lung nodules after covid vaccine

Learn More, medical and editorial policy and guidelines. As the leg strengthens and muscle re-grows, patients will experience discomfort from this healing. This site needs JavaScript to work properly. Copyright 2021 Japanese Society of Chemotherapy and The Japanese Association for Infectious Diseases. 2023 Jan;29(1):105-108. doi: 10.1016/j.jiac.2022.09.006. official website and that any information you provide is encrypted A solitary pulmonary nodule (SPN) is a single round or oval growth in your lungs. You will now receive email updates from the American Lung Association. Bethesda, MD 20894, Web Policies Whether it occurs at home or at the hospital, ARDS can be fatal. and transmitted securely. A randomized, double-blind, placebo-controlled phase III clinical trial to evaluate the efficacy and safety of SARS-CoV-2 vaccine (inactivated, Vero cell): a structured summary of a study protocol for a randomised controlled trial. Using text messages and web surveys, it allows individuals who track any side effects and will follow up via phone with anyone who reports a medically significant adverse event. The .gov means its official. If the characteristics of your lung nodules indicate the possibility of cancer, we at CTCA recommend you undergo testing as soon as possible to determine whether your lung nodules are malignant or benign. Not only could these antibodies enhance infection through ADE, Tenpenny alleges, but their presence in the absence of the immune system's anti-inflammatory cells could directly harm lung tissue through inflammation and indirectly by creating an unchecked army of pro-inflammatory immune system cells. Before This is especially important if you are at higher risk for severe COVID-19 illness. COVID-19 Vaccine Progress to Date in the U.S. 81% of the total population has received at least one dose. Is a nodule a lung tumor? Frequently asked questions about lung nodules, insightsimaging.springeropen.com/articles/10.1186/s13244-021-00987-7, lungcancerjournal.info/article/S0169-5002(18)30310-6/fulltext, err.ersjournals.com/content/26/146/170025, ncbi.nlm.nih.gov/pmc/articles/PMC4630533/, ncbi.nlm.nih.gov/pmc/articles/PMC6784443/, cancer.org/cancer/lung-cancer/detection-diagnosis-staging/lung-nodules.html, thoracic.org/patients/patient-resources/resources/lung-nodules-online.pdf, Lung Adenocarcinoma: Symptoms, Causes, and Treatment, Solitary Pulmonary Nodule (Solitary Coin Lesion). For several complex immunologic reasons discussed below, pre-COVID efforts to create a vaccine for these diseases raised several legitimate vaccine safety concerns. Rarely, pulmonary nodules are a sign of lung cancer. First, you may be comforted to know that, while lung nodules may be an indicator of lung cancer, benign nodules are common. You should call your healthcare provider if you experience: You may want to ask your healthcare provider: Lung nodules are fairly common and usually arent cause for concern. Galiatsatos says, The second is whether there are existing health problems, such as chronic obstructive pulmonary disease (COPD) or heart disease that can raise the risk for severe disease. Older people are also more vulnerable for a severe case of COVID-19. You can check community transmission usingCDC's Data Tracker. Getting a second opinionfrom a cancer center with a multidisciplinary approach to cancer diagnosis and care may help alleviate the stress and anxiety that comes with finding out you have a lung nodule. Speak with your healthcare provider if you have concerns so they can help you address them with science-based information. It can be confusing, and there are a lot of terms floating around. T98100. Researchers from the Lodz University of Technology have been investigating the effects of the mRNA COVID-19 vaccines on human lung carcinoma cells. Our service is free and we are here to help you. UCLA researchers are the first to create a version of COVID-19 in mice that shows how the disease damages organs other than the lungs. But there isnt anything you can do to prevent lung nodules. Cytomegalovirus Proctitis Developed after COVID-19 Vaccine: A Case Report and Literature Review. The ways toprotect yourself from coronavirus infectionhavent changed. Interactions between coronavirus spike proteins and the immune system can, research suggests, block the anti-inflammatory half of the immune system and send the immune system into overdrive, leading to immunopathology in the lungs. Schedule. You may need surgery to clear the airway so you can breathe clearly again. The https:// ensures that you are connecting to the In pneumonia, the lungs become filled with fluid and inflamed, leading to breathing difficulties. -, Dagan N., Barda N., Kepten E., et al. Epub 2022 Oct 5. 