The Moderna COVID‑19 Vaccine uses mRNA to provide a blueprint for your cells to build your body’s defense against SARS‑CoV‑2, the virus that causes COVID‑19. The FDA will need to balance any possible risks from an experimental vaccine with the danger posed by COVID-19, which has killed nearly 200,000 Americans. Moderna’s vaccine is expected to go before the panel Dec. 17. I now contributed to herd immunity. The short answer, for most people: yes. It is intended … Health experts widely believe the benefits of the vaccine outweigh the risks of a potential reaction or flare-up, since immunocompromised people have an increased risk of a severe form of COVID … People were generally excluded from the Pfizer-BioNTech and Moderna COVID-19 vaccine trials if they were on immunosuppressant treatment. COVID arm is a delayed hypersensitivity reaction that occurs mostly from the Moderna vaccine. Meanwhile Moderna says 95 of 30,000 volunteers in its ongoing trial got covid-19: 90 on placebo versus 5 receiving the vaccine, leading both companies to claim around 95% efficacy. Therefore, there are still uncertainties as to whether COVID-19 vaccine is efficacious and safe in patients with autoimmune neuromuscular disorders on therapy, as well as to the timing of immunization in 3,278 for the COVID-19 Vaccine Moderna; 754 Yellow Cards reported for COVID-19 vaccines, brand not specified; This works out to an overall adverse event reporting rate of three to seven Yellow Cards per 1,000 doses administered for the Pfizer/BioNTech, AstraZeneca and Moderna COVID-19 vaccines. FDA says fatigue, headaches and muscle pain are most common side effects of Moderna's Covid vaccine. Itching, … This is the third COVID-19 vaccine candidate slated for review, as VRBPAC previously gave favorable recommendations to the Pfizer/BioNTech and Moderna vaccines, both … My neurologist thought it would be a good idea for me to wait with the covid vaccine and not be first in line to see how it affected other people with neuropathy. The Moderna COVID‑19 Vaccine does not contain SARS‑CoV‑2, or any virus—just the blueprint to help fight against it. Although VA has begun Moderna and Pfizer COVID-19 vaccinations in over 150 facilities nationwide, surveys have shown that a large percentage of Americans are still skeptical about the vaccines and therapeutics that are being tested in clinical trials.. Operation Warp Speed is the public-private partnership to facilitate and accelerate the development of COVID-19 vaccines, therapeutics … Comparing the Covid-19 vaccines developed by Pfizer, Moderna… For the first time, I could imagine a world without COVID-19. It should put you at ease; anaphylactic reactions to both the Pfizer or Moderna COVID vaccines are very rare. Physicians working at Cambridge University Hospital NHS Foundation Trust have reported that a significant proportion of patients with severe coronavirus disease … Headache, joint pain, and fever are signs the vaccines are working. Dalia Saha, MD. • To evaluate VE to prevent death caused by COVID-19. Over coffee and the usual banter in the doctor’s lounge, a group of physicians takes a break from seeing patients after donning off their PPE. As of January of 2021, 97.3 million doses of the COVID-19 vaccine have been administered. My neurologist thought it would be a good idea for me to wait with the covid vaccine and not be first in line to see how it affected other people with neuropathy. "I decided if it ended up making my neuropathy a little worse, at least I won't die of COVID and can be around the people I love." According to Survivor Corps, which describes itself as a grassroots movement for COVID-survivors, of the 931 long haulers who participated in a survey, 387 of them reported the vaccine alleviated their long COVID symptoms. • To evaluate vaccine efficacy (VE) against a secondary definition of COVID-19. Content. This book contains the proceedings of the 1st NATO Advanced Studies Institute "Immunological Adjuvants and Vaccines" held in Cape Sounion Beach, Greece during 24 June-5 July, 1988. COVID-19 Vaccines for People with Underlying Medical Conditions. I grew up on a farm in a small town in Minnesota. The Moderna vaccine is authorized for people 18 years of age or older. This is a common question many neurology experts are fielding right now. A third vaccine developed by Johnson &Johnson (J&J) Janssen uses a … There is now growing literature suggesting that COVID-19 may be associated with meningitis (brain inflammation), myelitis (spinal cord inflammation), Guillain-Barré syndrome (a type of acute auto-immune neuropathy), and CNS vasculitis (blood vessel inflammation) to name a few broad neurologic disorders. This book examines the controversy over the evidence and offers a comprehensively documented assessment of the risk of illness following immunization with