Age: 48.0
Sex: F
Vaccine: COVID19, COVID19, COVID19
Symptoms: Onychomadesis, Pain, Pain in extremity, Palpitations, Petechiae
Clinical narrative: mini-stroke/difficulty articulating speech/vision is deteriorating; Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)/feel constant malaise/could not longer exercise/debilitating fatigue/feeling unwell/brain fog/ severe headaches/insomnia/heart palpitations/highly sensitive to light and noise; Chronic EBV/During EBV flare their body breaks out in rashes that travel from head down to toes/ I developed an unexplained rash with itching on my lower legs, ankles, and feet/unexplained weight loss/feel constant malaise; RheumatoidArthritis RA /Significant joint inflammation; high blood pressure; MONO; fibromyalgia; flares affect their digestive system, causing pain, IBS symptoms, and severe constipation; petechiae; flares affect their digestive system, causing pain, IBS symptoms, and severe constipation; popping in their hips, shoulders, and neck when walking; bipolar depression/agitation/depression; flares affect their digestive system, causing pain, IBS symptoms, and severe constipation/The pain often travels down one leg and exits through a toe; trigeminal neuralgia flares; complete loss of libido; extreme muscle loss; The pain often travels down one leg and exits through a toethree toenails have detached so far; also suffer from unexplained thigh pain; heart palpitations; Pain often travels down one leg and exits through a toe; also suffer from unexplained thigh pain; Pain often travels down one leg and exits through a toe; shingles/rash with itching on my lower legs, ankles and feet; This spontaneous case was reported by a consumer and describes occurrence of TRANSIENT ISCHAEMIC ATTACK (mini-stroke/difficulty articulating speech/vision is deteriorating), CHRONIC FATIGUE SYNDROME (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)/feel constant malaise/could not longer exercise/debilitating fatigue/feeling unwell/brain fog/severe headaches/insomnia/heart palpitations/highly sensitive to light and noise), EPSTEIN-BARR VIRUS INFECTION (Chronic EBV/During EBV flare their body breaks out in rashes that travel from head down to toes/ I developed an unexplained rash with itching on my lower legs, ankles, and feet/unexplained weight loss/feel constant malaise), RHEUMATOID ARTHRITIS (Rheumatoid Arthritis RA/Significant joint inflammation), HERPES ZOSTER (shingles/rash with itching on my lower legs, ankles and feet), HYPERTENSION (high blood pressure), INFECTIOUS MONONUCLEOSIS (MONO), FIBROMYALGIA (fibromyalgia), IRRITABLE BOWEL SYNDROME (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation), PETECHIAE (petechiae), CONSTIPATION (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation), JOINT NOISE (popping in their hips, shoulders, and neck when walking), BIPOLAR DISORDER (bipolar depression/agitation/depression) and PAIN (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation/The pain often travels down one leg and exits through a toe) in a 48-year-old female patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 039B21A and 027C21A) for COVID-19 prophylaxis. The occurrence of additional non-serious events is detailed below. No Medical History information was reported. In May 2021, PT received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular use) 1 dosage form. In May 2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (Intramuscular