Erythema on the left arm injection site after Bivalent Booster / Redness spread on the injected arm 1 day after Bivalent Booster; Warmth on the left arm injection site after Bivalent Booster / Hot to the touch left arm injection site after Bivalent Booster / Very blunt left arm injection site after Bivalent Booster; Swelling on the left arm injection site after Bivalent Booster; Pain on the left arm injection site after Bivalent Booster; This spontaneous case was reported by a pharmacist and describes the occurrence of VACCINATION SITE ERYTHEMA (Erythema on the left arm injection site after Bivalent Booster / Redness spread on the injected arm 1 day after Bivalent Booster), VACCINATION SITE WARMTH (Warmth on the left arm injection site after Bivalent Booster / Hot to the touch left arm injection site after Bivalent Booster / Very blunt left arm injection site after Bivalent Booster), VACCINATION SITE SWELLING (Swelling on the left arm injection site after Bivalent Booster) and VACCINATION SITE PAIN (Pain on the left arm injection site after Bivalent Booster) in a 59-year-old female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. 051D22A) for COVID-19 vaccination.     No Medical History information was reported.   On 28-Oct-2022, the patient received fourth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On 28-Oct-2022, the patient experienced VACCINATION SITE ERYTHEMA (Erythema on the left arm injection site after Bivalent Booster / Redness spread on the injected arm 1 day after Bivalent Booster), VACCINATION SITE WARMTH (Warmth on the left arm injection site after Bivalent Booster / Hot to the touch left arm injection site after Bivalent Booster / Very blunt left arm injection site after Bivalent Booster), VACCINATION SITE SWELLING (Swelling on the left arm injection site after Bivalent Booster) and VACCINATION SITE PAIN (Pain on the left arm injection site after Bivalent Booster). At the time of the report, VACCINATION SITE ERYTHEMA (Erythema on the left arm injection site after Bivalent Booster / Redness spread on the injected arm 1 day after Bivalent Booster), VACCINATION SITE WARMTH (Warmth on the left arm injection site after Bivalent Booster / Hot to the touch left arm injection site after Bivalent Booster / Very blunt left arm injection site after Bivalent Booster), VACCINATION SITE SWELLING (Swelling on the left arm injection site after Bivalent Booster) and VACCINATION SITE PAIN (Pain on the left arm injection site after Bivalent Booster) outcome was unknown.      For mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (Unknown), the reporter did not provide any causality assessments.   No concomitant information provided  Patient received First Primary dose: On 27MAR2021 (Lot# 013B21A & Exp. Date: unknown). Patient received2nd Primary dose: On 24APR2021 (Lot# 045B21A & Exp. Date: unknown). Patient received First Monovalent Booster shot (3rd Shot) : On 03DEC2021 (Lot# 012H21B & Exp. Date: unknown).  On 28OCT2022, in the evening, patient started having injection site reactions: Erythema, Warmth, Swelling and Pain on the injection site, on the left arm. The Redness spread on the injected arm the next day. The left arm was Hot to the touch and very blunt. She has not seen a doctor.  No treatment information provided