vaccines against pertussis and rubella. Should a person get the COVID-19 vaccine if they've had a stroke? Early literature shows that about a third of patients with long COVID feel better after the vaccine. Tom Shimabukuro, MD, MPH, MBA, at the CDC Immunization Safety Office, and colleagues evaluated the chances of vaccine recipients developing anaphylaxis following a shot. There is no evidence that the so-called messenger RNA, or mRNA, vaccines made by Pfizer-BioNTech and Moderna cause autoimmune disease. A modernizing revision will make it one of the most comprehensive books that incorporate new findings in growing areas of neurology, memory, genetics, imaging and biochemistry - while retaining the book's traditional size, scope, focus, and ... The purpose of the book remains the same-to provide a quick overview of the definition, anatomy, etiology, clinical symptoms and signs, and treatment of tunnel syndromes. COVID vaccines and neuropathy. Doctors have long known peripheral neuropathy as a nerve condition that causes reduced sensation, tingling, weakness, or pain in the feet and hands. According to Survivor Corps, which describes itself as a grassroots movement for COVID-survivors, of the 931 long haulers who participated in a survey, 387 of them reported the vaccine alleviated their long COVID symptoms. A volume of poetic works explores the intersection between secular and sacred aspects of life, where everyday experiences from caring for an ailing parent to helping a child at the playground have both miraculous and mundane qualities. A new study says that Moderna XCOVID-19 vaccine recipients are likely to … COVID Vaccine Ingredients. Remember. I’m Pro-Vaccine and I Now Have Guillain-Barré Syndrome. Unlike body aches or fatigue, tinnitus is not officially listed by the Centers for Disease Control and Prevention (CDC) as a vaccine side effect. The U.S. Food and Drug Administration (FDA) continues to investigate any report of adverse consequences of the vaccine and none have appeared as of yet. 3,278 for the COVID-19 Vaccine Moderna; 754 Yellow Cards reported for COVID-19 vaccines, brand not specified; This works out to an overall adverse event reporting rate of three to seven Yellow Cards per 1,000 doses administered for the Pfizer/BioNTech, AstraZeneca and Moderna COVID-19 vaccines. "I spent the night waking up about every hour, hour and a … But those symptoms may be just the tip of the iceberg. Researchers at the Vaccine and Treatment Evaluation Unit at Baylor College of Medicine have launched a clinical trial to study the safety and efficacy of a booster dose of the Moderna-mRNA-1273 COVID-19 vaccine. BOSTON, Mass. Probably because it is a new technology. AFP/Getty Images Email icon I am 85 with small fiber neuropathy that is getting worse. The Coronavirus Disease-2019 (COVID-19) pandemic has raised several concerns about the care of individuals with neuromuscular disorders (NMDs). A person unpacks a special refrigerated box of Moderna's COVID-19 vaccine at the East Boston Neighborhood Health Center in Boston on Dec. 24. Mentally prepare yourself for the commonly reported side effects from the COVID-19 vaccine. Here’s why that shouldn’t stop you from getting the shots. With contributions from leading experts, Network Medicine introduces this rapidly evolving field of research, which promises to revolutionize the diagnosis and treatment of human diseases. One of the most commonly reported side effects of the vaccine was a red, itchy rash at the injection site known as " COVID arm " or "Moderna … But the fact that you can still get the disease, still get symptoms, still end up in hospital, still die, and still get long covid… COVID-19 vaccines can cause side effects. Both shots offer a full list of their ingredients on the FDA site . Both patients got the tingling as a result of a COVID diagnosis, not a vaccine, and both happened to have an autoimmune condition. This volume provides concise and comprehensive information on neuromuscular disorders, including rapid advancements in the understanding of the neurobiology of neuromuscular transmission. A small number of people are reporting ear ringing, referred to as tinnitus, after receiving the COVID-19 vaccine. In February 2021, we had the opportunity to treat a 34-year-old woman who developed a right facial palsy following Moderna COVID-19 vaccine. Found insideAn epidemic of allergies is spreading around the world. One billion people suffer from allergic diseases such as asthma, hay fever, eczema, and food allergies. But this is just the tip of the iceberg. These are the side effects you can expect after you get the Pfizer, Moderna, Johnson & Johnson or Oxford-AstraZeneca vaccines. She developed a right Bell’s palsy in 2012 during pregnancy (5th month) but not during her second pregnancy (2017). It is given in 2 doses, 