Miguel's back in the present and he has two goals: prevent the changes to the early 21st Century that led to the world of Future Imperfect replacing his 2099, and spray his neighbor with future medicine to cure her terminal cancer. That ends oddly as the roommate does not like it when there's a guy in a spider costume in her bedroom.
There's a bit of a crossover with events in Amazing Spider-Man, as Miguel's employers at Alchemax competes with Peter Parker for a prison contract. Miguel has a team-up with Peter against a name villain (I'm not going to spoil everything) as they mull over the changes to the future.
Miguel gets home and his neighbor's celebrating a good prognosis. Things get kinda weird, and I'm hoping someone else can explain if we're supposed to recognize the monster in the final page.
I will say I enjoyed this issue. It functions well as a bridge between the Maestro story and the finale. Characterization is solid and a lot of stuff happens, without it being too crammed.