use) dosage was changed to 1 dosage form. In January 2025, PT experienced TRANSIENT ISCHAEMIC ATTACK (mini-stroke/difficulty articulating speech/vision is deteriorating) (seriousness criteria hospitalization and medically significant). On 12-Feb-2025, PT experienced HERPES ZOSTER (shingles/rash with itching on my lower legs, ankles and feet) (seriousness criterion medically significant). On an unknown date, PT experienced CHRONIC FATIGUE SYNDROME (Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS)/feel constant malaise/could not longer exercise/debilitating fatigue/feeling unwell/brain fog/ severe headaches/insomnia/heart palpitations/highly sensitive to light and noise) (seriousness criterion medically significant), EPSTEIN-BARR VIRUS INFECTION (Chronic EBV/During EBV flare their body breaks out in rashes that travel from head down to toes/ I developed an unexplained rash with itching on my lower legs, ankles, and feet/unexplained weight loss/feel constant malaise) (seriousness criterion medically significant), RHEUMATOID ARTHRITIS (Rheumatoid Arthritis RA/Significant joint inflammation) (seriousness criterion medically significant), HYPERTENSION (high blood pressure) (seriousness criterion medically significant), INFECTIOUS MONONUCLEOSIS (MONO) (seriousness criterion medically significant), FIBROMYALGIA (fibromyalgia) (seriousness criterion medically significant), IRRITABLE BOWEL SYNDROME (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation) (seriousness criterion medically significant), PETECHIAE (petechiae) (seriousness criterion medically significant), CONSTIPATION (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation) (seriousness criterion medically significant), JOINT NOISE (popping in their hips, shoulders, and neck when walking) (seriousness criterion medically significant), BIPOLAR DISORDER (bipolar depression/agitation/depression) (seriousness criterion medically significant), PAIN (flares affect their digestive system, causing pain, IBS symptoms, and severe constipation/The pain often travels down one leg and exits through a toe) (seriousness criterion medically significant), TRIGEMINAL NEURALGIA (trigeminal neuralgia flares), LOSS OF LIBIDO (complete loss of libido), MUSCLE ATROPHY (extreme muscle loss), ONYCHOMADESIS (The pain often travels down one leg and exits through a toethree toenails have detached so far), the first episode of PAIN IN EXTREMITY (also suffer from unexplained thigh pain), PALPITATIONS (heart palpitations), the first episode of PAIN IN EXTREMITY (Pain often travels down one leg and exits through a toe), the second episode of PAIN IN EXTREMITY (also suffer from unexplained thigh pain) and the second episode of PAIN IN EXTREMITY (Pain often travels down one leg and exits through a toe). At the time of the report, TRANSIENT ISCHAEMIC ATTACK, CHRONIC FATIGUE SYNDROME, EPSTEIN-BARR VIRUS INFECTION, RHEUMATOID ARTHRITIS, HERPES ZOSTER, HYPERTENSION, INFECTIOUS MONONUCLEOSIS (MONO), FIBROMYALGIA, IRRITABLE BOWEL SYNDROME, PETECHIAE, CONSTIPATION, JOINT NOISE, BIPOLAR DISORDER and PAIN had not resolved and TRIGEMINAL NEURALGIA, LOSS OF LIBIDO, MUSCLE ATROPHY, ONYCHOMADESIS, PALPITATIONS, the last episode of PAIN IN EXTREMITY and the last episode of PAIN IN EXTREMITY outcome was unknown. DIAGNOSTIC RESULTS: 14-Sep-2020: EBV AB (3.4010.10 mil/µL): 11.97 mil/µL High  25-Feb-2021: Eosinófilos (0.00.6 mil/µL): 0.3 mil/µL