Patient had severe pain in different sites of her right arm; Patient started to had severe pain in different sites of her right arm including the elbow every time she tried to pick or push something using her muscles; This spontaneous case was reported by a patient and describes the occurrence of PAIN IN EXTREMITY (Patient had severe pain in different sites of her right arm) and ARTHRALGIA (Patient started to had severe pain in different sites of her right arm including the elbow every time she tried to pick or push something using her muscles) in a 78-year-old female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS71488) for COVID-19 vaccination.     Patient never had COVID positive test or diagnosis.  Previously administered products included for COVID-19 prophylaxis: Moderna COVID-19 Vaccine (Dose 1, Route: Intramuscular, Lot: 026L20A, Expiration date: unknown) on 09-Feb-2021, Moderna COVID-19 Vaccine (Dose 2, Lot: 031620A, Expiration date: unknown) on 09-Mar-2021, Moderna COVID-19 Vaccine (First booster dose, Lot: 0FAA2101, Expiration date: 01-Dec-2021) on 12-Nov-2021, Moderna COVID-19 Vaccine (Second booster dose, Lot: 001M21A and Expiration date: 10-Jul-2022) on 15-Apr-2022. Past adverse reactions to the above products included No adverse event with Moderna COVID-19 Vaccine, Moderna COVID-19 Vaccine, Moderna COVID-19 Vaccine and Moderna COVID-19 Vaccine. Concurrent medical conditions included Allergy to antibiotic (Bactrim), Allergy to antibiotic (Ciprofloxacin), Allergy to antibiotic (Doxycycline), Drug allergy (Hydrochlorothiazide), Drug allergy (INH (Isoniazid)), Drug allergy (IV iron), Contrast media allergy (IVP dye), Paroxysmal atrial fibrillation since 1991, Diabetes mellitus (Diabetes) since 1974, Hypothyroidism since 1964, Osteoarthritis since 2000, Hypertension since 2000, GERD since 1985, Vertigo since 2005 and Hypercholesterolemia since 1988. Concomitant products included LEVOTHYROXINE SODIUM (SYNTHROID), ATENOLOL, FLECAINIDE ACETATE (TAMBOCOR), LANSOPRAZOLE, POTASSIUM CITRATE (UROCIT-K), INSULIN LISPRO (HUMALOG), GLIBENCLAMIDE (MICRONASE), APIXABAN (ELIQUIS), CHLORTALIDONE (CHLORTHALIDONE), OXYBUTYNIN, DIGOXIN and SEMAGLUTIDE (OZEMPIC) for an unknown indication.    On 14-Sep-2022, the patient received fifth dose of mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (unknown route) 1 dosage form. On 21-Sep-2022, the patient experienced PAIN IN EXTREMITY (Patient had severe pain in different sites of her right arm) and ARTHRALGIA (Patient started to had severe pain in different sites of her right arm including the elbow every time she tried to pick or push something using her muscles). The patient was treated with PARACETAMOL (TYLENOL) for Pain in arm and Pain in elbow, at an unspecified dose and frequency. At the time of the report, PAIN IN EXTREMITY (Patient had severe pain in different sites of her right arm) and ARTHRALGIA (Patient started to had severe pain in different sites of her right arm including the elbow every time she tried to pick or push something using her muscles) was resolving.            Patient did not experienced any side effects with previous vaccines, but one week after bivalent, patient started to had severe pain in different sites of her right arm, including the elbow every time patient tried to pick or push something using her muscles, it was severe pain enough to cry out. Patient decided to take Tylenol and it got a little better, but it still hurts if she tries to do anything. The adverse event outcome was reported as still ongoing and symptoms were improving. Patient mentioned she would visit an orthopedic doctor soon.