Myalgia, Fever, Tachycardia, chest and upper abdomen and back tightness/pain restricted inspiration and tight swallowing   Narrative:  Patient notes she had covid and later bacterial pneumonia  diagnosed 12/26/20 months ago and has had some intermittent chest tightness since. She is followed by a pulmonologist who noted she might have a pulmonary AVM but could not be sure due to the extent of infiltrates on her post covid CAT scan. Follow up chest ct with contrast is planned for the end of April. She notes  that a minute or two after she got her J+J vaccine on Monday she had a recurrence of her typical chest tightness which persisted without SOB/DOE of significance...( she always gets a bit dyspneic with activity when her chest feels tight) The  difference was it went from her upper abdomen area to her neck and was a  constant pressure/feeling. She feels she cannot take a truely deep breath limited by pain and the tight feeling. She also noticed a new effortful swallow without voice change. These symptoms persisted She noted she was nervous prior to her shot but had a normal heartrate. It went to the low 100's immediately after the shot and  persisted for the next 2 days. She developed a fever/chills/ myalgias that evening.  She also has fever, mualgias fatigue but no other symptoms. Her chest tightness persists without change since though the other symptoms resolved. She called her  PCPC who noted it was probably due to the shot and recommended observation.  She was evaluated in the ER and EKG were reportedly normal per Employee and the ER Dr. deferred labs. She also notes occasional sharp brief upper abdominal pain and left cv angle pain. no dysuria No leg myalgias calf pain or intermittent SOB at rest. No rash. No menses since stopping bcps in january ( 2 pregnancy tests recently negative) PHYSICAL: BP 116/66 hr 61 regular Resp rate 14 color good chest excursion slightly less than anticipated improves with  cuing and better posture but limited by pain inhibition L: CTA no wheeze or rales CV: RRR S1 S2 no JVD or edema rate 60s Employee is sharp and has normal  fluid speech and gets out full sentences without pausing for a breath. No obvious cervical or suprclavicular lymphadenopathy Left deltoid vaccination site looks fine/ no redness/fullness mild muscle tenderness with activation CRNI by  observation palate symmetric tongue normal Tends to sit forward flexed slightly ( rounded shoulders kyphotic back) NO midline thoracic or lumbar tenderness to palpation mild left cv angle tenderness Mild epigastric and uppermost left and right quadrant tenderness to palpation without rebound or appreciated guarding or mass. No costochondral tenderness to palpation Skin intact )abdomen arms face lower legs) no rash/petechiae Motor strength and gait is normal intact RAMs without Hoffmans sign ankle or wrist clonus 2-3+ DTRs throughout No sensory symptoms Shoulder ER/abduction is intact grip is strong and equal FINDINGS: Atypical perceived chest and upper abdomen tightness persistent and immediate after her 4/12 J+J vaccination. Minimal perceived effortful swallow Prior covid pneumonia and secondary bacterial pneumonia with slowly improving intermittent chest tightness and pain Possible lung AVM per Employee's Pulmonologist note sed rate 9; normal troponin and d-dimer test, normal platelest ( 235) mildly low wbc 3.5   Other relevant History: