COVID for fifth time; Parkinson's disease; diagnosed with Parkinson's disease and was shaking a lot; his arms and hands to shake after getting all COVID vaccines and boosters; Congestive heart failure; shaking has made him unable to do what he normally does on the job, caretaker helped him with daily activites; Tyvaso DPI was nasty; Dry cough with Tyvaso DPI doses; Joint pain; This spontaneous case was reported by a patient and describes the occurrence of COVID-19 (COVID for fifth time), PARKINSON'S DISEASE (Parkinson's disease; diagnosed with Parkinson's disease and was shaking a lot; his arms and hands to shake after getting all COVID vaccines and boosters) and CARDIAC FAILURE CONGESTIVE (Congestive heart failure) in a 58-year-old male patient who received mRNA-1273 (Moderna COVID-19 Vaccine) for COVID-19 immunization. The occurrence of additional non-serious events is detailed below.    Co-suspect products included non-company products TREPROSTINIL inhalation powder for Secondary pulmonary arterial hypertension and TREPROSTINIL SODIUM (TYVASO DPI) inhalation powder for Secondary pulmonary arterial hypertension.    Concurrent medical conditions included Secondary pulmonary arterial hypertension and Parkinson's disease. Concomitant products included POTASSIUM CHLORIDE, HYDROCODONE BITARTRATE, PARACETAMOL (HYDROCODONE/ACETAMINOPHEN), SPIRONOLACTONE, ASPIRIN [ACETYLSALICYLIC ACID], COLCHICINE, HYDROMORPHONE HYDROCHLORIDE (DILAUDID), FUROSEMIDE (LASIX [FUROSEMIDE]), ALLOPURINOL, SILDENAFIL CITRATE (REVATIO), LOPERAMIDE, VITAMIN D3 and VITAMINS NOS for an unknown indication.   On 05-Dec-2022, the patient started TREPROSTINIL SODIUM (TYVASO DPI) (Inhalation use) 48 microgram four times per day. On an unknown date, the patient received dose of mRNA-1273 (Moderna COVID-19 Vaccine) (unknown route) 1 dosage form and TREPROSTINIL (Inhalation use) at an unspecified dose. On an unknown date, the patient experienced COVID-19 (COVID for fifth time) (seriousness criterion hospitalization), PARKINSON'S DISEASE (Parkinson's disease; diagnosed with Parkinson's disease and was shaking a lot; his arms and hands to shake after getting all COVID vaccines and boosters) (seriousness criterion medically significant), CARDIAC FAILURE CONGESTIVE (Congestive heart failure) (seriousness criterion medically significant), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (shaking has made him unable to do what he normally does on the job, caretaker helped him with daily activites), PATIENT DISSATISFACTION WITH TREATMENT (Tyvaso DPI was nasty), COUGH (Dry cough with Tyvaso DPI doses) and ARTHRALGIA (Joint pain). At the time of the report, COVID-19 (COVID for fifth time), PARKINSON'S DISEASE (Parkinson's disease; diagnosed with Parkinson's disease and was shaking a lot; his arms and hands to shake after getting all COVID vaccines and boosters), CARDIAC FAILURE CONGESTIVE (Congestive heart failure), LOSS OF PERSONAL INDEPENDENCE IN DAILY ACTIVITIES (shaking has made him unable to do what he normally does on the job, caretaker helped him with daily activites), PATIENT DISSATISFACTION WITH TREATMENT (Tyvaso DPI was nasty), COUGH (Dry cough with Tyvaso DPI doses) and ARTHRALGIA (Joint pain) outcome was unknown.        The action taken with mRNA-1273 (Moderna COVID-19 Vaccine) (Unknown) was unknown.       The patient was hospitalized overnight as he had COVID for the fifth time (COVID-19) and developed parkinson's that caused his arms and hands to shake after getting all the COVID vaccines and boosters. He was in the tree  business and the shaking had made him unable to do what he normally does on the job and his job caused him joint pain. The patient had congestive heart failure and a caretaker helped him with daily activities. He had dry cough with Tyvaso DPI doses.   The reporter did not provide the causality for the events of COVID-19, cardiac failure congestive, arthralgia, and loss of personal independence in daily activities with Tyvaso DPI. The reporter's causality for the event of cough with Tyvaso DPI was considered to be possibly related. The reporter's causality for the event of parkinson's disease with Moderna COVID-19 vaccine was considered to be possibly related.   No treatment medications were reported.   Reporter did not allow further contact; Sender's Comments: This spontaneous case concerns a 58-year-old male patient with medical history of Co-suspect products included TREPROSTINIL for Secondary pulmonary arterial hypertension,  Parkinson's disease; concomitant products included POTASSIUM, HYDROCODONE, PARACETAMOL, SPIRONOLACTONE, ASPIRIN, COLCHICINE, HYDROMORPHONE, FUROSEMIDE, ALLOPURINOL, SILDENAFIL, LOPERAMIDE, VITAMINS who experienced the unexpected hospitalization seriousness criteria event of Covid-19; the unexpected medically significant seriousness criteria events of Cardiac failure congestive (AESI), Parkinson´s disease; the unexpected events of loss of independence in daily activities, patient dissatisfaction with treatment, cough and other expected event unknown days after a. dose of mRNA-1273 vaccine. Events cough and patient dissatisfaction with treatment considered as not related since those events attributed to non-company suspects. At the time of the report, the outcome of the events were unknown.    The benefit-risk relationship of mRNA-1273 vaccine is not affected by this report.