COVID-19; COVID exposure from an asymptomatic person on flight; This spontaneous case was reported by a patient and describes the occurrence of EXPOSURE TO SARS-COV-2 (COVID exposure from an asymptomatic person on flight) and COVID-19 (COVID-19) in a 54-year-old female patient who received mRNA-1273 BIVALENT .222 (MODERNA COVID-19 VACCINE, BIVALENT (ORIGINAL AND OMICRON BA.4/BA.5)) (batch no. AS7145B) for COVID-19 prophylaxis.     The patient's past medical history included Atrial septal defect (ASD w/right to left shunt), Platypnea (platypnea orthodeoxia with portable oxygen prescription for flights and elevations above 4000ft), Pulmonary embolism (history of bilateral pulmonary embolisms), DVT and Methicillin-sensitive Staphylococcus aureus infection (inpatient MSSA staph blood infection). Previously administered products included for Product used for unknown indication: PFIZER BIONTECH COVID-19 VACCINE (Time of injection: 13:00, Dose Number: 1, Batch/Lot No: EN6205, Route: Intramuscular, Anatomical site: Left deltoid) on 01-Mar-2021, PFIZER BIONTECH COVID-19 VACCINE (Time of injection: 13:00, Dose Number: 2, Batch/Lot No: ER8727, Route: Intramuscular, Anatomical site: Left deltoid) on 22-Mar-2021, PFIZER BIONTECH COVID-19 VACCINE (Time of injection: 03:45 pm, Dose Number: 3 (Booster), Batch/Lot No: FF2589, Route: Intramuscular, Anatomical site: Left deltoid) on 07-Oct-2021, TETRACYCLINE, erythromycin, PENICILLIN [PENICILLIN NOS], gluten and titanium; for COVID-19 prophylaxis: MODERNA (Dose Number: 4 (Booster), Batch/Lot No: 049L21A, Route: Intramuscular and Anatomical site: Left deltoid) on 03-May-2022. Past adverse reactions to the above products included Allergy with PENICILLIN [PENICILLIN NOS], TETRACYCLINE, erythromycin, gluten and titanium; and No adverse event with MODERNA, PFIZER BIONTECH COVID-19 VACCINE, PFIZER BIONTECH COVID-19 VACCINE and PFIZER BIONTECH COVID-19 VACCINE. Concurrent medical conditions included Ex-smoker (Former smoker), Allergy to metals (nitinol) and Polymers allergy (bone cement monomer).    On 20-Sep-2022 at 3:00 PM, 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 23-Nov-2022, the patient experienced EXPOSURE TO SARS-COV-2 (COVID exposure from an asymptomatic person on flight). On 26-Nov-2022, the patient experienced COVID-19 (COVID-19). The patient was treated with NIRMATRELVIR, RITONAVIR (PAXLOVID) from 26-Nov-2022 to 30-Nov-2022 at an unspecified dose and frequency; ASPIRIN [ACETYLSALICYLIC ACID] on 26-Nov-2022 at a dose of 81 milligram once a day; ASPIRIN [ACETYLSALICYLIC ACID] on 01-Dec-2022 at a dose of 325 milligram and ZINC on 26-Nov-2022 at a dose of 15 milligram. On 20-Dec-2022, EXPOSURE TO SARS-COV-2 (COVID exposure from an asymptomatic person on flight) and COVID-19 (COVID-19) had resolved.      DIAGNOSTIC RESULTS (normal ranges are provided in parenthesis if available): On 25-Nov-2022, SARS-CoV-2 test: (Negative) Time: 08:00. On 26-Nov-2022, Body temperature: 99.2 F. On 26-Nov-2022, SARS-CoV-2 test: (Positive) Time: 07:30 am. On 28-Nov-2022, SARS-CoV-2 test: Positive. On 02-Dec-2022, SARS-CoV-2 test: Negative. On 03-Dec-2022, SARS-CoV-2 test: Positive and (Positive) Time: 09:40 am. On 04-Dec-2022, SARS-CoV-2 test: Positive. On 06-Dec-2022, SARS-CoV-2 test: Positive. On 09-Dec-2022, SARS-CoV-2 test: Positive. On 12-Dec-2022, SARS-CoV-2 test: (Negative) Time: 08:00 am. On 20-Dec-2022, SARS-CoV-2 test: Negative, Negative, (Negative) at 16:00 and (Positive) very light positive COVID test. On 21-Dec-2022, SARS-CoV-2 test: Negative.         No concomitant medications were taken by the patient.  On 23-Nov-2022, the patient had COVID exposure from an asymptomatic person who did not take precautions on flight or did not do rapid test. On 24-Nov-2022, the patient had mild sore throat.  On 25-Nov-2022, the patient had sore throat, persistent mild headache frontal lobes and mild congestion.  On 26-Nov-2022, the patient had overnight insomnia, lower back pain for which the patient woke up at 02:30 am, congestion and sore throat. On the same day, the patient had temperature of 99.2 F. On the same day at 14:50, the patient had dull heart ache, sinus congestion felt a bit run down.   On 27-Nov-2022, the patient woke improved from yesterday. On the same day at 12:00 pm, the patient had front upper and lower tooth pain, congestion and fatigue. At 13:08, sharp L calf pain and poplitealish (5" above ankle). At 22:00, the patient felt better.  On 28-Nov-2022, the patient had positive COVID PCR test. The patient had mild SOB and just rolling trash can out.  On 29-Nov-2022, the patient had weary edge to just walking across the room.  On 30-Nov-2022 at 10:00 am, the patient had sudden sharp/stabbing pain mid R back in chest, dull throb remaining all day. Due to that the patient visited to emergency room and diagnosis of acute right thoracic pain was made. Blood work revealed D-Dimer of 0.19 uL and no CT scan was needed.  On 01-Dec-2022 at 12:00 pm, the patient had borderline diarrhea.  On 02-Dec-2022 by 11:00 am, the patient had severe blood diarrhea which continued for all day.  On 03-Dec-2022, severe diarrhea continued all day. By pm, the patient had sneezing, sinus congestion, L thigh inner ache and mild scratchy throat.  