This case was reported by a lawyer and described the occurrence of joint pain in a male subject of unspecified age who was vaccinated with LYMERIX. A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of LYMERIX. At an unspecified time after vaccination with LYMERIX, the subject experienced joint pain, flu-like symptoms, tingling in extremities, numbness, shooting pains, possible memory loss, headaches, possible neurological injuries, possible autoimmune disease, and decreased activities of daily life. At the time of reporting the outcome of the events was unspecified. This information was received via a Statement of Injuries. Follow up information was received on 06 October 2008 via medical records. The subject had a "long history" of knee pain since the early 1980's, with knee injuries in the 1980's and 1997 to the left and right knees respectively, knee arthroscopy, a partial meniscectomy to the left knee, and an open meniscectomy to the right knee. The subject was possibly vaccinated with LYMERIX in March 1999. In June 1999, the subject was evaluated for right knee pain and was assessed as having probable osteoarthritis complicated by the subject's weight. The subject was vaccinated with LYMERIX on 14 March 2000 (0.5mL, intramuscular, left deltoid), and on 04 August 2000 (0.5 mL, intramuscular, left deltoid). On 27 March 2000, the subject reported left foot numbness. On 09 August 2000, the subject was evaluated for complaints including low back pain and sciatica, and progress notes  indicated "LYMERIX/OA, check HLA-DR4 today". HLA-DR4 was positive. In December 2000, the subject was evaluated for sciatica, back pain, and intermittent burning and pain down the back of the left leg with associated numbness. He reported temporary relief of back pain with chiropractic manipulation. In March 2001, he experienced osteoarthrosis and unspecified disc degeneration. On 20 June 2002, progress notes indicated "received Lyme vaccine in past". At that time, the subject experienced bilateral elbow burning sensation (possible increased use at work), occasional pain on waking, and occasional numbness and tingling of the hands. The subject was provided with a wrist splint. Assessment also included left leg osteoarthrosis, bilateral knee osteoarthritis, and joint/ elbow pain "? related to Lyme vaccine, possible carpal 2002 tunnel variant ". Cartilagenous damage to the knee was confirmed by magnetic resonance imaging. On 17 September 2002 he was seen for an opinion regarding knee and back problems, and diagnoses included advanced severe tri-compartmental bilateral knee degenerative joint disease and lumbar degenerative disc disease. The patient was referred to an orthopedist on 17 October 2002 due to the knee osteoarthritis involving all three compartments of the knee. The orthopedist commented "it is quite honestly one of the worst cases I have seen in someone this young". He had previously been treated with cortisone injections which provided relief for only three to four weeks, and joint replacement was assessed as the subject's "best option". The subject was hospitalized on 09 December 2002, and on the same date underwent left uncemented total knee arthroplasty due to post-traumatic left knee osteoarthritis. He was discharged on 12 December 2002, with discharge medications included Percocet and Coumadin. Other treatment medications for the subject's knee problems included Vioxx, Bextra, and Celebrex. The patient was re-hospitalized on 24 February 2003, and on the same date he underwent uncomplicated right uncemented total knee arthroplasty. He was discharged on 27 February 2003. On 01 May 2003 he was seen for post surgical follow up diagnosed with right knee pre-patellar bursitis, which persisted on 02 June 2003. He was seen for follow up of bilateral total knee arthroplasties on 08 July 2003, and assessment included recurrent pre-patellar bursitis on the right knee, which was aspirated. Treatment also included physical and occupational therapy.