Diagnosed with Iron deficiency anemia; Felt tired,worn out; Injection site painful; This spontaneous case was reported by a patient and describes the occurrence of IRON DEFICIENCY ANAEMIA (Diagnosed with Iron deficiency anemia), FATIGUE (Felt tired,worn out) and VACCINATION SITE PAIN (Injection site painful) in a 64-year-old female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS7165B) for COVID-19 prophylaxis.     Patient had not tested positive for covid-19. Patient had no acute illness at the time of vaccination or up to one month before.  Concurrent medical conditions included Allergy to antibiotic (Bactrum), Drug allergy (Avelox), Artificial sweetener intolerance (All artificial sweeteners), Hay fever (Seasonal Hay fever), Migraine since 2000, Fibromyalgia since 2000, Chronic pain since 2000, Hypothyroidism since 1993, Hyperaldosteronism since 1990, Palpitations, High cholesterol, Hypertriglyceridemia (High triglycerides), GERD, Hypomagnesemia, Iron deficiency anemia and Stroke. Concomitant products included GABAPENTIN from 2002 to an unknown date for Chronic pain, PANTOPRAZOLE from 2016 to an unknown date for GERD, ROSUVASTATIN CALCIUM (CRESTOR) from 2002 to an unknown date for High cholesterol, EZETIMIBE (ZETIA) from 2022 to an unknown date for Hypertriglyceridemia, MAGNESIUM from 2017 to an unknown date for Hypomagnesemia, LEVOTHYROXINE SODIUM (SYNTHROID) from 1993 to an unknown date for Hypothyroidism, PETASITES HYBRIDUS RHIZOME (PETADOLEX) from 2021 to an unknown date and ACETYLCYSTEINE, CALCIUM LEVOMEFOLATE, MECOBALAMIN (CEREFOLIN NAC [ACETYLCYSTEINE;CALCIUM LEVOMEFOLATE;MECOBALAMIN]) from 2021 to an unknown date for Migraine, ACETYLSALICYLIC ACID (BABY ASPIRIN) from 2005 to an unknown date for Migraine, Stroke and Complicated migraine, METOPROLOL SUCCINATE (TOPROL XL) from 2000 to an unknown date for Palpitations.    On 07-Oct-2022, the patient received fifth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Intramuscular) 1 dosage form. In October 2022, the patient experienced IRON DEFICIENCY ANAEMIA (Diagnosed with Iron deficiency anemia), FATIGUE (Felt tired,worn out) and VACCINATION SITE PAIN (Injection site painful). The patient was treated with FERROUS SULFATE (SLOW FE) (oral) ongoing from 2022 for Iron deficiency anemia, at a dose of UNK, qd. At the time of the report, IRON DEFICIENCY ANAEMIA (Diagnosed with Iron deficiency anemia), FATIGUE (Felt tired,worn out) and VACCINATION SITE PAIN (Injection site painful) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 02-Nov-2022, Blood iron: 38. On 02-Nov-2022, Haematocrit: 34.8. On 02-Nov-2022, Haemoglobin: 10.8. On 02-Nov-2022, Iron binding capacity total: 431. On 02-Nov-2022, Mean cell haemoglobin concentration: 31.0. On 02-Nov-2022, Red blood cell count: 3.84. On 02-Nov-2022, Serum ferritin: 9. On 02-Nov-2022, Transferrin saturation: 9 %.     For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Intramuscular), the reporter did not provide any causality assessments.   Bloodwork taken from first vaccine through fifth showed decline in RBC, HgB, HcT, TIBC, Iron -diagnosed with Iron deficiency anemia.There was no internal bleeding. Patient had afebrile which went on with her day.  Patient was put on Pre-Natal Vitamins for Iron deficiency anemia.