On 04-Dec-2022, resting HR increased by 10 overnight, backache and continued bloody diarrhea all day. By 09:00 pm, RR was 23-24, sitting HR 101-123.  On 05-Dec-2022, minimum oxygen saturation was 88% with average oxygen saturation was 95%. Minimum HR was 75/min, average was 85/min and maximum was 105/min (while asleep wearing CPAP for 2 hours and 10 minutes). At 06:15 am, woke up with coughing sinus block nasal congestion, Minimum oxygen saturation was 94%, average was 95% and maximum was 96%. At 11:00 am, the patient had light red/bloody mucus bowel movement. The patient also had dry cough. RR high with the result of 23-26. At 22:10, the patient had temperature of 100.5 F, complete sinus block, nasal swelling and could not use CPAP but oxygen saturation was 94-97%.  On 06-Dec-2022, at 08:00 am, the patient had phlegmy hacking cough (08:00 am to 12:00 pm) and sinus congestion. At 11:15 am, the patient had sinus block. At 12:10 pm, the patient had achy pain lower front teeth. Phlegmy hacking cough continued (12:00 pm to 05:00 pm). Then the patient had mix of dry and phlegmy hacking cough, more on the dry side. At 23:00, the patient had thick concrete mucus in nose and throat and at the same time the patient had RR of 15.  On 07-Dec-2022, during night the patient did not used CPAP. The patient tried sleeping on stomach with chest elevated above neck and face and facing down, then slept mouth open propped up nasal block and woke up sweaty but no fever. At 10:00 am, sticky wet cough, less phlegmy than yesterday, head felt weird, no fever, sinus congestion, but improved. HR was 84-87 and RR was 17. At 10:30 am, ears pop blowing nose, coughing with stiff phlegm in shower. At 13:55, lightheaded siting on couch. All afternoon to 21:00, spot of sticky crap felt like kept getting repeatedly stuck behind left tonsil causing hard cough, really difficult to break loose. At 22:30, coughing almost absent, nasal congestion still there but significantly decreased. Decided not to use CPAP.  On 08-Dec-2022 at 06:45, the patient woke up sweaty and woke by dry coughing. But felt better than yesterday. Mild runny nose with mild congestion. At 09:30, really phlegmy coughing and snotty nose bleeding. Ears popping on nose bleeding. At 17:00, the patient had milder phlegmy coughs and ear popping continued. At 22:00, the patient was sneezing and had raspy phlegmy coughing.  On 09-Dec-2022, the patient was less coughing overnight, woke with running nose, alternating nostrils and wet phlegmy cough. The patient had bad raspy coughing in shower, runny nose, persistent raspy phlegm stuck in throat with hacking cough, persistent drippy nose. Coughing of the patient improved overnight.  On 10-Dec-2022, the patient woke with sinus pain, ears pop when blowing nose. From 08:00 am to 12:00 pm, the patient had continued phlegmy coughing from throat, ears popping with blowing runny congested nose, odd mild lightheaded feeling. From 18:00 to 21:00, coughing nearly nonexistent.  On 11-Dec-2022 at 08:00 am, the patient had pus-fitted blister and skin peeling under nose. At 09:48, the patient had tiny heart ache sitting. At 10:00 am, the patient had mild GI aches. At 14:00, the patient went to rapid care because of lightheaded, ears popping, post-nasal drip and flu test was negative. At 23:00, the hacking cough continued with post nasal drip.  On 12-Dec-2022 the patient had ears popping with blowing nose and lightheaded.  On 13-Dec-2022, the patient had ears popping with blowing nose, runny nose, post nasal drip continued and mild wonky lightheaded.  On 14-Dec-2022 at 08:00 am, the patient had ongoing sinus stuff. At 09:50am, the patient had wonky light head and felt mildly nauseous.  On 15-Dec-2022, the patient had cleared throat and it's mild, no coughing and nose clear.  On 16-Dec-2022, the patient and insomnia and woke groggy. Barely had to clear throat, no coughing sinus for mot part clear. At 22:00, the patient had bad lower GI cramps.  On 17-Dec-2022, the patient had upper teeth pain across the front six. At 19:20, while siting on sofa the patient had sudden vertical disequilibrium/head spin.  On 18-Dec-2022 at 09:55 am, the patient had mild lightheadness.  On 19-Dec-2022 from 01:20 to 04:30 am, the patient had insomnia. At 13:00, the patient had front teeth nerve pain, baby tooth over across front tooth on right upper like more than 10 minutes.  On 20-Dec-2022, from 10:00 to 11:00 am, very light positive COVID test, followed by two separate back to back negative rapid test at the correct 15 minutes interval. The patient had dry throat and sort of scratchy, coughing in shower.  On 21-Dec-2022, the patient had front teeth shooting pain upper and lower.   Most recent FOLLOW-UP information incorporated above includes: On 01-Feb-2023: Upon follow-up, case classification 'tracking only' was removed and this case was updated to a valid case. Patient information, lab data, additional previous vaccination details, additional suspect vaccine dosing details and treatment drug were added. Previously reported event was deleted and new events were added. Event description was updated.