Table 1.
Structured patient interview used to evaluate patient-reported symptoms.
| Symptoms: | Is the symptom present? | If yes, enter severity |
|---|---|---|
| Feeling feverish | □YES □NO | □MILD □MODERATE □SEVERE |
| Shaking/chills | □YES □NO | □MILD □MODERATE □SEVERE |
| Malaise | □YES □NO | □MILD □MODERATE □SEVERE |
| Frequency of urination | □YES □NO | □MILD □MODERATE □SEVERE |
| Urgency of urination | □YES □NO | □MILD □MODERATE □SEVERE |
| Dysuria (painful urination) | □YES □NO | □MILD □MODERATE □SEVERE |
| Urinary incontinence | □YES □NO | □MILD □MODERATE □SEVERE |
| Cloudy or change in color of urine | □YES □NO | □MILD □MODERATE □SEVERE |
| Nausea | □YES □NO | □MILD □MODERATE □SEVERE |
| Vomiting | □YES □NO | □MILD □MODERATE □SEVERE |
| Pain above the pubic bone | □YES □NO | □MILD □MODERATE □SEVERE |
| Abdominal pain | □YES □NO | □MILD □MODERATE □SEVERE |
| Flank/back/costovertebral angle pain or tenderness | □YES □NO | □MILD □MODERATE □SEVERE |
| Back pain | □YES □NO | □MILD □MODERATE □SEVERE |
| Other a specify:____________________________ | □YES □NO | □MILD □MODERATE □SEVERE |
a
Only if considered by the investigator to be related to complicated urinary tract infection.