EBV AB (3.4010.10 mil/µL): 10.36 mil/µL High HCT (35.946.1%): 39.8% Hb (11.615.4 g/dL): 13.1 g/dL IG (0.00000.0300 mil/µL): 0.0300 mil/µL Linfocitos (0.63.2 mil/µL): 3.1 mil/µL % Linfocitos (12.145.3%): 30.3% MCH (27.633.1 pg): 30.0 pg MCHC (31.334.9 g/dL): 32.9 g/dL MCV (83.799.5 fL): 91.1 fL MPV (9.212.2 fL): 11.1 fL Monocitos (0.20.9 mil/µL): 0.6 mil/µL % Monocitos (4.412.5%): 6.2% Neutrófilos (1.46.8 mil/µL): 6.2 mil/µL Plaquetas (126432 mil/µL): 333 mil/µL Proteínas totales (6.68.7 g/dL): 7.4 g/dL RBC (4.005.30 M/µL): 4.37 M/µL  07-Sep-2021: Eosinófilos: 0.2 mil/µL EBV AB: 8.62 mil/µL HCT: 39.7% Hb: 13.1 g/dL IG: 0.0400 mil/µL High Linfocitos: 2.4 mil/µL % Linfocitos: 27.3% MCH: 29.8 pg MCHC: 33.0 g/dL MCV: 90.4 fL MPV: 11.2 fL Monocitos: 0.5 mil/µL % Monocitos: 5.6% Neutrófilos: 5.4 mil/µL Plaquetas: 322 mil/µL Proteínas totales: 6.8 g/dL RBC: 4.39 M/µL  11-Jan-2022: Eosinófilos: 0.4 mil/µL EBV AB: 8.81 mil/µL HCT: 43.5% Hb: 14.5 g/dL IG: 0.0600 mil/µL High Linfocitos: 2.5 mil/µL % Linfocitos: 28.5% MCH: 30.1 pg MCHC: 33.3 g/dL MCV: 90.4 fL MPV: 11.4 fL Monocitos: 0.7 mil/µL % Monocitos: 7.8% Neutrófilos: 5.1 mil/µL Plaquetas: 325 mil/µL Proteínas totales: 7.7 g/dL RBC: 4.81 M/µL  23-Feb-2022: Eosinófilos: 0.0 mil/µL HCT: 39.0% Hb: 13.1 g/dL IG: 0.09 mil/µL High Linfocitos: 3.0 mil/µL % Linfocitos: 19.9% MCH: 29.9 pg MCHC: 33.6 g/dL MCV: 89.0 fL MPV: 10.6 fL Monocitos: 0.6 mil/µL % Monocitos: 4.1% Low Neutrófilos: 11.2 mil/µL High NRBC (0.00.2/100 WBC): 0.0/100 WBC Plaquetas: 333 mil/µL Proteínas totales: 7.2 g/dL RBC: 4.38 M/µL WBC (5.410.8 mil/µL): 15.0 mil/µL High  02-May-2022: Basófilos: 0.06 mil/µL % Basófilos: 0.6% Eosinófilos: 0.36 mil/µL % Eosinófilos: 3.6% EBV AB: 9.96 mil/µL HCT: 41.0% Hb: 13.5 g/dL IG: 0.05 mil/µL High Linfocitos: 2.79 mil/µL % Linfocitos: 28.0% MCH: 30.5 pg MCHC: 32.9 g/dL MCV: 92.8 fL MPV: 11.6 fL Monocitos: 0.72 mil/µL % Monocitos: 7.2% Neutrófilos: 5.98 mil/µL % Neutrófilos: 60.1% Plaquetas: 302 mil/µL Proteínas totales: 7.0 g/dL RBC: 4.42 M/µL  11-Nov-2022: Proteínas totales: 6.7 g/dL  01-Mar-2023: Basófilos: 0.09 mil/µL % Basófilos: 1.0% Eosinófilos: 0.45 mil/µL % Eosinófilos: 4.9% EBV AB: 9.21 mil/µL HCT: 40.4% Hb: 13.8 g/dL IG: 0.04 mil/µL High Linfocitos: 2.18 mil/µL % Linfocitos: 23.7% MCH: 30.7 pg MCHC: 34.2 g/dL MCV: 89.8 fL MPV: 11.3 fL Monocitos: 0.58 mil/µL % Monocitos: 6.3% Neutrófilos: 5.87 mil/µL % Neutrófilos: 63.7% NRBC: 0.0/100 WBC Plaquetas: 311 mil/µL Proteínas totales: 6.9 g/dL RBC: 4.50 M/µL RDW (38.650.2 fL): 40.2 fL 08-Mar-2023: Basophil (0.000.10 mil/µL): 0.09 mil/µL % Basophil (0.01.0%): 1.0% Eosinophil (0.00.6 mil/µL): 0.34 mil/µL % Eosinophil (0.05.6%): 3.9% EBV AB (3.4010.10 mil/µL): 8.76 mil/µL HCT (35.946.1%): 39.3% Hb (11.615.4 g/dL): 13.4 g/dL IG: 0.3% and 0.03 mil/µL Lymphocyte (0.63.2 mil/µL): 2.08 mil/µL % Lymphocyte (12.145.3%): 23.7% MCH (27.633.1 pg): 30.7 pg MCHC (31.334.9 g/dL): 34.1 g/dL MCV (83.799.5 fL): 90.1 fL MPV (9.212.2 fL): 11.0 fL Monocyte (0.20.9 mil/µL): 0.52 mil/µL % Monocyte (4.412.5%): 5.9% Neutrophil (1.46.8 mil/µL): 5.70 mil/µL % Neutrophil (42.777.1%): 65.2% NRBC (0.00.2/100 WBC): 0.0/100 WBC Platelets (126432 mil/µL): 296 mil/µL Protein total (6.68.7 g/dL): 6.9 g/dL RBC (3.795.19 M/µL): 4.36 M/µL RDW (38.650.2 fL): 40.1 fL  16-Aug-2023: Basophil: 0.09 mil/µL % Basophil: 0.9% Eosinophil: 0.32 mil/µL % Eosinophil: 3.4% EBV AB: 9.54 mil/µL HCT: 39.3% Hb: 13.3 g/dL IG: 0.5% and 0.05 