stated that she can not sleep "due to the pain". The vaccinee was seen by the vaccine provider on 4/22/99 for follow up on right kneww not feeling better. Onset of the knee problem was not provided. The physician's impression/diagnosis was "right knee pain. rule out meniscal tear." He prescribed Celebrex 200mg twice daily and ordered an x-ray of the knee. The results of the x-ray were not provided. The vaccinee returned to the physician on 4/26/99, reporting "no improvement" in right knee pain. The physician prescribed Relafen 1900mg daily, a knee supportere, and physical therapy. He referred the vaccinee to an orthopedist. On an unspecified date, the vaccinee underwent MRI of the right kneww and a bone scan(results not provided). On 7/26/99, the vaccinee was referred to a neurologist for an unspecified reason. No further mention of the vaccinee's knee, or any orthopedic complaints was made in the vaccine providers office records until 2/24/00. The vaccinee presented to the physician on that date for blood pressure check. Has question about arthroscopic surgery. The vaccinee returned to the physician on 3/9/00 for pre-surgery testing on right knee: the surgical clearance form indicated that the vaccinee was to undergo arthroscopic surgery on the right knee on 4/18/00. The diagnosis on the clearnace form was osteoarthritis. Medications at that time included glucosamine 500mg daily, chondroitin 1000mg daily, Premarin .3mg daily, lisinopril 20mg/Zestroatic 12.5mg one tablet daily, and Norvasc 5mg daily. The physician's impression/diagnosis were recorded in the office note as 1. Hypertension. 2. Right knee pain. The vaccinee returend to the physician on 4/6/00 for blood pressure check. She requested a referral to a chiropractor. She also received the third injetion of Lymerix. The physician's impressions/diagnosis were 1. Right knee pain. 2. OA (osteoarthritis). The next mention of orthopedic complaints was made on 6/6/00, when the vaccinee returned to the physician "for follow up on orthopedic surgery. Patient complains of right and left ankle swelling. They physician's impression/diagnosis were 1. Hypertension. 2. Osteoarthritis. He prescribed NSAID (nonsteroidal anti-inflammatory drug). P.T. (physical therapy). The vaccinee returned to the physician to have her blood pressure checked on 6/30/00. They physicain's diagnosis were 1. Essential hypertension. 2. Edema. 3. Arthralgia. He prescribed a daily multivitamin. The physician saw the vaccinee on 9/22/00. The reason for the visit was recorded as "follow up on increased blood pressure, referall for MRI neck, back, ?. Medications at that time included Lestorestic, Norvasc, Premarin, Neurtontin 300mg daily as needed that had been prescribed by another physician, and ? 10mg daily as needed that had been prescribed  by another physician. The physician's impression/diagnosis were 1. Neck/back pains. 2. Hypertension. 3. Knee. On 11/6/00, antinuclear antibody ? and rheumatoid factor were negative. On 12/7/00, the vaccine provider noted that the vaccinee was taking Motrin 800mg daily, Zestoratin, Norvasc, and Premarin. The next mention of orthapedic complaints in the office records was made on 5/25/01, when the vaccines presented to the physician to discuss surgery on knee". The vaccinee reported that she was takin Neurontin 300mg as needed, extended-release diclofenac sodium (Voltaren XR) 100mg as needed, Zestroretic, Norvasc, and Premarin. The physicia's impression/diagnosis were "polyarthritis, osteoarthritis, hypertension". The vaccinee had repeat bloodwork performed on 12/6/01. On 9/13/01, the vaccinee complained of "mild ankle swelling". The vaccinee returned to the physician on 9/20/01 with "both swollen ankles - patient feels good." The ony medications reported by the vaccinee were Zastroretic and Norvasc. The physician's impression/diagnosis were "hypertension, Increased uric acid - ? Gout, increased cholesterol." No futher mention of orthopedic complaints was made in the office notes, which continued to 1/31/02. Medications on 1/31/02 included Zestoretic, Norvasc, Levoxyl 75mg daily, Votaren XR 100mg as needed, Motrin 800mg as needed, Aleve as needed, and Neurontin 300mg as needed. The most recent information received by 5/2/02, did not provde the outcome of the reported events. As of 9/20/01, the vaccinee had swelling of both ankles, but she "feels good".  The destroyed" knee cartilage is considered  medically serious by the manufacturer.