This report described the occurrence of mood swings in an approximately 42 year old male patient who received Lyme disease vaccine recombinant OspA for prophylaxis. This report was received as part of litigation proceedings, and has not been verified by a physician or other health care professional. The patient received his first injection of Lymerix on 3/3/00. At that time, he complained of joint pain in  his hands and shoulder, and hand cramps. There was no swelling. The physician made diagnoses of tenosynovitis of the dorsum of the left hand and bilateral subdeltoid inflammation and bursitis. The patient wishes to have it treated. The physician prescribed a four inch Ace bandage, applications of moist heat, and flurbiprofen. The physician wrote "he is to have his Lyme series of injections." No adverse events were recorded in the office notes following this dose of vaccine. The patient received his second dose of Lymerix on 4/7/00. No adverse events were recorded in the office notes provided by the patient's attorney. On 9/3/03, the patient's attorney alleged that the patient "suffered flu-like symptoms within one week of his first vaccinations. After his second vaccination, he noted worsening flu-like symptoms with joint pain, severe fatigue, rashes, tingling in his toes, memory problems, concentration problems, and mood swings." Time to onset of these events, treatment, and outcomes were not reported. On 15 September 2004, the patient's attorney alleged that the patient experienced "severe joint pain, fatigue tingling, memory loss, concentration problems, and dizziness." Time to onset, treatment and outcomes were not reported. Follow up information was received on 14 August 2006 via the attorney, who reported that the patient had a history of Lyme disease. Immediately following his second LYMERIX vaccination in April 2000, the patient experienced "adverse rheumatologic and neurological pain" and neuropsychological dysfunction. Symptoms included pain in the arms and hands, fatigue, headaches, numbness and pain in the arms and legs, joint achesm mood disturbance, and memory loss. "Immediate treatment included intravenous ROCEPHIN, without resolution of symptoms. The patient was subsequently diagnosed with chronic inflamatory demyelinating polyradiculoneuropathy and encephalopathy. Neuropsychological testing reportedly revealed impaired learning and memory with variable performance in attention, concentration, and deductive reasoning. According to the attorney, the patient "is currently debilitated", and received monthly treatment with intravenous immunoglobulin. The events were unresolved at the time of this report. Follow up informaiton was received on 10 October 200 via medical records. Medical history included a cervical spine fracture with back pain, degenerative changes if the lumbar soine, and headaches. Prior to receiving LYMERIX, in November 1998, complaints included difficulty with memeory, trouble problem solving; and feeling a bit hesitant mentally. The patient was reportedly diagnosed with Lyme disease in 1990, but initially developed a bull's eye rash in 1997. On 30 May 2000, his physician noted that the subject reported fatigue and weariness, and his physician noted that the subject "almost reveals hypochondria". In June 2000, the patient reported fatigue and tireness which he believed to be the result of relapse of Lyme disease. Treatment included amoxicillin. A progress note date 31 July 2000 indicated that the subject had a "fixation on his Lyme problem", and it was indicated that his problem might have an emotional component. On 03 August 2000, the subject presented withcomplaints of some short-term memory loss. He was diagnosed with active Lyme disease with a possible cerebrospinal fluid component, and was hospitalized. Treatment included intravenous ROCEPHIN, ANCEF and Llactated ringery, and Hickman catheter subsequently placed. By 23 August 2000, the subject was described as 35 percent improved overall, with continued fatigue and ability to work intermittently. On 13 March 2002, the pattient expereinced fatigue, dizziness, headaches, joint (elbow) pain and left hand pain, memory difficulties with lost of concentration, diminished strength and stamina, and "stomach problems". The subject noted that the symptoms worsened with stress. According to a progress note dated 13 July 2002, the subject claimed that he had been receiving ceftin for approximately one and a half year for treatment of chronic Lyme disease. Physical examination revealed vitiligo, which he "blames...on the Lyme disease". The physician prescribed coftin "out of courtesy" and was encouraged to return to his primary care provider. In February 2002, the patient was evaluated for low back pain with guarded range of motion. Treatment included FLEXERIL and DARVOCET. Additional treatment medication included amitryptiline, nystatin, FLAGIL, and VIOXX. In June 2003, the subject was reportedly advised that "the (Lyme) infection is reportedly building up in his system again", with symptoms of chronic joint pain, numbness, and tingling. Treatment with erythromycinwas prescribed at that time, in addition to ATIVAN which replaced PAXIL for anxiety. On 06 January 2004, the subject was evaluated for memory problems and blurred vision "in the hetting of a history of Lyme disease in 1999". Impressions upon evaluation included memory complaints, fatigue, joint pains, anxiety and depression, and Lyme disease. On 19 July 2004, the subject underwent a neuropsychological evaluation for cognitive problems that he associated with complications resulting from LYMERIX vaccine. At the time of examination, physical problems included chronic fatigue, dizziness, and headaches which occurred on an almost daily bases. Additional complaints included blurred vision, bilateral leg cramps with pain and stiffness, and photosensitivity. According to the patient, following LYMERIX vaccination, in 2000 he developed cognitive problems including difficulty remembering recent information (eg. details of conversations, name of people, appointments, etc.), difficulty concentrating, difficulty analyzing problems, and speech and language problems including "sometimes mixing up words". testing revealed "relative impairment on measures of naming and memory, with variable performances on tasks of attention/concentrationa and mild weakness on a measure of deductive reasoning. It was also noted that the subject was experienicing emotional distress as a result of his symptoms, including depression, stress, and anxiety. On 03 August 2000, the subject knelt on a nail and subsequently developed knee pain " for a long time" requirirng antibiotic therapy. This was considered to be an incidental finding on review of medical record. Future expedited VAERS reports for this LYMERIX case shall be referrenced to RR-IND 5420, which is a change frompast reports referencing the voluntary revoked license (STN 1037571).