mil/µL High Lymphocyte: 2.13 mil/µL % Lymphocyte: 22.3% MCH: 30.4 pg MCHC: 33.8 g/dL MCV: 89.7 fL MPV: 11.0 fL Monocyte: 0.66 mil/µL % Monocyte: 6.9% Neutrophil: 6.29 mil/µL % Neutrophil: 66.0% NRBC: 0.0/100 WBC Platelets: 290 mil/µL Protein total: 6.6 g/dL RBC: 4.38 M/µL RDW: 40.8 fL  09-Oct-2023: Basophil: 0.12 mil/µL High % Basophil: 0.9% Eosinophil: 0.22 mil/µL % Eosinophil: 1.7% EBV AB: 12.85 mil/µL High HCT: 38.8% Hb: 13.2 g/dL IG: 0.8% and 0.10 mil/µL Lymphocyte: 2.73 mil/µL % Lymphocyte: 21.2% MCH: 30.6 pg MCHC: 34.0 g/dL MCV: 89.8 fL MPV: 11.0 fL Monocyte: 0.87 mil/µL % Monocyte: 6.8% Neutrophil: 8.81 mil/µL High % Neutrophil: 68.6% NRBC: 0.0/100 WBC Platelets: 324 mil/µL Protein total: 6.8 g/dL RBC: 4.32 M/µL RDW: 41.3 fL  09-Jan-2024: Basophil: 0.08 mil/µL % Basophil: 0.9% Eosinophil: 0.43 mil/µL % Eosinophil: 5.0% EBV AB: 8.65 mil/µL HCT: 44.8% Hb: 15.0 g/dL IG: 0.5% and 0.04 mil/µL Lymphocyte: 2.61 mil/µL % Lymphocyte: 30.2% MCH: 30.8 pg MCHC: 33.5 g/dL MCV: 92.0 fL MPV: 11.1 fL Monocyte: 0.70 mil/µL % Monocyte: 8.1% Neutrophil: 4.79 mil/µL % Neutrophil: 55.3% NRBC: 0.0/100 WBC Platelets: 305 mil/µL Protein total: 7.3 g/dL RBC: 4.87 M/µL RDW: 42.8 fL  19-Mar-2024: Basophil: 0.07 mil/µL % Basophil: 0.8% Eosinophil: 0.32 mil/µL % Eosinophil: 3.8% Epstein-Barr virus antibody: (Positive) Abnormal (Normal Range: Negative), 1.3 AI, High (Normal Range: Less than <0.9 AI), >8.0 AI, High (Normal Range: Less than <0.9 AI), >8.0 AI, High (Normal Range: Less than <0.9 AI), 0.3AI (Normal Range: Less than <0.9 AI), (Positive) Abnormal, (Normal Range: Negative), (Negative) (Normal Range: Negative) and 8.39 thousand/microlitre. Epstein-Barr virus infection: (Positive) Abnormal, (Normal Range: Negative). HCT (35.9-46.1 %): 41.5 %. Hb (11.6-15.4 gram/decilitre): 13.9 gram/decilitre. IG count (0.0-0.5 %): 0.4 % and 0.03 thousand/microlitre. Lymphocyte count (0.6-3.2 thousand/microlitre): 2.69 thousand/microlitre. Lymphocyte percentage (12.1-45.3 %): 32.1 %. MCH(27.6-33.1 picogram): 30.2 picogram. MCH concentration (31.3-34.9 gram/decilitre): 33.5 gram/decilitre. MCV (83.7-99.5 femtolitre): 90.2 femtolitre. MPV (9.2-12.2 femtolitre): 11.1 femtolitre. Monocyte count (0.2-0.9 thousand/microlitre): 0.51 thousand/microlitre. Monocyte percentage (4.4-12.5 %): 6.1 %. Neutrophil count (1.4-6.8 thousand/microlitre): 4.77 thousand/microlitre. Neutrophil percentage (42.7-77.1 %): 56.8 %. Nucleated red cells (0.0-0.2/100 WBC): 0.0/100 WBC. Platelet count (126-432 thousand/microlitre): 329 thousand/microlitre. Protein total (6.6-8.7 gram/decilitre): 7.4 gram/decilitre. RBC count (3.79-5.19 million/microlitre): 4.60 million/microlitre. Red cell distribution width (38.6-50.2 femtolitre): 40.4 femtolitre. On 26-Sep-2024 patient had : Basophil count (0.00-0.10 thousand/microlitre): 0.09 thousand/microlitre. Basophil percentage (0.0-1.0 %): 1.0 %. Eosinophil count (0.0-0.6 thousand/microlitre): 0.32 thousand/microlitre. Eosinophil percentage (0.0-5.6 %): 3.5 %. Epstein-Barr virus antibody: (Positive) Abnormal (Normal Range: Negative), 1.4 AI, High (Normal Range: Less than <0.9 AI), >8.0 AI, High (Normal Range: Less than <0.9 AI), 7.0 AI, High (Normal Range: Less than <0.9 AI), 0.3AI (Normal Range: Less than <0.9 AI), (Positive) Abnormal, (Normal Range: Negative), (Negative) (Normal Range: Negative) and 9.20 thousand/microlitre. Epstein-Barr virus infection: (Positive) Abnormal, (Normal Range: Negative). HCT: 