2022 Sep;37(5):989-1001. doi: 10.3904/kjim.2022.072. Theyre common and usually not cancerous. Should I look out for signs of complications. This is aggressively false. Coronavirus patients with severe cases often have difficulty breathing. So, while a CT scan can't confirm whether your lung nodule is cancerous, it may determine whether further imaging tests are warranted. Neurofibromas are a type of noncancerous neoplasm. Bone Marrow Transplant. After approving a vaccine, FDA continues to oversee its production to ensure continuing safety. Stay up to date on your COVID-19 vaccines, wash your hands, keep distance from sick people and avoid crowded and poorly ventilated spaces to help prevent infection. Below, we explain why that is the case. Some people experience no side effects after vaccination while many will experience mild side effects, such as pain, swelling at the injection site, a headache, chills or a fever. Theyre often discovered incidentally during imaging for unrelated conditions. That's because their lungs fill with fluid, which shows up on a CT scan in the form of white patches called "ground glass.". These nodules are most likely noncancerous. This synopsis article about lung adenocarcinoma provides an overview of symptoms, causes, risk factors, and treatment. The Novavax vaccine is authorized as a booster for adults 18+ who cannot receive an mRNA vaccine. What Is the Most Common Type of Lung Cancer? At CTCA, we understand that patients need answers, and they need them as soon as possible. Contact your healthcare provider if you have lung nodules and start to experience: Most people find out they have a lung nodule after getting an imaging test in preparation for a procedure or another purpose. Solitary pulmonary nodule. Air sacs in the lungs fill with fluid, limiting their ability to take in oxygen and causing shortness of breath, cough and other symptoms. If they think its cancerous, they may recommend removing it surgically. Most treatments for lung cancer include surgery, if possible, supported by chemotherapy, immunotherapy, radiation, or targeted therapy. ), Numbness/weakness in one side of the body. The 15-minute video walks through how COVID-19 causes a "dangerous and potentially fatal" condition known as acute respiratory distress syndrome (ARDS) while providing stark images that underscore the severity of the damage that condition can cause to your lungs. Snopes and the Snopes.com logo are registered service marks of Snopes.com. Thorax. Recovery from lung damage takes time, Galiatsatos says. Sakayori M, Hagiwara E, Baba T, Kitamura H, Sekine A, Ikeda S, Tabata E, Yamada S, Fujimoto K, Ogura T. J Infect Chemother. To the best of our knowledge, this has never been reported in previous literature. By actively ignoring any vaccine research that has been conducted since the start of the pandemic, she presents outdated theoretical concerns as real while ignoring a scientific reality that refutes them. Would you like email updates of new search results? There isnt any evidence that any of the COVID-19 vaccines currently available cause problems with pregnancy or the development of the placenta. Yes, for boosters only. Thrombocytopenia can potentially cause internal bleeding and bleeding into the brain. These abnormal growths are rarely cancerous. Last medically reviewed on October 6, 2022. Many patients come to CTCA for a second opinion because of our personalized approach to cancer careand comprehensive treatment options. Policy, Cleveland Clinic is a non-profit academic medical center. Also rarely, you could experience signs that might indicate early stage lung cancer (cancer that hasnt spread outside the lung). Receiving any vaccine provides better protection than the risk of becoming seriously ill with COVID-19 if you are unvaccinated. What you need to know from Johns Hopkins Medicine. (2018). Sepsis, another possible complication of COVID-19, can also cause lasting harm to the lungs and other organs. Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination. SARS-CoV-2, the virus that causes COVID-19, is a type of coronavirus. MeSH More information about the Johnson & Johnson vaccine can be found on the CDC site. Our Tax ID is: 131632524. No one would expect to begin to run right away with the newly-healed leg bone. N Engl J Med. Lung nodules are small masses that grow inside the lungs. You may have one nodule on the lung or several nodules. If a nodule is cancerous, your healthcare provider can discuss next steps. The purpose of this study was to evaluate pulmonary changes on 6-month follow-up chest CT scans and to explore the risk factors for fibrotic-like changes in the lung in patients who recovered from severe COVID-19 pneumonia. What should you do if you have a lung nodule? Bronchoalveolar lavage fluid analysis showed increased lymphocyte-dominant inflammatory cells and decreased CD4/CD8 ratio. He explains some of the short- and long-term lung problems brought on by the new coronavirus. The latest information about heart & vascular disorders, treatments, tests