Your COVID-19 Symptoms May Vary Based on How Many Shots You’ve Had

If you find yourself sneezing excessively but aren’t experiencing shortness of breath or fever, don’t be too quick to write off COVID-19.

The most common COVID-19 symptoms have shifted throughout the course of the pandemic, according to a new report. What’s more, the number of COVID-19 vaccinations a person has received could play a role in which symptoms they are most likely to experience if they become infected.

The report comes as an update to a years-long COVID study in which patients use a health app called ZOE to log their vaccine records and daily symptoms. ZOE now includes data from more than 4.8 million people. The health study is a collaborative data project by researchers at Massachusetts General Hospital, the Harvard T.H. Chan School of Public Health, King’s College London, and Stanford University School of Medicine.

Researchers divided the patients into three groups: unvaccinated, vaccinated with one dose, and vaccinated with two doses. (Booster doses were not a part of this report.) People who were vaccinated and experienced a breakthrough COVID infection reported fewer symptoms and a shorter illness.

“When an individual has symptoms from an infectious disease, it is a result of the combination of the pathogen and the immune system,” Amesh A. Adalja, MD, a senior scholar at the Johns Hopkins Center for Health Security, told Verywell. “As people’s immune systems have changed through vaccination, it’s not surprising that symptoms will also be somewhat altered.”

How Have Symptoms Changed Over Time?

Some of the symptoms that were associated with COVID-19 at the beginning of the outbreak have dropped on ZOE’s ranking. Notably, having a persistent cough is no longer a primary indicator that someone has COVID-19. It now ranks fifth overall.

Other seemingly tell-tale signs of infection have also become less common across all groups. For instance, shortness of breath now ranks at spot 29. Loss of smell is now the sixth most common symptom, and fever is now eighth.

Patients are presenting with cold-like symptoms more now than earlier in the pandemic, said William Schaffner, MD, medical director of the National Foundation for Infectious Diseases (NFID) and professor of medicine in the division of infectious diseases at the Vanderbilt University School of Medicine.

“This loss of taste and smell, which was so very prominent early with COVID, has really receded into the background,” Schaffner said.

The ZOE researchers said people who had been vaccinated and later got sick with COVID-19 were more likely to report sneezing as a top symptom compared to those who were not vaccinated.

Even among unvaccinated individuals, COVID-19 symptoms can look slightly different than they did in the earlier days of the pandemic. Shortness of breath ranks number 30 while loss of smell is at number 9.

Are Vaccines or Variants Responsible?

In a July consensus study, researchers compared symptoms commonly reported during the Omicron, Delta, and original COVID-19 waves.

When the Omicron variant was rampant, symptoms like runny nose, sneezing, and sore throat were more common than during the Delta wave. People infected with Omicron were less likely to experience fatigue and fever than those infected with original COVID-19 and Delta. And it became far less common cough or to lose taste and smell.

These findings generally align with the ZOE report. But neither group parsed out just how much the variation in symptoms is caused by vaccination or by new variants.

Why Knowing Your Illness Matters

The symptoms of COVID-19 now appear much like those of influenza and respiratory syncytial virus—two other upper respiratory tract infections which are widely circulating now. For people who are older, have underlying illnesses, or are immunocompromised, each of these infections could cause serious illness. If a provider knows the cause of an infection, they can offer the right treatments.

For everyone else, Adalja said there should be a “low threshold to test.” Even if you’ve already recovered from COVID-19, your symptoms could look different a second or third time around.

Testing when symptoms arise, regardless of how mild, could prevent the spread of COVID-19 to people who are more susceptible to the disease.

“No one wants to be a dreaded spreader,” Schaffner said.

The information in this article is current as of the date listed, which means newer information may be available when you read this. For the most recent updates on COVID-19, visit our coronavirus news page.