42.8% Hb: 14.4 g/dL IG: 0.5% and 0.05 mil/µL High Linfocitos: 2.49 mil/µL % Linfocitos: 27.1% MCH: 31.2 pg MCHC: 33.6 g/dL MCV: 92.8 fL MPV: 11.0 fL Monocitos: 0.68 mil/µL % Monocitos: 7.4% Neutrófilos: 5.57 mil/µL % Neutrófilos: 60.5% NRBC: 0.0/100 WBC Plaquetas: 322 mil/µL Proteínas totales: 6.8 g/dL RBC: 4.61 M/µL RDW: 43.5 fL  22-Oct-2024: Basófilos: 0.07 mil/µL % Basófilos: 0.8% Eosinófilos: 0.28 mil/µL % Eosinófilos: 3.2% EBV AB: 8.68 mil/µL HCT: 42.8% Hb: 14.1 g/dL IG: 0.7% High and 0.06 mil/µL High Linfocitos: 1.75 mil/µL % Linfocitos: 20.2% MCH: 30.4 pg MCHC: 32.9 g/dL MCV: 92.2 fL MPV: 11.3 fL Monocitos: 0.58 mil/µL % Monocitos: 6.7% Neutrófilos: 5.94 mil/µL % Neutrófilos: 68.4% NRBC: 0.0/100 WBC Plaquetas: 306 mil/µL Proteínas totales: 7.6 g/dL RBC: 4.64 M/µL RDW: 43.5 fL  13-Jan-2025: Alfa 1 globulina: 3.7% High and 0.30 g/dL Alfa 2 globulina: 10.5% and 0.70 g/dL Beta globulina: 11.9% and 0.80 g/dL Albúmina: 4.50 g/dL and 63.2% Inmunoglobulinas: 10.7% and 0.80 g/dL Proteínas totales: 7.1 g/dL 29-Jan-2025: Basophil: 0.09 mil/µL % Basophil: 1.0% Eosinophil: 0.40 mil/µL % Eosinophil: 4.6% EBV AB: 8.73 mil/µL HCT: 43.7% Hb: 14.6 g/dL IG: 0.5% and 0.04 mil/µL Lymphocyte: 2.84 mil/µL % Lymphocyte: 32.5% MCH: 30.5 pg MCHC: 33.4 g/dL MCV: 91.2 fL MPV: 11.0 fL Monocyte: 0.67 mil/µL % Monocyte: 7.7% Neutrophil: 4.69 mil/µL % Neutrophil: 53.7% NRBC: 0.0/100 WBC Platelets: 329 mil/µL Protein total: 7.4 g/dL RBC: 4.79 M/µL RDW: 41.1 fL  17-Apr-2025: EBV antibody: Positive Abnormal, 3.4 AI High, >8.0 AI High, >8.0 AI High, 0.4 AI, Positive Abnormal, Negative EBV infection: Positive Abnormal Protein total: 7.9 g/dL  01-May-2025: Basophil: 0.10 mil/µL % Basophil: 1.1% High Eosinophil: 0.35 mil/µL % Eosinophil: 3.8% EBV AB: 9.31 mil/µL HCT: 37.4% Hb: 12.8 g/dL IG: 0.4% and 0.04 mil/µL Lymphocyte: 2.64 mil/µL % Lymphocyte: 28.4% MCH: 31.2 pg MCHC: 34.2 g/dL MCV: 91.2 fL MPV: 11.0 fL Monocyte: 0.52 mil/µL % Monocyte: 5.6% Neutrophil: 5.66 mil/µL % Neutrophil: 60.7% NRBC: 0.0/100 WBC Platelets: 290 mil/µL Protein total: 7.1 g/dL RBC: 4.10 M/µL RDW: 42.4 fL  14-May-2025: Alpha 1 globulin: 4.5% High and 0.30 g/dL Alpha 2 globulin: 10.6% and 0.70 g/dL Basophil: 0.11 mil/µL High % Basophil: 1.0% Beta globulin: 11.4% and 0.80 g/dL Albumin: 4.20 g/dL and 62.3% Eosinophil: 0.35 mil/µL % Eosinophil: 3.3% EBV AB: 10.48 mil/µL High HCT: 39.5% Hb: 13.5 g/dL IG: 0.5% and 0.05 mil/µL Immunoglobulins: 11.2% and 0.80 g/dL Lymphocyte: 3.06 mil/µL % Lymphocyte: 29.2% MCH: 32.1 pg MCHC: 34.2 g/dL MCV: 93.8 fL MPV: 11.3 fL Monocyte: 0.71 mil/µL % Monocyte: 6.8% Neutrophil: 6.20 mil/µL % Neutrophil: 59.2% NRBC: 0.0/100 WBC Platelets: 278 mil/µL Protein total: 6.8 g/dL RBC: 4.21 M/µL RDW: 44.4 fL On an unknown date patient had: Blood pressure measurement: High. Blood test: Abnormal. Electrocardiogram ambulatory: had an echocardiogram and wore a Holter monitor for 5 days. They saw some irregularity but not enough to be concerned about. Endoscopy: had two upper and lower scopes. Polyps were found, but no cause was identified for my chronic digestive symptoms. Weight: unexplained weight loss. It was reported that PT was on hormone due to menopause. It was reported that PT received both doses of Moderna vaccine in May-2021. Within six months patient felt unwell and was not well a single day since. After any physical activity she experience a debilitating fatigue that lasts for days. She developed an unexplained