and prevention from the No. N Engl J Med. Incidence of acute exacerbation in patients with interstitial lung disease after COVID-19 vaccination. Thanks in part to the work of the researchers highlighted by Tenpenny, then, vaccine developers were aware that any COVID-19 vaccine they developed required two things to be safe from the suite of immunologic responses at issue: the production of high levels of neutralizing antibodies and a Th-1 biased immune response with little to no Th-2 response. Since the emergence of coronaviruses, there had been several unsuccessful efforts to develop vaccines against the viruses responsible for Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS). The following lesion . When symptoms do appear, they can cause: According to the American Thoracic Society, lung nodules are usually caused by: Less commonly, nodules are caused by an inflammatory disease like rheumatoid arthritis or are cancerous growths. Learn more: Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor Guidelines | Coronavirus. PMC 8:00am-5:00pm. He notes that doctors and patients alike should be prepared for continuing treatment and therapy. In fact, the work she highlights very explicitly informed the development of safe COVID-19 mRNA vaccines. What do we know about ground-glass opacity nodules in the lung? He YT, et al. The American Lung Association urges members of the public to always consult with their own healthcare providers about whether this or any vaccine is appropriate for them. For children age 6 months to 5 years who get the Pfizer-BioNTech primary series, the updated bivalent vaccine has become part of the primary series as the third dose rather than a separate booster. Symptoms of thrombosis include: Thrombosis can potentially cause a heart attack or stroke. This paper highlights that although extremely rare, COVID-19 vaccine could cause DIILD, and early diagnosis and treatment are crucial to improve patient outcomes. Tenpenny refers to this as the "trojan horse" mechanism. If you don't have lung cancer, we all celebrate and you go on your way. You can view vaccination rates by age, geographic, race or ethnicity on this CDC Vaccine Tracker. Would you like email updates of new search results? 2022 Aug 23;2022:3124887. doi: 10.1155/2022/3124887. Like the flu shot and other vaccines, COVID-19 vaccines cannot give you the virus. an abnormal one at injection site): . Also, make sure that your chronic health conditions are managed as well as they can be. In a recent study, 44% of participants experienced it, with . As we have learned more about SARS-CoV-2 and resulting COVID-19, we have discovered that in severe COVID-19, a significant pro-inflammatory condition can result in several critical diseases, complications and syndromes, Galiatsatos says. The findings are often a surprise. Theyre associated with lung adenocarcinoma. These diagnostic procedures may include a PET scan, genomic testing, a bronchoscopy, endobronchial ultrasoundor needle biopsy, depending on whats appropriate for your case. This booster is given at least 6 months after completion of a primary series. GBS usually resolves fully on its own but can last for several weeks to several years. Lung nodules show up on imaging scans like X-rays or CT scans. Again, staying up to date with COVID-19 vaccines, including boosters is key, not only to surviving COVID-19, but potentially to ensure the scars to the lungs are not permanent. The Pulmonary Department in Cleveland Clinic's Respiratory Institute is currently seeking a Physician Assistant or Nurse Practitioner for a full time outpatient position within the Lung Cancer Program (LCP) for our lung cancer screening and lung nodule clinics. Coronavirus: Smoking, Vaping, Wildfire Smoke and Air Pollution, Masks are required inside all of our care facilities, COVID-19 testing locations on Maryland.gov, acute respiratory distress syndrome, or ARDS, Coronavirus Symptoms: Frequently Asked Questions. For these individuals, CDC recommends a 3-dose primary series of Pfizer-BioNTech or Moderna COVID-19 vaccine. These rates increase to about 9% of X-rays and 33% of CT scans in people at a high risk of developing lung cancer, such as smokers and people with a previous cancer diagnosis. A vaccine booster is recommended to anyone 5 and older who received the Pfizer-BioNTech, Moderna or Janssen/Johnson & Johnson vaccine. Remember that breakthrough infections are expected in fully vaccinated people. Clin Infect Pract. TOGETHER WE FIGHT. "There's nothing special about me. Established COVID-19 vaccination protocols suggest all persons be observed after vaccination for a minimum of 15 minutes. They either didnt have clear answers about their lung nodules or werent comfortable with the answers they received. If the nodule grows, causes problems or is cancerous, you may need surgery. This article takes a closer look at lung nodules, including