This report describes the occurrence of panic disorder and depression in an adult female of unspecified age who was vaccinated with Lyme disease vaccine recombinant OspA for prophylaxis. This report was received from the subject and has not been verified by a physician or other health care professional. The subject's medical history, concurrent conditions, and concurrent medications were not reported. The subject stated that she received her first injection of LYMErix on 6/9/99. She reported that on "that very day," she experienced racing of the heart and a feeling of faintness. She reported that her "doctor dismissed these side effects, saying they had nothing to do with the vaccine." The subject reportedly received her second injection of LYMErix on 7/8/99. She stated that the heart racing and feeling of faintness recurred that day, she also stated, because of the recurrence, "there was no doubt the reaction could only be to the vaccine." She reported that "since this initial reaction to the vaccine, I experienced these side effects, like my heart racing, compounded with other side effects, which were clinically diagnosed as depression and a panic disorder." She reported that she could not enjoy outdoor recreational activities, "as they trigger my panic disorder." She also reported that she had been hospitalized and taken "extensive medical leaves from work." She attributed the depression and panic disorder to "the chemical imbalance this vaccine afflicted my body with." As of 1/5/03, the depression and panic disorder reportedly persisted. Follow up on 11/14/2003: "On 09/03/2003, the patient's attorney alleged that the patient "suffered palpitationis, pain, left arm discomfort, fatigue and neck and shoulder complaints.  The onset of her symptoms is not clear at this time."  Treatment and outcome of the alleged events were not reported.  On 10/30/2003, it was determined that the report received from the attorney on 09/03/2003 referred to this patient.  All information received from the attorney has been merged into this case which will remain the case of record for this patient." Follow up on 12/23/04: "The following information was obtained from medical records.  The pt was seen by her primary physician from 08/27/01.  The pt reported that she "had not had any problems with anxiety or depression until about two years ago (1999)."  She had been through a "difficult emotional time and then when it was pretty much resolved she went down to Florida for some time off and was hit by a pretty classic sounding panic attack."  She was evaluated in the ER and her symptoms were believed to be panic attacks.  She was prescribed paroxetine (Paxil) and clonazepam (Klonopin).  The pt did well on the medication and then discontinued therapy without further recurrence of any attacks.  Two years later in 2001 the pt began having panic attacks again after making a major move to care for her ailing mother.  The attacks started after her home was sold and everything settled down again.  Paxil and Klonopin were restarted again with good results.  On 03/25/02 the pt was doing well after discontinuing Paxil and Klonopin.  In 10/02 the panic attacks returned with palpitations and tingling feeling in her head.  The pt reported that "the panic would be caused by any known precipitant."  The pt was hospitalized on 11/30/02 with depression and suicidal thoughts with a plan to overdose. She also noted more frequent anger and irritability.  She reported that "her panic disorder began in June 1999, following a Lyme vaccine.  She reported getting a panic attack shortly afterwards and then when she went for a followup vaccination some time later, she had another panic attack with no panic attacks between the two injections."  The pt was treated for depression with Celexa and Klonopin.  The pt was discharged after 11 days.  She was to be seen by an outpt psychotherapist.  The psychologist prescribed quetiapine fumarate (Seroquel) for depression.  The pt became more depressed on this medication and it was stopped.  She was then started on an Lexapro but her symptoms never improved.  It was recommended that she go back to the hospital.  The pt was admitted to the hospital again for worsening depression on 04/06/03.  The pt reported that she is "starting to have an intense fear of getting out in public."  The psychiatrist noted that the pt was becoming more angry and irritable with insomnia.  The pt was treated with Klonopin, Seroquel and Sonata.  The pt was re-admitted to the hospital on 09/16/03 for complaints of depression, suicidal thoughts, and chest pressure.  Treatment medications included mirtazapine (Remeron), Klonopin and Lexapro.  The pt was discharged on an unknown date.  On 01/13/03, the pt was evaluated by her PCP for depression, arthralgias and fatigue.  She dates the onset of her depression to "after receiving the Lyme vaccine in June 1999."  The pt also reported that she "had discovered that there is a class-action suit involving individuals with symptoms similar to hers since the vaccin.  She also has diffuse joint pains since that time."  She denied having swollen or red joints or rashes.  Pt also complained of tightness in the left arm and sharp pain in the right arm.  Physical examination revealed "no evidence of joint destruction." Western blot Lyme test was negative.  Following the reported onset of panic disorder and depression, the subject experienced joint pain, arthralgias, migraines, mood swings, vitamin A toxicity, and sinusitis.  These were not reported as adverse events due to vaccine administration, but were found during the course of review of the pt's medical records.  Therefore, they are not listed as adverse events.  The most recent information received on 12/08/03 did not reveal the outcome of the events. "