Her red blood count cells are low; Massive nose bleeds; This is a spontaneous report from a Pfizer sponsored program. A contactable 59-year-old female consumer(patient) reported that she received the second dose of BNT162B2 at single dose for COVID-19 immunisation on 21Apr2021 (59-year-old at vaccination).  The patient also received mometasone furoate (NASONEX ALLERGY) Nasal Spray (Lot No.:S036080, Expiry date: Oct2021), 50mcg. Relevant history included Nose bleeds on and off for years; the nose bleeds were mainly during allergy season, these nose bleeds were only during a dry season. For instance, like winter time and allergy season. The nose bleeds would start up in October, slack off in December, and not start back until Spring time. She mentions she was a CNA (certified nursing assistant) over 20 years ago. Relevant concomitant drug was unknown. Past drug included tofacitinib citrate (XELJANZ XR, Lot No.PAA113610, Expiry Date: Feb2022) tablet orally at 11mg once daily since 2018 to 23Mar2021 for Severe rheumatoid arthritis. The patient previously received the first dose of BNT162B2 for COVID-19 immunization on 24Mar2021 with no adverse reaction. The patient experienced massive nose bleeds since 18May2021. The patient also experienced red blood cell count low since unknown date. The patient had nose bleeds on and off for years and confirms they were not real bad. The nose bleeds were mainly during allergy season and she was never concerned until 2.5 weeks ago. Her nose had been pouring and yesterday her nose bled 3 times a day. There was blood on her clothes, towels. She was trying to remember what she was told, she believed her red count was 3 point something but she did not remember exactly. The caller clarified she had been getting nose bleeds prior to starting Xeljanz XR. However, these nose bleeds were only during a dry season. For instance, like winter time and allergy season. The nose bleeds would start up in October, slack off in December, and not start back until Spring time. Her nose bleeds have never been like what was happening this time. There was nothing normal about what was happening. She was waking up in blood from her nose bleeds. The caller believed her first massive nose bleed was on 18May2021. She knew the nose bleeds did not have anything to do with the Xeljanz XR because she had to get off the Xeljanz XR when she was getting the COVID vaccine. She took her last dose of the Xeljanz XR on 23Mar2021 before her first COVID-19 vaccine. Her doctor told her not to take the Xeljanz XR for 2 weeks but because she had to wait another 3 week to get her second dose, she stayed off of the Xeljanz during that time period. She didn't start back on the Xeljanz XR until Friday, 21May2021. As treatment, she started a generic Bactroban cream which was the ENT doctor gave her last week. She clarified it's a generic Bactroban cream to put in her nose that was given to her last week. She was sup-posed to see the ENT doctor again in 6 weeks. The nose spray her doctor believed was causing the nose bleeds was Nasonex Nasal Spray.  Her nose has been pouring and yesterday her nose bled 3 times a day. No further information was provided or obtained regarding the cream she is using as treatment.  She had not started any new medications within the 2 week time period leading up to the massive nose bleeds. Her medications have remained the same. The action taken with Nasonex was unknown. The outcome of event Massive nose bleeds was not resolved. The outcome of event red blood count cells low was unknown.      Information on the lot/batch number has been requested.