Yes	No
Pain	1	2
Tiredness	1	2
Weakness	1	2
Nausea	1	2
Vomiting	1	2
Lack of appetite	1	2
Trouble sleeping	1	2
Shortness of Breath	1	2
Constipation	1	2
Diarrhea	1	2
Sweating	1	2
Other (specify): __________	1	2