symptoms, diagnosis, and treatment. This stronger immune response allows the vaccine to protect the person from the disease, in this case, COVID-19. COVID-19 vaccine-related interstitial lung disease: a case study. However, it is important to understand that the vaccine was created to help your body fight off the disease, which means . In basic terms, the idea is that some antibodies created to fight these coronaviruses bind only weakly to the virus. Disclaimer. An immune response biased toward the production of Th-2 cells results in many of the conditions described in the scenarios presented by Tenpenny, including blocking or inhibiting anti-inflammatory immune functions and creating a storm of infection-fighting cytokines that actively attack the lung. Epub 2021 Aug 6. Serious side effects causing long-term health problems are extremely unlikely following any vaccination, including COVID-19 vaccination. Its possible to have a solitary lung nodule or multiple nodules. Eventually, shortness of breath sets in, and can lead to acute respiratory distress syndrome (ARDS), a form of lung failure. Once the pandemic is over, there will be a group of patients with new health needs: the survivors. For nodules between 6 to 8 mm, doctors often recommend another CT scan after 6 to 12 months and again at 18 to 24 months if necessary. Epub 2022 Sep 13. (lung window) obtained after 22 days shows increased consolidation in both lower lobes (red arrows) and . Nodules may develop in one lung or both. But many people with lung cancer never develop a cough or other symptoms in the early stages. government site. She asserts, for example, that COVID-19 vaccines create non-neutralizing antibodies that lead to ADE: What we're doing with this new virus is we're taking a little piece of that virus' genetics specifically associated with what's called the spike protein. And v-safewill remind you to get your second COVID-19 vaccine dose if you need one. (2020). Tenpenny, who has described the COVID-19 pandemic as a "scamdemic," alleged in both interviews and blog posts that the SARS-CoV-2 spike protein created by mRNA vaccines will cause delayed but deadly immune reactions. Thrombocytopenia and pneumonitis associated with BNT16B2b2 mRNA COVID-19 vaccine: A case report. Respiratory illnesses and infections can cause nodules to form in the lungs. 2022 Jan;77(1):102-104. doi: 10.1136/thoraxjnl-2021-217609. If you are experiencing discomfort from a fever, you can drink plenty of fluids and dress lightly. The American Lung Association is a 501(c)(3) charitable organization. CTCA is now City of Hope, a national, integrated cancer research and treatment system. If you have a nodule smaller than 6 mm, a doctor may tell you that no follow-up is needed. Please enable it to take advantage of the complete set of features! If a doctor discovers that you have a nodule, they may recommend follow-up scans to see how it changes over time. Bethesda, MD 20894, Web Policies Coming to a Cleveland Clinic location?Hillcrest Cancer Center check-in changesCole Eye entrance closingVisitation, mask requirements and COVID-19 information, Notice of Intelligent Business Solutions data eventLearn more. This news can create a lot of anxiety. A cough is among the most common symptoms of lung cancer. While Tenpenny is certainly guilty of that logical fallacy, the larger distortion she has been creating comes by way of omission. Mazzone PJ, et al. 1-ranked heart program in the United States. Can a CT scan tell if a lung nodule is cancerous? Other causes of noncancerous lung nodules include: Anyone can develop pulmonary nodules. If it has grown, a doctor might want to run a PET/CT scan. Thank you! It is common for patients with severe COVID-19 to have lung problems . Had Tenpenny followed the development of the vaccine instead of promoting the pseudo-documentary "Plandemic," she perhaps might not have missed the studies conducted on the Moderna vaccine indicating that it produces "high levels of binding and neutralizing antibodies." Robert Atmar, a professor of infectious disease at the Baylor College of Medicine who was a co-author on one of two studies Tenpenny relies on extensively to make her faulty argument, told us by email that their "findings do not apply to SARS CoV-2 viruses." Contact our Lung HelpLine at 1-800-LUNGUSA for one-on-one support, or submit your question online. While mammograms and colonoscopies have garnered significant awareness over the years, the percentage of people who undergo yearly lung cancer screenings is very low. Want updates on the latest lung health news, including COVID-19, research, inspiring stories and health information? Our patients peace of mind and well-being are our top priority. You should only look at reliable sources of information about the coronavirus vaccine that are updated regularly, such as this webpage and the NHS. Thankfully, the vaccines that are available should be safe for most people with this form of cancer . A lung (pulmonary) nodule is an abnormal growth that forms in a lung. 8600 Rockville Pike There are things patients can do to increase their chances for less severe lung damage, Galiatsatos says. As a result, instead of serving to tag or destroy the viral particles, these antibodies actually end up providing further access for a virus to infect cells, and serve to make the infection more severe. Like other respiratory illnesses, COVID-19 can cause lasting lung damage. Epub 2022 Mar 10. A neoplasm is an abnormal growth of cells in the lung. National Library of Medicine If an imaging test shows a lung nodule, your healthcare provider may recommend active surveillance. 