She has also had a chronic migraine which she feels is leveling out now; sore shoulder; fatigue; Covid 19; This spontaneous case was reported by a nurse and describes the occurrence of COVID-19 (Covid 19), MIGRAINE (She has also had a chronic migraine which she feels is leveling out now), ARTHRALGIA (sore shoulder) and FATIGUE (fatigue) in a 61-year-old female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS7164B) for COVID-19 prophylaxis.     Previously administered products included for Product used for unknown indication: Influenza vaccine. Past adverse reactions to the above products included No adverse event with Influenza vaccine. Concurrent medical conditions included Asthma, Irritable bowel syndrome (IBS), Allergy to NSAIDs (Gastric sensitivity) and Gluten intolerance. Concomitant products included FLUTICASONE PROPIONATE (FLOVENT) for Asthma, BACLOFEN, RIZATRIPTAN, PSEUDOEPHEDRINE, OXYMETAZOLINE HYDROCHLORIDE (DECONGESTANT [OXYMETAZOLINE HYDROCHLORIDE]) and FLUTICASONE PROPIONATE (FLONASE [FLUTICASONE PROPIONATE]) for an unknown indication.    On 18-Nov-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 11-Feb-2023,  after starting mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)), the patient experienced COVID-19 (Covid 19). On an unknown date, the patient experienced MIGRAINE (She has also had a chronic migraine which she feels is leveling out now), ARTHRALGIA (sore shoulder) and FATIGUE (fatigue). The patient was treated with NIRMATRELVIR, RITONAVIR (PAXLOVID) from 30-Jan-2023 to 05-Feb-2023 at a dose of 1 dosage form. At the time of the report, COVID-19 (Covid 19), MIGRAINE (She has also had a chronic migraine which she feels is leveling out now), ARTHRALGIA (sore shoulder) and FATIGUE (fatigue) had not resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 08-Feb-2023, SARS-CoV-2 test: Negative. On 13-Feb-2023, SARS-CoV-2 test: Negative.     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.   On 24-NOV-2021, patient took third dose of Moderna vaccine with batch/Lot No: 939909 and location of injection was arm right. She had received all Moderna vaccines but was not sure of the number. Her last COVID-19 vaccine was a Moderna Bivalent BA.4/BA.5 vaccine administered in NOV2022. With the most recent dose she experienced a sore shoulder. With previous doses she had experienced a sore shoulder and was tired. After receiving the most recent dose she had COVID-19 with some continuing symptoms. This started in FEB2022 when she had bladder pain that was worse than her usual bladder pain. She also had a chronic migraine which she felt was leveling out now. She also had fatigue. She believed she has an undiagnosed history of interstitial cystitis and thought her increased bladder pain was due to a UTI. She had not taken any medications or treatments for her symptoms.  She had rebound Covid after finishing course of treatment for Covid.   This case was linked to US-MODERNATX, INC.-MOD-2023-739543 (E2B Linked Report).   Most recent FOLLOW-UP information incorporated above includes: On 01-Sep-2023: Significant Follow-up received. Historical Vaccine added, Events updated, Suspect product updated, Paxlovid was updated as treatment medication; Sender's Comments:  US-MODERNATX, INC.-MOD-2023-739543:Monovalent dose