rash with itching on her lower legs, ankles, and feet and gradually had to stop exercising altogether because her body could no longer tolerate it. Overtime she developed severe brain fog that lasted for more than two years, along with heart palpitations and difficulty articulating speech. It was reported that PT had ongoing health issues. Her symptoms continued to worsen and she felt constant malaise and her body temperature doesn't regulate properly. She currently experienced severe headaches, which were eventually identified as trigeminal neuralgia flares. She also had unexplained blood pressure issues, agitation, insomnia, depression, and complete loss of libido. In Jan-2022, suffered a mini-stroke and was admitted to hospital under a stroke alert. In 2022/2023 she was diagnosed with chronic Epstein-Barr Virus (EBV), Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), Rheumatoid Arthritis, bipolar depression, high blood pressure, and petechiae. She also experienced significant joint inflammation, and popping in her hips, shoulders, and neck when walking. During Epstein Barre Virus flare, which was almost constant, her body breaks out in rashes that travel from her head down to her toes. These flares affected her digestive system, caused pain, IBS symptoms, and severe constipation. The pain often travelled down one leg and exits through a toe and three toenails have detached so far. She also suffered from unexplained thigh pain. Once proud of her athletic legs, she now hides them due to extreme muscle loss and unexplained weight loss. She had ruled out other possible causes: mold testing was negative, metal levels are within range, and while she was in menopause, she take hormones as needed. During primary care, she was diagnosed with chronic Epstein-Barr Virus, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome. She also visited two neurologist for memory loss and brain fog. She also had two upper and lower scopes. Polyps were found, but no cause was identified for her chronic digestive symptoms. After her mini stroke she had an echocardiogram and wore a Holter monitor for 5 days and saw some irregularity but not enough to be concerned about. When she began losing toenails and developed herpes-like symptoms starting in her head & moving down her body. Lesions/blisters on my toes, she was told it may be fungal. However, when the pedicures were stopped it spread to other toes over the years. She saw multiple providers for depression. Most want to medicate, but due to brain fog, she was sensitive to anything affecting cognition. She continued therapy to manage the emotional toll. She had a scheduled oncology appointment on 14-May-2025 to rule out cancer due to the recent onset of petechiae, a potential sign of a blood disorder. It was unknown if patient experienced any additional symptoms or events. No treatment medications were reported. Most recent FOLLOW-UP information incorporated above includes: On 27-May-2025: Live follow up received contains significant information and reporter details updated, lab data updated, events added, narrative updated.; Reporter's Comments: Previous infection with Epstein-Barr virus is a confounder for the event Chronic fatigue syndrome. Transient ischaemic attack and Herpes Zoster are assessed as not related due to lack of temporal association (too long latency). The benefit-risk relationship of product is not affected by this report.