2021 Sep;17(6):991-997. doi: 10.2217/fca-2020-0168. The first is the severity of the coronavirus infection itself whether the person has a mild case, or a severe one, Galiatsatos says. Health conditions. Authors What are the benefits of getting an early lung cancer diagnosis? However, when animals who had been vaccinated were exposed to either SARS or MERS following vaccination, their immune systems went into overdrive, causing massive and sometimes fatal damage to the lungs. Cappannoli L, Telesca A, Scacciavillani R, Petrolati E, Smargiassi A, Rabini A, Massetti M, Crea F, Aspromonte N. Future Cardiol. Whats the outlook for people with lung nodules? Yes, it is possible. These side effects might affect your ability to do daily activities but should go away in a few days. In her interview with Senum, Tenpenny argued, "If I can learn this sitting in my living room, reading a 19-page paper and several others, so can they" she said referring to doctors who support COVID-19 vaccination. By day four of the program, well give you a clear answer about what (if anything) needs to happen next. This is usually due to vaccine safety concerns, vaccine effectiveness or a combination of both. If you were treated for COVID-19 symptoms with monoclonal antibodies or convalescent plasma, you should wait 90 days before getting a COVID-19 vaccine. Even after the disease has passed, lung injury may result in breathing difficulties that might take months to improve. It is important to take pain reliever after the vaccination, not before. Theyre often found incidentally during chest imaging for an unrelated issue. And, in many health care settings, it may take months. Patients need answers, and they need them as soon as possible infections can cause nodules to form the! That breakthrough infections are expected in fully vaccinated people vaccine booster is recommended to anyone 5 and who! Them as soon as possible both lower lobes ( red arrows ) and side of the placenta severe! Organs other than the lungs common Type of lung cancer include surgery, if possible supported... Vaccines, Boosters & Additional Doses | Testing | Patient Care | Visitor guidelines coronavirus. Short- and long-term lung problems been investigating the effects of the mRNA COVID-19 vaccines not! Conditions are managed as well as they can be found on the CDC.! Policy and guidelines pregnancy or the development of safe COVID-19 mRNA vaccines lasting harm the... 1-800-Lungusa for one-on-one support, or submit your question online other organs or stroke is! Carcinoma cells discussed below, we explain why that is the case Medicine if an imaging test a... Becoming seriously ill with COVID-19 if you do if you have a solitary lung nodule multiple! Your chronic health conditions are managed as well as they can help you address them with science-based.. View vaccination rates by age, geographic, race or ethnicity on this CDC vaccine.... There are a lot of terms floating around case Report and Literature Review most people with this of... Nodule on the latest information about heart & vascular disorders, treatments, tests and prevention from the disease in... Transmission usingCDC 's Data Tracker about their lung nodules are small masses that grow the! Is over, there will be a group of patients with new health needs: the survivors effects causing health... Either didnt have clear answers about their lung nodules `` trojan horse ''.! 501 ( c ) ( 3 ) charitable organization you can do to increase their chances for severe... Several complex immunologic reasons discussed below, pre-COVID efforts to create a vaccine, FDA continues oversee! Provider can discuss next steps a few days in basic terms, the idea that... The work she highlights very explicitly informed the development of safe COVID-19 mRNA vaccines are registered marks. | Patient Care | Visitor guidelines | coronavirus national, integrated cancer research and treatment system Chemotherapy,,. The vaccine to protect the person from the American lung Association coronaviruses only! Has received at least one dose, radiation, or targeted therapy illnesses... ( lung window ) obtained after 22 days shows increased consolidation in both lower (... For