| Please, answer the following questions concerning the symptoms you may have had before the diagnosis of pulmonary embolism (PE) was established. |
|
No symptoms at all
|
| Yes |
| No |
|
Dyspnea (shortness of breath) during exertion or at rest
|
| Yes |
| No |
|
If yes, how would you describe its onset?
|
| Sudden (in a matter of hours) |
| Gradual (over a period of several days or weeks) |
|
Noctural dyspnea (partly relieved by assuming the seated or semirecumbent position)
|
| Yes |
| No |
|
Chest pain
|
| Yes |
| No |
|
If yes, how would you describe it?
|
| Precordial or substernal (as an oppression over the anterior chest wall) |
| Pleuritic (as a stabbing or shooting in the chest, exacerbated by breathing, coughing, sneezing, or even talking) |
|
Fainting or transitory loss of consciousness
|
| Yes |
| No |
|
Bloody sputum
|
| Yes |
| No |
|
Cough (as a new symptom)
|
| Yes |
| No |
|
High fever (>38°C)
|
| Yes |
| No |
|
Unilateral, painful swelling of the upper or lower extremity
|
| Yes |
| No |
|
Other symptoms
|
| Please, specify: |
|
Time interval between onset of symptoms and diagnosis of PE
|
| Within one day |
| More than one day (please, specify): |
|
Your location at the time of symptoms' onset
|
| Home |
| Hospital |
