SECTION 7: GASTROINTESTINAL SYMPTOMS
41. Nausea and/or vomiting (feeling or being sick)
Over the last month, how often did you have this symptom?
I do not have this symptom Some of the time Most of the time All of the time
.
42. Abdominal pain and/or bloating
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
43. Excessive flatulence (farting a lot)
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
44. Changes in bowel habit: diarrhea, constipation, urgency and /or frequency of defecation (having a poo)
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
45. Change of appetite: increase or decrease.
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
45. Eating and drinking problems; biting, chewing and/or swallowing difficulties.
NB If you are unable eat, answer 'very severe'.
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
46. Being too tired to eat.
NB If you are unable eat, answer 'very severe'.
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
47. Dry eyes and/or mouth
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
48. Bladder problems: frequency or urgency of urination (having a wee), or feeling the bladder is not completely empty
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- Moderate symptoms.- some of the time and/or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
SECTION 8: CARDIOVASCULAR and RESPIRATORY SYMPTOMS
50. Palpitations: fast or irregular heartbeats during/after previously undemanding activity, or at rest
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
51. Chest pain at rest or during/ after previously undemanding activity
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
52. Shortness of breath or trouble catching your breath. At rest, or during /after previously undemanding activity
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
53. Poor circulation: Cold hands, and/or feet which is not caused by the temperature of the surroundings and/or inability to warm up promptly after becoming cold
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
54. Orthostatic intolerance:
Increase in symptoms (e.g. dizziness, light-headedness/ fainting, palpitations, breathlessness, headache, nausea) when changing to a more upright position (e.g. moving from lying to sitting or standing up) or while sitting or standing. Symptoms may ease when you sit or lie with their feet up. Or you may be able to do more cognitive activity (e.g. reading, talking, or desk work) when lying or with feet up rather than when sitting or standing.
NB If you are unable to sit or stand, answer 'very severe'.
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
55. Swollen extremities (hands /fingers or feet/toes) if in upright position (sitting or standing) for a long time. The skin may also become discoloured (usually turning pink or purple).
NB If you are unable to sit or stand, answer 'very severe'.
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
56. Abnormal sweating (e.g. night sweats/ hot flushes or chills)
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
SECTION 9: IMMUNE SYSTEM SYMPTOMS
57. Sore throat or hoarse voice
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
58. Tender or sore lymph nodes in the armpits, groin and/or neck
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
59. Feeling like you have a raised temperature with hot sweats and/or chills, although it may be normal when measured
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
60. Allergic reactions (e.g. runny eyes, stuffy nose, cough, abdominal pain, feeling sick, flushed/blotchy/itchy skin, rashes, headache, wheezing or breathlessness) to smells, tastes, foods, medications, plants, or chemicals that you did not previously react to
Over the last month, how severe has this symptom been?
I do not have this symptom Mild- moderate symptoms - Some of the time and / or interfering with some activities Severe symptoms - most of the time and/or interfering with most activities Very severe symptoms - all of the time and/or unable to carry out activities
.
61. Alcohol intolerance: feeling ill after drinking alcoholic drinks
Over the last month, have you experienced this symptom?
- No
- Yes
- Not relevant - I do not drink alcohol for other reasons
Final Section
Is there anything else about your symptoms you would like us to know?
Is there anything else about the questionnaire you would like to tell us?