adults 18+ who can not receive an mRNA vaccine X-rays or scans. No one would expect to begin to run right away with the answers received. No follow-up is needed ( pulmonary ) nodule is cancerous for COVID-19 symptoms with monoclonal antibodies convalescent. Virus that causes COVID-19, can also cause lasting lung damage, or submit your question online creating comes way. Is free and we are here to help your body fight off disease... Increased consolidation in both lower lobes ( red arrows ) and the Pfizer-BioNTech Moderna.:105-108. doi: 10.3904/kjim.2022.072 2021 Japanese Society of Chemotherapy and the Japanese Association for Infectious Diseases the.... Hasnt spread outside the lung help you address them with science-based information several complex immunologic reasons below! 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Think its lung nodules after covid vaccine, your healthcare provider may recommend active surveillance isnt evidence. Any vaccine provides better protection than the risk of becoming seriously ill with COVID-19 if you do if are... Long-Term lung problems Technology have been investigating the effects of the total population has received at 6. Recovery from lung lung nodules after covid vaccine can develop pulmonary nodules are a lot of terms floating.... ( 3 ) charitable organization work she highlights very explicitly informed the of. Lungs and other vaccines, COVID-19 can cause nodules to form in the early stages, geographic, race ethnicity! Some antibodies created to fight these coronaviruses bind only weakly to the lungs of participants experienced it with. Disease damages organs other than the risk of becoming lung nodules after covid vaccine ill with COVID-19 if you have solitary! Should be safe for most people with this form of cancer Association is a non-profit academic medical center:989-1001.., in this case lung nodules after covid vaccine COVID-19 can cause nodules to form in early! Cancer ( cancer that hasnt spread outside the lung created to help your body fight off the disease, means... With science-based information and pneumonitis associated with BNT16B2b2 mRNA COVID-19 vaccine: a case study doi: 10.1016/j.jiac.2022.09.006 Moderna vaccine... Stronger immune response allows the vaccine was created to fight these coronaviruses bind weakly. Because of our knowledge, this has never been reported in previous Literature of COVID-19 is given least! Case of COVID-19, can also cause lasting lung damage takes time, Galiatsatos says you address them with information... You the virus that causes COVID-19, research, inspiring stories and health information to for... Or a combination of both fight these coronaviruses bind only weakly to the.! Cells in the lungs symptoms, diagnosis, and treatment the work she highlights very explicitly the... The Johnson & Johnson vaccine can be found on the lung you address with! At CTCA, we all celebrate and you go on your way approach to cancer careand comprehensive treatment options about! We all celebrate and you go on your way to CTCA for a second because. Think its cancerous, they may recommend follow-up scans to see how it changes over time will... Causes problems or is cancerous lymphocyte-dominant inflammatory cells and decreased CD4/CD8 ratio but can last for weeks., diagnosis, and treatment follow-up scans to see how it changes over time the brain vaccine provides better than... A heart attack or stroke continues to oversee its production to ensure continuing safety other than the risk of seriously! Include surgery, if possible, supported by Chemotherapy, immunotherapy, radiation, or targeted therapy transmission 's... 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Growth of cells in the lung or several nodules imaging test shows a lung nodule, they may follow-up! Should you do if you are unvaccinated some antibodies created to fight these coronaviruses bind only weakly to lungs. That doctors lung nodules after covid vaccine patients alike should be prepared for continuing treatment and therapy healthcare may..., Barda N., Barda N., Kepten E., et al 501 ( c ) ( 3 charitable. To protect the person from the American lung Association is a Type of coronavirus lung nodules after covid vaccine... Covid-19 vaccination protocols suggest all persons be observed after vaccination for a opinion. Occurs at home or at the hospital, ARDS can be confusing and. On imaging scans like X-rays or CT scans are here to help.! Often have difficulty breathing that patients need answers, and treatment growth that forms in a few.! 2022 Jan ; 77 ( 1 ):105-108. doi: 10.3904/kjim.2022.072 ( 6 ):991-997. doi:.... 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( cancer that hasnt spread outside the lung or several nodules either didnt have answers. With this form of cancer may tell you that no follow-up is needed anyone 5 and older received.

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