This report described the occurrence of hand pain in a 42 year old male patient who received Lyme disease vaccine recombinant for prophylaxis. This report was received as part of litigation proceedings. Medical records were subsequently received. The patient's attorney reported that Vaccinations began after 1998 and he had three; but, the dates are not known by the client. Most likely, the vaccinations were administered in 1999 as the client was not in the clinical trials. On 9/3/03, the patient's attorney alleged that the patient suffered hand, shoulder and neck pain after his third vaccination. The onset of his symptoms is not clear at this time. Treatment and outcomes of the alleged events were not reported. The following information was provided via medical records. Medical history included right shoulder discomfort approximately one and a half years following Bristow shoulder reconstruction, with mild rotator cuff tendinitis and impingement, in addition to nephrolithiasis. The patient received his initial Lymerix vaccination on 4/29/99, his second Lymerix vaccination on 5/25/99 and his third Lymerix vaccination on 3/14/00. Approximately 11 months after his third Lymerix vaccination, in February 2001, the patient complained of multiple joint involvement with swelling and pain, and the evaluating physician suspected an underlying rheumatologic condition. The physician commented that the patient's musculoskeletal pain seemed primarily structural or myofascial without evidence of inflammatory arthritis. No synovitis was palpable, and the physician stated I would think that if he had a musculoskeletal side effect from Lyme disease vaccine, I would have expected an inflammatory pattern. Treatment with Sulindac was started. It was noted that the patient had seen a chiropractor for neck/hip pain which had started approximately October 2000. Magnetic resonance imaging revealed a small cyst on the superior aspect of the femoral neck, with the appearance of a benign lesion. The following month, a whole body scan revealed mild arthritic changes at the left hip, mild arthritis in the right knee, and mild arthritis in the neck at C2 through C3. Moderately increased uptake was seen at both sacroiliac joints, and was noted to be consistent with arthritis or mechanical stress. The physician commented I still can't conceive that this is related to the Lyme disease vaccine. There is not evidence of true inflammation. Re-examination for arthralgia revealed decreased hand and shoulder pain, although the back of necks and hips continued to hurt. Labs were unremarkable with the exception of elevated C-reactive protein and rheumatoid factor. His symptoms were improved on Sulindac. Radiography was performed on 3/11/02 for a history of neck pain and osteoarthritis, and revealed a mild degree of degenerative spondylotic changes at the C5-C6 level, with moderate narrowing of the C5-C6 interspace. In April 2002, only left trochanteric pain persisted. On 7/18/02 he was evaluated for right posterior shoulder pain following weight lifting. He was diagnosed with right rotator cuff tendintiis with weakness, and was instructed in appropriate home rehab, anti-inflammatories, and activity modification. Shoulder pain persisted, and the following month he received an injection of Kenalog and Xylocain in the subacromial space. Additional treatment included extra-strength Tylenol and ibuprofen. Following the reported onset of hand, neck, and shoulder pain, the patient experienced sinus infection, right flank pain possibly attributable to irritable bowel syndrome or lactose intolerance, nephrolithiasis, hypertension, slight cardiac hypertrophy, prolapsed mitral valve with regurgitation, gastritis, Gilbert's syndrome, elbow injury, and lipoma. These were not reported as adverse events due to vaccine administration, but were found during the course of review of the patient's medical records. Therefore, they are not listed as adverse events. The most recent information received on 12/8/03, did not provide the outcome of the reported adverse events.