Table 1.

A Portion of the Urinary Tract Infection Symptom Assessment Questionnaire

About Your Symptoms and Their Impact on Your Life (For Use After Visit 1)
Since you last completed this questionnaire, please indicate whether you have had the following symptoms/problems and how severe they were (please circle one number for each symptom):					Since you last completed this questionnaire, if you have experienced these symptoms/problems, please indicate how bothersome they were (please circle one number for each symptom):
Did not have	Mild	Moderate	Severe		Not at all	A little	Moderately	A lot
0	1	2	3	Frequency of urination (going to the toilet very often)	0	1	2	3
0	1	2	3	Urgency of urination (a strong and uncontrollable urge to pass urine)	0	1	2	3
0	1	2	3	Pain or burning when passing urine	0	1	2	3
0	1	2	3	Not being able to empty your bladder completely/passing only small amounts of urine	0	1	2	3
0	1	2	3	Pain or uncomfortable pressure in the lower abdomen/pelvic area caused by your urinary tract infection	0	1	2	3
0	1	2	3	Low back pain caused by your urinary tract infection	0	1	2	3
0	1	2	3	Blood in your urine	0	1	2	3
Please give an overall rating of the severity of your urinary tract infection symptoms as they are (Please circle the number of your answer)
0 No symptoms at all			1 Mild		2 Moderate		3 Severe