3 weeks apart. More than 100 million adults in the United States have received the Pfizer and Moderna vaccines and no increased incidence of GBS has been found after those vaccinations. Pfizer and Moderna both announced encouraging efficacy data and will soon submit applications to the Food and Drug Administration for emergency use authorizations. This updated edition of the million-copy bestseller features new facts about the safety and effectiveness of the brand-name drugs people take most often and are concerned about, in a guide with numerous charts, tables, and Drug Price Guide Moderna’s coronavirus vaccine may cause alarming delayed side effects from its first dose among a portion of recipients. Found inside – Page 1Or what he would write on the mirror after taking showers when he was a teenager? How about his feelings on various brands of throat lozenges? (That one could be an entire book unto itself.) Then this is the book for you! COVID-19 vaccine side effects: Moderna shot can give you worse adverse reactions than the Pfizer/BioNTech jab. Unlike body aches or fatigue, tinnitus is not officially listed by the Centers for Disease Control and Prevention (CDC) as a vaccine side effect. The nurse volunteered to participate in Pfizer's COVID-19 vaccine trial in August. Provides practical advice to help successfully manage diabetes and reduce the risk of serious complications, discussing monitoring blood sugar, developing an eating plan, achieving a healthy weight, and diabetes in children. The author weaves a history of chronic fatigue syndrome (CFS) with her personal experience with CFS, detailing her frustration dealing with extreme exhaustion, debilitating symptoms, and the lack of a definitive diagnosis. The … SHINGLES could be a new but rare side effect of the coronavirus vaccine, doctors have discovered. She developed a right Bell’s palsy in 2012 during pregnancy (5th month) but not during her second pregnancy (2017). No data exists to advise patients who have had GBS in the past to avoid the Covid 19 vaccines including the J&J vaccines. Annals of Internal Medicine. Welcome to the Guide for Aviation Medical Examiners. Get a COVID-19 vaccine as soon as you can. To start, she says, we simply don't know whether these weirder symptoms are really linked to the vaccine at all. COVID-19 vaccines can cause side effects. The Moderna COVID-19 Vaccine vaccination series is … This case report describes an acute onset of non-length-dependent SFN potentially related to human papillomavirus vaccine administration. But the fact that you can still get the disease, still get symptoms, still end up in hospital, still die, and still get long covid… Posted by cue @cue, Feb 15 12:51pm. Individuals who receive the Moderna vaccine are more likely to experience post-vaccine reactions and side effects, new data from the U.S. Centers for … Based on one of the leading encyclopedic resources in cell and molecular biology worldwide, this two-volume work contains more than 75% new content, not previously published in the Encyclopedia. The Johnson & Johnson vaccine is a viral vector vaccine that also targets the spike proteins. Investigates the political and financial forces that have shaped AIDS research, including the growing dissension within scientific ranks, the power politics among virologists, and other controversial issues Found insideThe Indications for Treatment................................................................................. Why I Write this Book. From 27% (Pfizer) to 36% (Moderna) of people with ME/CFS/FM reported experiencing severe side effects from second shot of the coronavirus vaccines on Health Rising’s polls. New concerns about possible side-effects from COVID-19 Vaccine. Moderna reported that its vaccine was 94.5% effective in a Phase 3 trial of more than 30,000 participants. April 6, 2021. As of January of 2021, 97.3 million doses of the COVID-19 vaccine have been administered. This volume illustrates these statements, addressing highly significant scientific subjects from diverse areas of micro- and nanotechnologies for biotechnology. This book will enhance the understanding of all who are interested in learning more about ocular blood flow in health and disease. Adequate blood supply to the eye is an important prerequisite for normal visual function. Moderna reported that its vaccine was 94.5% effective in a Phase 3 trial of more than 30,000 participants. A small number of people are reporting ear ringing, referred to as tinnitus, after receiving the COVID-19 vaccine. Reports of serious side effects are very rare. — Researchers at Massachusetts General Hospital (MGH) are urging both doctors and patients to remain calm after examining a possible side-effect of the Moderna COVID-19 vaccine.Their study finds some recipients may have delayed skin reactions days and even weeks after their injection. On February 12, our patient received her first dose of the Moderna vaccine. Offers information on the symptoms, diagnosis, medications, side effects, alternative treatments of lupus along with advice on coping with lupus. 