mildly lethargic; vomited; fever of 100.4/ fever that increased to 101.8/ fever dropped below 100 degrees and stayed between 99 and 100.; mild pain in the shoulder was present; injection site pain; injection site felt warm to the touch; Two hours following immunization, severe pain in the left scapular area rated 6-7/10; unable to move arm backwards without increasing pain; This is a spontaneous report received from contactable reporter(s) (Consumer or other non HCP). The reporter is the patient.  A 27-year-old female patient (not pregnant) received BNT162b2, BNT162b2 omi ba.4-5 (BNT162B2, BNT162B2 OMI BA.4-5), on 22May2023 at 11:30 as dose 4 (booster), single (Lot number: GJ3268) at the age of 27 years, in left arm for covid-19 immunisation. The patient's relevant medical history included: "seasonal allergies" (unspecified if ongoing). Concomitant medication(s) included: CETIRIZINE; FLUTICASONE. Vaccination history included: Covid-19 vaccine (Dose 1, Single, Manufacturer unknown), for Covid-19 immunization; Covid-19 vaccine (Dose 2, Single, Manufacturer unknown), for Covid-19 immunization; Covid-19 vaccine (Dose 3 (Booster), Single, Manufacturer unknown), for Covid-19 immunization. The following information was reported: MUSCULOSKELETAL PAIN (non-serious) with onset 22May2023 at 13:30, outcome "recovered", described as "Two hours following immunization, severe pain in the left scapular area rated 6-7/10"; JOINT RANGE OF MOTION DECREASED (non-serious) with onset 22May2023 at 13:30, outcome "recovered", described as "unable to move arm backwards without increasing pain"; VACCINATION SITE WARMTH (non-serious) with onset 23May2023, outcome "recovered", described as "injection site felt warm to the touch"; VACCINATION SITE PAIN (non-serious) with onset 23May2023, outcome "not recovered", described as "injection site pain"; ARTHRALGIA (non-serious) with onset 23May2023, outcome "not recovered", described as "mild pain in the shoulder was present"; PYREXIA (non-serious) with onset 23May2023 at 01:00, outcome "recovered", described as "fever of 100.4/ fever that increased to 101.8/ fever dropped below 100 degrees and stayed between 99 and 100."; VOMITING (non-serious) with onset 23May2023 at 02:00, outcome "recovered", described as "vomited"; LETHARGY (non-serious) with onset 24May2023, outcome "not recovered", described as "mildly lethargic". Relevant laboratory tests and procedures are available in the appropriate section. Therapeutic measures were taken as a result of musculoskeletal pain, joint range of motion decreased, pyrexia, arthralgia, vaccination site pain. Therapeutic measures were not taken as a result of vomiting, vaccination site warmth, lethargy.  Additional information: Two hours following immunization, severe pain in the left scapular area rated 6-7/10 and was unable to move arm backwards without increasing pain. Pain dulled with 600 mg ibuprofen. 1 AM woke up to a fever of 100.4 and took 400 mg ibuprofen, slept until 2 am and woke with a fever that increased to 101.8 and vomited. Fever persisted into the following morning, however in the afternoon the fever dropped below 100 degrees and stayed between 99 and 100. On Tuesday with the fever, mild pain in the shoulder was present along with injection site pain and the injection site felt warm to the touch. On Wednesday the fever broke but was mildly lethargic with mild injection site pain still present. Patient had no covid prior to vaccination and she was not tested positive post vaccination. There was no other relevant medical history. There was no other vaccine in four weeks. The other medications in two weeks were cetirizine, fluticasone nasal spray, and supplement.