This case was reported by a lawyer and described the occurrence of joint pain 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 joint pain, flu-like symptoms, swelling, muscle pain, numbness, shooting pains, headache, weakness, possible nerve injury, possioble autoimmune disease, activities of daily living impaired, heart problems, fatigue and possible memory loss. 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 23 July 2007 via medical records. The subject was a 48 year old female who was vaccinated with LYMErix on 25 May 1999, 26 June 1999, and 20 May 2000. In approximately November 2000, the subject developed sudden onset of left knee pain especially when walking. She was evaluated on 07 November 2000, and examination revealed left anterior knee swelling without decreased range of motion. Assessment was of tenosynovitis, and Clinoril was initiated. She continued to experience pain, and Vioxx was prescribed on 20 November 2000. By 28 November 2000, she also began experiencing right knee pain and physical examination showed widened knee joint. Prednisone was initiated for ongoing tenosynovitis. Lyme and rheumatoid titers were negative. She was evaluated by an orthopedist on 12 December 2000, who observed mild varus deformity of both knees resulting in an assessment of early osteoarthritic changes of the knees. Vioxx was continued, and Mobic was prescribed. In approximately September 2001, she experienced numbness and tingling in her left arm, and in October 2001 was evaluated for left arm pain. She was diagnosed with paresthesias. In November 2001, she experienced an anterior myocardial infarction and underwent a cardiac catherization and coronary artery stent placement. She was re-evaluated by a cardiologist on 06 December 2001 with "brief twinges of chest pain but no chest pressure like her initial presentation for her myocardial infarction." Complaints included fatigue, dyspnea on exertion, and occasional lightheadedness. Medications included Atenolol and Plavix. Cardiologist's impression was of coronary artery disease, status post-myocardial infarction with angioplasty of left anterior desceding (LAD0 artery. Her chest pain was considered to be unlikely cardiac in nature. On 12 December 2001, a myocardial perfusion scan showed abnormal findings consistent with infarct with a relatively small area of ischemia. She was  hospitalized on 20 December 2001 and underwent a second cardiac catherization on 21 December 2001. On 08 March 2002, she was hospitalized with atypical left arm symptoms of "thickness and heaviness and some paresthesias in the left forearm which occurred following a 45-minute walk. Medications at the time of admission included aspirin (81 mg), atenolol, sublingual nitroglycerin, in addition to Claritin, Prilosec, and Carafate. She reported feeling lightheaded "all the time". She was discharged the following day following a negative stress test. On 13 August 2002, diagnostic findings included normal left ventricular function with focal hypokinesis, trace mitral regurgitation, and trace tricuspid regurgitation. She continued to experience ongoing fatigue. By July 2003, she was noted to have stable coronary artery disease with "excellent" secondary prevention efforts, in addition to carotid calcification, chronic continuous left arm pain, and a "dropping feeling" (very low likelihood that it is cardiac). On 21 February 2004, the subject was evaluated for a three week history of calf pain of unclear etiology. In October 2004, she developed lateral elbow pain aggravated by activity, and received a working diagnosis of lateral epicondylitis treated with Naprosyn. Upon cardiology examination on 26 January 2005, she continued to experience rare atypical chest pain "which is unchanged over the past few years". She reportedly generally felt welt, and walked 20 to 25 miles per week. She was switched from Lipitor and Zetia to Crestor in an effort to improve lipid management. In September 2005, she again presented with left knee pain accompanied by crepitus and swelling. She was advised to ice her knee after walking and to treat pain with ibuprofen. X-rays showed mild narrowing of the medial compartment and osteopenia. On 08 February 2006, cardiac evaluation revealed that the subject continued to do an "excellent job regarding secondary prevention" of coronary artery disease, although she was not at goal lipid levels. Beginning in 2001, treatment for depression was initiated and included Celexa, Effexor, and Wellbutrin SR. In February 2002, the subject was diagnosed with borderline anemia, and in March 2002 and April 2002 was evaluated for leukopenia, macrocytosis and vitamin B12 deficiency. She was also diagnosed with gastroesophageal reflux disease and Barrett's esophagus, and it was noted that she experienced myalgias associated with Crestor therapy. These were considered to be incidental findings upon medical record review.