GENERAL __ Fatigue, made worse by physical exertion or stress __ Activity level decreased to less than 50% of pre-illness activity level __ Recurrent flu-like illness __ Sore throat __ Hoarseness __ Tender or swollen lymph nodes (glands), especially in neck and underarms __ Shortness of breath (air hunger) with little or no exertion __ Frequent sighing __ Tremor or trembling __ Severe nasal allergies (new allergies or worsening of previous allergies) __ Cough __ Night sweats __ Low-grade fevers __ Feeling cold often __ Feeling hot often __ Cold extremities (hands and feet) __ Low body temperature (below 97.6) __ Low blood pressure (below 110/70) __ Heart palpitations __ Dryness of eyes and/or mouth __ Increased thirst __ Symptoms worsened by temperature changes __ Symptoms worsened by air travel __ Symptoms worsened by stress __ Symptoms worsened by barometric changes

PAIN __ Headache __ Tender points or trigger points __ Muscle pain __ Muscle twitching __ Muscle weakness __ Paralysis or severe weakness of an arm or leg __ Joint pain __ TMJ syndrome __ Chest pain

GENERAL NEUROLOGICAL __ Lightheadedness; feeling "spaced out" __ Inability to think clearly ("brain fog") __ Seizures __ Seizure-like episodes __ Syncope (fainting) or blackouts __ Sensation that you might faint __ Vertigo or dizziness __ Numbness or tingling sensations __ Tinnitus (ringing in one or both ears) __ Photophobia (sensitivity to light) __ Noise intolerance

EQUILIBRIUM / PERCEPTION __ Feeling spatially disoriented __ Dysequilibrium (balance difficulty) __ Staggering gait (clumsy walking; bumping into things) __ Dropping things frequently __ Difficulty judging distances (e.g. when driving; placing objects on surfaces) __ "Not quite seeing" what you are looking at

SLEEP __ Hypersomnia (excessive sleeping) __ Sleep disturbance: unrefreshing or non-restorative sleep __ Sleep disturbance: difficulty falling asleep __ Sleep disturbance: difficulty staying asleep (frequent awakenings) __ Sleep disturbance: vivid or disturbing dreams or nightmares __ Altered sleep/wake schedule (alertness/energy best late at night)

MOOD / EMOTIONS __ Depressed mood __ Suicidal thoughts __ Suicide attempts __ Feeling worthless __ Frequent crying __ Feeling helpless and/or hopeless __ Inability to enjoy previously enjoyed activities __ Increased appetite __ Decreased appetite __ Anxiety or fear when there is no obvious cause __ Panic attacks __ Irritability; overreaction __ Rage attacks: anger outbursts with little or no cause __ Abrupt, unpredictable mood swings __ Phobias (irrational fears) __ Personality changes

EYES AND VISION __ Eye pain __ Changes in visual acuity (frequent changes in ability to see well) __ Difficulty with accommodation (switching focus from one thing to another) __ Blind spots in vision

SENSITIVITIES __ Sensitivities to medications (unable to tolerate "normal" dosage) __ Sensitivities to odors (e.g., cleaning products, exhaust fumes, colognes, hair sprays) __ Sensitivities to foods __ Alcohol intolerance __ Alteration of taste, smell, and/or hearing

UROGENITAL __ Frequent urination __ Painful urination or bladder pain __ Prostate pain __ Impotence __ Endometriosis __ Worsening of premenstrual syndrome (PMS) __ Decreased libido (sex drive)

GASTROINTESTINAL __ Stomach ache; abdominal cramps __ Nausea __ Vomiting __ Esophageal reflux (heartburn) __ Frequent diarrhea __ Frequent constipation __ Bloating; intestinal gas __ Decreased appetite __ Increased appetite __ Food cravings __ Weight gain __ Weight loss

SKIN __ Rashes or sores __ Eczema or psoriasis

OTHER __ Hair loss __ Mitral valve prolapse __ Cancer __ Dental problems __ Periodontal (gum) disease __ Aphthous ulcers (canker sores)

COGNITIVE __ Difficulty with simple calculations (e.g., balancing checkbook) __ Word-finding difficulty __ Using the wrong word __ Difficulty expressing ideas in words __ Difficulty moving your mouth to speak __ Slowed speech __ Stuttering; stammering __ Impaired ability to concentrate __ Easily distracted during a task __ Difficulty paying attention __ Difficulty following a conversation when background noise is present __ Losing your train of thought in the middle of a sentence __ Difficulty putting tasks or things in proper sequence __ Losing track in the middle of a task (remembering what to do next) __ Difficulty with short-term memory __ Difficulty with long-term memory __ Forgetting how to do routine things __ Difficulty understanding what you read __ Switching left and right __ Transposition (reversal) of numbers, words and/or letters when you speak __ Transposition (reversal) of numbers, words and/or letters when you write __ Difficulty remembering names of objects __ Difficulty remembering names of people __ Difficulty recognizing faces __ Difficulty following simple written instructions __ Difficulty following complicated written instructions __ Difficulty following simple oral (spoken) instructions __ Difficulty following complicated oral (spoken) instructions __ Poor judgment __ Difficulty making decisions __ Difficulty integrating information (putting ideas together to form a complete picture or concept) __ Difficulty following directions while driving __ Becoming lost in familiar locations when driving __ Feeling too disoriented to drive