Shortly following the 3rd dose, the pt became acutely more symptomatic. On 10/30/00, he was seen by a rheumatologist. Approximately three weeks post vax, the pt had severe bilateral knee pain. On physical exam, the knees were warm and an effusion was detected. Arthrocentesis of one knee yielded joint fluid that was interpreted by the reporter as consistent with osteoarthritis and not an inflammatory arthritis. The results of joint fluid analysis are not available at this time. As of 11/2/00, the outcome is ongoing. The follow up states the vaccinee is intolerant of Relafen, Ketoprofen, Daypro, and Butasolidin. The vaccinee gives a two year history of pain and tenderness of the carpel metacarpal joints at the base of the thumb. He also has a history of right shoulder bursitis. He denies any symmetrical arthritis and there is no generalized prolonged morning stuffness. He has no symptoms to suggest lupus and there is no history of psoriasis, colitis or dry eyes. He has hypertension and a heart murmur. In September 1999, November 1999, April 2000, and on 4/4/00, the vaccinee received his first, second, third and fourth doses of Lymerix, respectively. 31 days after receiving his fourth dose of Lymerix, on 5/5/00, the vacinee became acutely more symptomatic and experienced the sudden onset of severe stiffness and swelling of both knees. The onset coincided with the vaccinee's turkey hunting. X-rays showed degenerative joint disease. A subsequent MRI confirmed a partialy torn cruciate ligament at least in the left knee. The vaccinee's bilateral knees wee injected with deposteroids which reportedly did not help is situation. On 7/30/00, he underwent arthroscopy of the left knee and was told he had moderate degenerative joint disease. At this time, he was tried on a number of NSAIDS and he continued to have symptoms without much relief, despite the steroids injections, arthroscopy, and nonsteroidals. On 10/30/00, he was seen by a rheumatologist. On physical examination, the knee were warm, and an effusion was detected on x-ray. The knee x-ray showed degenerative changes with medial joint compartment narrowing. The joint examination revealed a few Heberdon's nodes of the index fingers. There was slight tenderness of the carpal metacarpal joints. The rheumatologist's impression was that the vaccinee had generalized osteoarthritis of the knees. The vaccinee also had a history of hypertension. The rheumatologist stated that the Lymerix booster shots seemed to induce, within weeks of administration, makred increase in the pain, stiffness, swelling, and warmth of both knees. The vaccinee was treated with Tylenol extra-strength and Voltaren XR. Vioxx was discontinued. The rheumatologist injected the left knee with 1ml of Depo-Medrol. The results of synovial analysis are listed in the lab values section. Additional studies, including radiograms and lab analyses are planned. Rheumatoid factor, and ANA were negative. Sedimentation rate was 5, WBC with differential was normal. Blood chemistry was normal. This case is considered serious since the reporting physician stated that the adverse events resulted in permanent disability. As of 11/15/00, the outcome of the events is ongoing.