This case was reported by a lawyer via a statement of injuries and described the occurrence of arthralgia in a female subject of unspecified age who was vaccinated with Lymerix for prophylaxis. A physician or other health care professional has not verified this report. On an unspecified date the subject received unspecified dose of Lymerix (unknown). At an unspecified time after vaccination with Lymerix, The subject experienced arthralgias and myalgias, especially in her knees, shoulders, hips, back and neck. She also experienced fatigue characterized by the reporting attorney as "debiliting". The statement alleged that the events "negatively impacted her activities of daily living and enjoyment of life. At the time of reporting the outcome of the events were was unspecified. Follow up information was received on 21 March 2007 via medical records. No information regarding specific dates of Lymerix vaccination and/or onset of symptoms were received. The subject was estimated to be in her fifties at the time of onset of the reported events. The following information was obtained from medical records provided by the subjects orthopedist: On 25 August 1999, the subject was evaluated for complaints of right knee pain on and off; at that time, medication included Relafen. In September 1999, she returned "essentially with no severe complaints of pain or discomfort about the knee. Physical examination revealed mild effusion of the right knee without significant joint tenderness. Upon evaluation on 18 April 2002, complaints included left shoulder pain with a sense of grinding and popping at times. At that time, she was receiving Relafen for "other degenerative changes about her knees and lower back area". Impression was of degenerative changes as well as impingement syndrome in the shoulder, and treatment included Solumedrol. On 03 July 2003, she presented with intensification of left shoulder and right knee "symptomolology". By 25 July 2003, she had been diagnosed with reactive tenosynovitis in addition to known degenerative changes, and she was treated wit an unspecified "local injection". She was seen for follow up on 06 November 2003, with left shoulder pain characterized as "Status Quo" and "symptomatic" knees that required treatment with a brace. On 19 February 2004, 26 February 2004, and 04 March 2004 she received Synvisc injections in her left knee. IN July 2006, the subject was evaluated for left shoulder pain, hip pain, osteoarthritis, degenerative disc disease, lower back pain, and knee pain and effusion. She subsequently noted increased function and decreased pain. On 21 July 2004, she was evaluated for diagnoses of significant basal joint arthrosis and carpal tunnel syndrome of the right wrist. The wrist was injected with Lidocaine and Celestone, and was assessed to be resolving by 04 August 2004. On 16 August 2004, she began receiving Synvisc for treatment of the right knee, which was completed on 30 August 2004. On 22 June 2005, she underwent release of right carpal tunnel with median nerve epineurolysis. Synvisc treatment of the left knee was repeated in August 2005, and of the right knee in September 2005. On 01 September 2005, she presented for carpal tunnel release, and was noted to be "doing well without complaints of pain and or discomfort". On 30 January 2006, she returned wit a chief complaint of left shoulder pain, and impression was osteoarthritis of the left shoulder. Treatment included Kenalog and cortisone, and the subject was instructed on stretching techniques. The physician noted that at some point in time in the future she will probably necessitate total shoulder arthroplasty. In May 2006, she experienced "re-exacerbation of symptoms secondary to osteoarthritis of the left shoulder", and cortisone injection was repeated. Synvisc in the right knee was repeated in September 2006 and October 2006. Radiology on 25 July 2006 showed advanced degenerative arthritis of the left shoulder "possibly due to prior trauma or osteonecrosis", advanced osteoarthritis of both knees, "significant" degenerative changes of the right thumb joint, severe left hip osteoarthritis, moderate scoliosis of the distal lumbar spine, with secondary spondylosis and facet arthropathy, and two suspected exostoses at the time of the left thumb joint. The following information was received via medical records provided by the subjects rheumatologist" At 17 years of age, the subject underwent a right knee arthrotomy for a torn meniscus, an in 1990 underwent right knee arthroscopy. On 10 July 2006, the subject reported that she received "Lyme vaccine three or four years ago. Upon examination, complaint included fatigue, occasional edema, and muscle weakness, and she noted that past treatment with Celebrex and Bextra had been ineffective. Physical examination was consistent with osteoarthritis in multiple joints including the thumbs, knees, hips and shoulders. Diagnostic tests "did not show any sign of an inflammatory arthritis or other connective tissue disease". On 02 October 2006, the subject was evaluated for complaints of persistent aches in the knees, hips, left shoulder, lower back, and neck, crepitus of the cervical spine, and severe osteoarthritis of multiple joints. She reported "some relief" with Lidoderm patches, Ultracet, Arthrotec, Glucosamine, and Tramadol. Assessment following examination included severe osteoarthritis of multiple joints and left trochanteric bursitis.