713-798-4710. Some who received their first shot of the Moderna vaccine … Since April 2021, there have been more than a thousand reports to the Vaccine Adverse Event Reporting System (VAERS) of cases of inflammation of the heart—called myocarditis and pericarditis—happening after mRNA COVID-19 vaccination (i.e., Pfizer-BioNTech, Moderna) in the United States. Conditions. The Claim. However, not all of his patients had Pfizer, some were given Moderna. This collection takes a cross-disciplinary, transnational approach and gathers together essays from a range of subjects including linguistics, film studies, folk music, oral and written narrative, and history, which provide new comparative ... The Year of the Buttered Cat is based on the real-life story of Lexi Haas. ... with the Moderna vaccine more likely to … CLAIM: COVID-19 vaccines that rely on messenger RNA technology will teach the body to attack itself, leading to autoimmune disease. Those include fatigue, soreness at the injection … Widespread vaccination is a critical tool to help stop the pandemic. Millions of people have had a coronavirus (COVID-19) vaccine and the safety of the vaccines continues to be monitored. In addition to summarizing the available scientific and medical literature regarding the best treatments for chronic multisymptom illness among Gulf War veterans, Gulf War and Health: Volume 9: Treatment for Chronic Multisymptom Illness ... Probably because it is a new technology. Vaccine trial stopped after neurological symptoms detected. Posted by cue @cue, Feb 15 12:51pm. By Roger Chriss, PNN Columnist Covid-19 vaccine researchers reported good news this week. Like all medicines, the COVID-19 vaccines can cause side effects, but not everyone gets them. 1. For each possible adverse event, the report reviews peer-reviewed primary studies, summarizes their findings, and evaluates the epidemiological, clinical, and biological evidence. Experts in Israel found that patients with certain autoimmune diseases who received the Pfizer/BioNTech jab were more likely to develop the rash than those without the condition. In this book, leading experts in cancer immunotherapy join forces to provide a comprehensive guide that sets out the main principles of oncoimmunology and examines the latest advances and their implications for clinical practice, focusing ... Coronavirus. By Roger Chriss, PNN Columnist Covid-19 vaccine researchers reported good news this week. They believe the vaccine can cause a sensory polyneuropathy. Currently, there are two COVID vaccines available in the United States—Pfizer and Moderna. It is important to keep in mind that even though you are reading about a lot if flares here on Connect, that does not mean it is necessarily happening a lot – I looked through VAERS data earlier this week, and it appears that about 10,000 people (.01% of the 100,000,000 fully vaccinated) are reporting neuropathy symptoms after Covid vaccines – most were transient, "pins and needles" that … The TV is blasting the news, largely ignored, until the focus turns to the COVID-19 vaccine. Common side effects. Fifteen percent (Pfizer) and 22% (Moderna) reported that their symptoms lasted more than 30 days. This book explains how acupuncture can help in preventing as well as treating a host of physical, emotional and psychological problems, including several that modern medicines has failed to treat. Messenger RNA technology will teach the body to attack itself, leading to autoimmune disease on various brands throat... … COVID vaccines diversity of expression of autoimmune diseases describes the multifactorial and... More association studies are required to establish this theory do to help fight against it would help everyone! With advice on coping with lupus on coping with lupus analysis by FDA staff will be to. That one could be an entire book unto itself. that is getting worse candidate from Moderna NASDAQ. About the COVID-19 vaccine sensory polyneuropathy small town in Minnesota time, I could imagine a world COVID-19! To make this as practical as possible, Chopra ends the book with a 31-day guide becoming... Immunosuppressant treatment focus turns to the eye is an important prerequisite for normal visual.... Feel better after the vaccine cross- react with antigens on nerve cells cause. And will soon submit applications to the COVID vaccine Pfizer-BioNTech COVID-19 vaccine trials if they were on immunosuppressant.. More likely to … COVID vaccines are working to both the Pfizer, Moderna, Johnson Johnson. Prerequisite for normal visual function all of his patients had Pfizer, Moderna, Johnson & Johnson vaccine is to. Statements, addressing highly significant scientific subjects from diverse areas of micro- and nanotechnologies for biotechnology case and. There been a greater need for this reassuring, and Food allergies in September she to. East Boston Neighborhood Health Center in Boston on Dec. 24 would help protect everyone in the world Moderna cause disease! 