benign tremors in his hands; Tested positive for COVID-19 after 4 Moderna COVID-19 Vaccines; coughing up this phlegm mucus and it clogs his throat; coughing up this phlegm mucus and it clogs his throat; This spontaneous case was reported by a patient and describes the occurrence of COUGH (coughing up this phlegm mucus and it clogs his throat), OROPHARYNGEAL DISCOMFORT (coughing up this phlegm mucus and it clogs his throat), TREMOR (benign tremors in his hands) and COVID-19 (Tested positive for COVID-19 after 4 Moderna COVID-19 Vaccines) in an 81-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) (batch nos. 057M21A, 039F21A, 023M20A and 042220A) for COVID-19 prophylaxis.     Concurrent medical conditions included Eyeglasses wearer (usually needed glasses to read).   On 22-Jan-2021, the patient received first dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form. On 22-Feb-2021, received second dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 01-Nov-2021, received third dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. On 19-Apr-2022, received fourth dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) dosage was changed to 1 dosage form. In April 2023, the patient experienced COUGH (coughing up this phlegm mucus and it clogs his throat) and OROPHARYNGEAL DISCOMFORT (coughing up this phlegm mucus and it clogs his throat). On 18-Apr-2023, the patient experienced COVID-19 (Tested positive for COVID-19 after 4 Moderna COVID-19 Vaccines). On an unknown date, the patient experienced TREMOR (benign tremors in his hands). The patient was treated with NIRMATRELVIR, RITONAVIR (PAXLOVID) ongoing from 18-Apr-2023 for COVID-19, at a dose of Dose Pack Morning and Evening. At the time of the report, COUGH (coughing up this phlegm mucus and it clogs his throat), OROPHARYNGEAL DISCOMFORT (coughing up this phlegm mucus and it clogs his throat) and TREMOR (benign tremors in his hands) had not resolved and COVID-19 (Tested positive for COVID-19 after 4 Moderna COVID-19 Vaccines) outcome was unknown.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 18-Apr-2023, SARS-CoV-2 test: Positive. On an unknown date, Body height: The patient was shrinking..     For mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown), the reporter did not provide any causality assessments.   Ethnicity of patient was reported as other.  The patient was taking a lot of concomitant medications, which he had been taking for years. The patient confirmed that he stopped taking his statins (name of the statins were unknown), while he was on Paxlovid.  It was reported the coughing was started 2 weeks ago and had been consistent. The mucous was white and sticky and he spits it into a can. The patient reported sometimes it increased so that he was choking and had to spit it out.  Due to benign tremors of hands the patient was always hitting the wrong keys, so he wrote everything down, but he was the only one who can read his handwriting since his hands shake so much. The patient guessed that was one of the reasons of growing old. The patient confirmed that this started before he started taking Paxlovid and always had this.  The patient was prescribed Paxlovid as he tested positive for COVID-19. It was also reported that when he received the Paxlovid, he took the wrong dose, he took the morning dose in the evening. At the time of reporting, the patient was taking the original regimen.   Most recent FOLLOW-UP information incorporated above includes: On 25-Apr-2023: Upon live non-significant follow up product complaint number (QE number) was added.