Symptoms	Frequency: Throughout the past 6 months, how often have you had this symptom? For each symptom listed below, circle a number from: 0 = none of the time 1 = a little of the time 2 = about half the time 3 = most of the time 4 = all of the time					Severity: Throughout the past 6 months, how much has this symptom bothered you? For each symptom listed below, circle a number from: 0 = symptom not present 1 = mild 2 = moderate 3 = severe 4 = very severe
13) Fatigue/extreme tiredness	0	1	2	3	4	0	1	2	3	4
14) Dead, heavy feeling after starting to exercise	0	1	2	3	4	0	1	2	3	4
15) Next day soreness or fatigue after non-strenuous everyday activities	0	1	2	3	4	0	1	2	3	4
16) Mentally tired after the slightest effort	0	1	2	3	4	0	1	2	3	4
17) Minimum exercise makes you physically tired	0	1	2	3	4	0	1	2	3	4
18) Physically drained or sick after mild activity	0	1	2	3	4	0	1	2	3	4
19) Feeling unrefreshed after you wake up in the morning	0	1	2	3	4	0	1	2	3	4
20) Need to nap daily	0	1	2	3	4	0	1	2	3	4
21) Problems falling asleep	0	1	2	3	4	0	1	2	3	4
22) Problems staying asleep	0	1	2	3	4	0	1	2	3	4
23) Waking up early in the morning (e.g. 3am)	0	1	2	3	4	0	1	2	3	4
24) Sleep all day and stay awake all night	0	1	2	3	4	0	1	2	3	4
25) Pain or aching in your muscles	0	1	2	3	4	0	1	2	3	4
26) Pain/stiffness/tenderness in more than one joint without swelling or redness	0	1	2	3	4	0	1	2	3	4
27) Eye pain	0	1	2	3	4	0	1	2	3	4
Symptoms	Frequency: Throughout the past 6 months, how often have you had this symptom? For each symptom listed below, circle a number from: 0 = none of the time 1 = a little of the time 2 = about half the time 3 = most of the time 4 = all of the time					Severity: Throughout the past 6 months, how much has this symptom bothered you? For each symptom listed below, circle a number from: 0 = symptom not present 1 = mild 2 = moderate 3= severe 4 = very severe
28) Chest pain	0	1	2	3	4	0	1	2	3	4
29) Bloating	0	1	2	3	4	0	1	2	3	4
30) Abdomen/stomach pain	0	1	2	3	4	0	1	2	3	4
31) Headaches	0	1	2	3	4	0	1	2	3	4
32) Muscle twitches	0	1	2	3	4	0	1	2	3	4
33) Muscle weakness	0	1	2	3	4	0	1	2	3	4
34) Sensitivity to noise	0	1	2	3	4	0	1	2	3	4
35) Sensitivity to bright lights	0	1	2	3	4	0	1	2	3	4
36) Problems remembering things	0	1	2	3	4	0	1	2	3	4
37) Difficulty paying attention for a long period of time	0	1	2	3	4	0	1	2	3	4
38) Difficulty finding the right word to say or expressing thoughts	0	1	2	3	4	0	1	2	3	4
39) Difficulty understanding things	0	1	2	3	4	0	1	2	3	4
40) Only able to focus on one thing at a time	0	1	2	3	4	0	1	2	3	4
41) Unable to focus vision and/or attention	0	1	2	3	4	0	1	2	3	4
42) Loss of depth perception	0	1	2	3	4	0	1	2	3	4
43) Slowness of thought	0	1	2	3	4	0	1	2	3	4
44) Absent-mindedness or forgetfulness	0	1	2	3	4	0	1	2	3	4
45) Bladder problems	0	1	2	3	4	0	1	2	3	4
46) Irritable bowel problems	0	1	2	3	4	0	1	2	3	4
Symptoms	Frequency: Throughout the past 6 months, how often have you had this symptom? For each symptom listed below, circle a number from: 0 = none of the time 1 = a little of the time 2 = about half the time 3 = most of the time 4 = all of the time					Severity: Throughout the past 6 months, how much has this symptom bothered you? For each symptom listed below, circle a number from: 0 = symptom not present 1 = mild 2 = moderate 3= severe 4 = very severe
47) Nausea	0	1	2	3	4	0	1	2	3	4
48) Feeling unsteady on your feet, like you might fall	0	1	2	3	4	0	1	2	3	4
49) Shortness of breath or trouble catching your breath	0	1	2	3	4	0	1	2	3	4
50) Dizziness or fainting	0	1	2	3	4	0	1	2	3	4
51) Irregular heart beats	0	1	2	3	4	0	1	2	3	4
52) Losing or gaining weight without trying	0	1	2	3	4	0	1	2	3	4
53) No appetite	0	1	2	3	4	0	1	2	3	4
54) Sweating hands	0	1	2	3	4	0	1	2	3	4
55) Night sweats	0	1	2	3	4	0	1	2	3	4
56) Cold limbs (e.g. arms legs, hands)	0	1	2	3	4	0	1	2	3	4
57) Feeling chills or shivers	0	1	2	3	4	0	1	2	3	4
58) Feeling hot or cold for no reason	0	1	2	3	4	0	1	2	3	4
59) Feeling like you have a high temperature	0	1	2	3	4	0	1	2	3	4
60) Feeling like you have a low temperature	0	1	2	3	4	0	1	2	3	4
61) Alcohol intolerance	0	1	2	3	4	0	1	2	3	4
62) Sore throat	0	1	2	3	4	0	1	2	3	4
63) Tender/sore lymph nodes	0	1	2	3	4	0	1	2	3	4
64) Fever	0	1	2	3	4	0	1	2	3	4
65) Flu-like symptoms	0	1	2	3	4	0	1	2	3	4
66) Some smells, foods medications, or chemicals make you feel sick	0	1	2	3	4	0	1	2	3	4