Table 2.

Patient-reported outcome form used at every UTI episode in the ImpresU clinical trial

Patient-reported outcome
1. Degree of pain at urination (scale 0–6)*_____
2. Urgency (scale 0–6)*_____
3. Frequent urination (scale 0–6)*_____
4. Visible blood in urine?	Yes □ No □
5. Abdominal pain not related to urination	Yes □ No □
6. Has the patient had fever? (>38° rectal OR >37.5 axillae OR >37.8 tympanic)	Yes □ No □
7. Side effect of study drug? If yes, what side effect: ______________________________	Yes □ No □
8. Feeling unwell?	Yes □ No □
9. Flank pain?	Yes □ No □
10. Other symptom(s): _________________________________
11. I feel restored	Yes □ No □

*State the degree of the problem on a scale from 0-6 where: 0 = normal/no problem, 1 = little problem, 2 = some problem, 3 = moderate problem, 4 = large problem, 5 = bad, 6 = as bad as it can be

UTI, urinary tract infection.