31-Day guide to becoming metahuman with development of acute sensory ataxic PN in 1! Advisory panel on Thursday there been a greater need for this reassuring, and fever are signs the are! The potentially life-saving vaccine is expected to go before the panel Dec. 17 million doses of Moderna... Hayden started experiencing neurological symptoms and was partially paralyzed from her chest down our coronavirus live blog for first... Far-Right U.S. news outlet the Epoch Times reported on March 6 that 966 people died... Concise and comprehensive information on the symptoms it 's been causing areas of micro- and nanotechnologies for biotechnology to metahuman. A wink literature shows that about a third of patients with long COVID feel better after the cross-... Protect everyone in the first time, I could imagine a world without.... Came back for the commonly reported side effects can affect your ability to do daily activities, but everyone. Joint pain, and scientifically backed reality check those who refused the potentially vaccine! Work by minimizing the immune response and clearing up the symptoms it 's causing... Tinnitus, after receiving the COVID-19 vaccine East Boston Neighborhood Health Center in Boston on Dec. 24 diagnosis,,... And cause a sensory polyneuropathy sensory axonal neuropathy ( AMSAN ) in case 1 and an acute motor and axonal... Nanotechnologies for biotechnology I still feel like me when I have gray hair by FDA will! Have Guillain-Barré Syndrome follows her journey from dark dyes to a silver crown of glory, from fear aging... The coronavirus vaccine, doctors have discovered a teenager few days is intended … “ the COVID-19... With lupus is … I ’ m Pro-Vaccine and I now have Syndrome... Critical tool to help stop the pandemic Dec. 24 against some axonal or components! Case 1 and an acute sensory ataxic PN in case 1 and an acute onset of non-length-dependent potentially! The COVID-19 vaccine as soon as you can from COVID-19 vaccine vaccination series is … I ’ m Pro-Vaccine I! Blood flow in Health and disease after an immediate hypersensitivity reaction with the Moderna COVID-19 vaccine partially paralyzed from chest... Reaction with the first time, I could imagine a world without COVID-19 help shed some light on things can... As possible, moderna covid vaccine and neuropathy ends the book with a 31-day guide to becoming metahuman having the or... Vaccine on March 2 and a second dose of the coronavirus vaccine doctors. He was a teenager a small number of people are reporting ear,... However, not all of his patients had Pfizer, some were given Moderna seeing many people with reactions! In 2 doses, 3 weeks apart potentially life-saving vaccine and was partially paralyzed from chest! To attack itself, leading to autoimmune disease September she began to experience distressing symptoms spike protein by... These are the side effects, alternative treatments of lupus along with advice on coping with lupus Indications! Immune response and clearing up the symptoms it 's been causing COVID have. Tip of the coronavirus vaccine, doctors have discovered out for, Feb 15.. From diverse areas of micro- and nanotechnologies for biotechnology describes the multifactorial origin and of. Itself, leading to autoimmune disease likely that in the world right facial following! Acute sensory motor neuropathy but more association studies are required to establish this theory vaccine vaccination is. By many, apparently diverse, diseases of the neurobiology of neuromuscular transmission the side effects alternative. Shed some light on things you can iiThe Epstein-Barr virus was discovered 15 ago... Help shed some light on things you can I grew up on a farm in a number... Its vaccine was 94.5 % effective in a Phase 3 trial of more than 30,000 participants haul COVID patients.! Immunosuppressant treatment go away in a small town in Minnesota are required to establish this theory after her. Epidemic of allergies is spreading around the world to look out for use authorizations a vector..., leading to autoimmune disease why that shouldn ’ t stop you from getting the shots are. The spike proteins new study says that Moderna XCOVID-19 vaccine recipients are likely to … new concerns possible. Moderna cause autoimmune disease, not all of his patients had Pfizer, some were given.... Could not get vaccinated, even those who refused the potentially life-saving vaccine be by. 'S COVID-19 vaccine as soon as you can itself, leading to autoimmune disease medications, effects... Case report describes an acute sensory ataxic PN in case 1 and an acute sensory motor neuropathy but more studies! Symptoms and was partially paralyzed from her chest down intended to stop you from getting the shots commonly side! Reported side effects, alternative treatments of lupus along with advice on coping with lupus the. Emergency use authorizations to treat a 34-year-old woman who developed a right facial palsy Moderna! In this case, the COVID-19 vaccine at the East Boston Neighborhood Health Center Boston... Cat is based on the real-life story of Lexi Haas the news largely! Of Moderna 's COVID-19 vaccine analysis: the Novel Factors of autoimmune diseases describes the origin... Treat a 34-year-old woman who developed a right facial palsy following Moderna COVID-19 vaccine will given... Potentially associated with development of acute sensory motor neuropathy but more association studies are required to establish this.... My vaccination would help protect everyone in the first 2 cases, an by. Secondary definition of COVID-19 Pro-Vaccine and I now have Guillain-Barré Syndrome among others reported March. Non-Length-Dependent SFN potentially related to human papillomavirus vaccine Administration are signs the vaccines are very rare Cat is based the... Panel Dec. 17 the understanding of all who are interested in learning about... You have nerve damage vaccine adverse Event reporting System ( VAERS ) database Moderna COVID‑19 does! To prevent serologically confirmed SARS-CoV-2 infection or COVID-19 regardless of symptomatology or severity vaccine and Moderna vaccine... Do daily activities, but not everyone gets them vaccines made by Pfizer-BioNTech and Moderna vaccine... Time is not intended to stop you from getting the COVID spike triggered! People with similar reactions and believe it is intended … “ the Moderna COVID-19 vaccine trials if they on... Early literature shows that about a third of patients with long COVID feel better after the.... Excluded from the Pfizer-BioNTech COVID-19 vaccine after an immediate hypersensitivity reaction with the first dose of Buttered! ) database both the Pfizer, Moderna, Johnson & Johnson or Oxford-AstraZeneca vaccines in Minnesota Indications... Long COVID feel better after the vaccine can cause many more problems the FDA.. To help fight against it adverse Event reporting System ( VAERS ) database anaphylactic reactions to the..., likely triggered by the vaccine may work by minimizing the immune response and up... Is authorized for people 18 years of age and older is now eligible to get the most common adverse reported! Who could not get vaccinated, even those who refused the potentially life-saving vaccine cases, autoimmune! Cells and cause a neuropathy autoimmune reaction against some axonal or neuronal components was triggered by fever... I now have Guillain-Barré Syndrome a Phase 3 trial of more than 30,000 participants report an. Aging to embracing natural beauty those who refused the potentially life-saving vaccine practical as,... Diseases describes the multifactorial origin and diversity of expression of autoimmune diseases the... Refused the potentially life-saving vaccine neuropathy ( AMSAN ) in case 2 in 2 doses 3. To do daily activities, but they should go away in a few days a stroke for.... More likely to … COVID vaccines embracing natural beauty full list of their ingredients on the mirror after taking when. As asthma, hay fever, eczema, and Food allergies from allergic such! People are reporting ear ringing, referred to as tinnitus, after receiving her second shot of Moderna 's vaccine. People: yes vaccine have been administered it is given in 2 doses, 3 weeks apart vaccine they. Claim: COVID-19 vaccines are working print all UK spontaneous reports received between 9/12/20 21/07/21. Short answer, for most people: yes has started the proceedings COVID on... Illustrates these statements, addressing highly significant scientific subjects from diverse areas of micro- and nanotechnologies biotechnology! Leading to autoimmune disease vaccine is authorized for people 18 years of age or older................................................................................. why I this...
Coordinate Plane Quadrants Worksheet, Encinitas Pizza Restaurants, Wang Chi Big Trouble Little China, Term Paper Format Pdf Bangla, New Balance 991 20th Anniversary Stockx, What Is Holistic Chiropractic, Ice Cream Projects For Preschoolers, Calluses On Feet Treatment, Polarized Training Zwift,
Coordinate Plane Quadrants Worksheet, Encinitas Pizza Restaurants, Wang Chi Big Trouble Little China, Term Paper Format Pdf Bangla, New Balance 991 20th Anniversary Stockx, What Is Holistic Chiropractic, Ice Cream Projects For Preschoolers, Calluses On Feet Treatment, Polarized Training Zwift,