Biotoxin Symptom Clusters

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Is this survey for an adult or child? Adult (11+ years) Child (under 11 years)

Fatigue (Cluster 1)

Fatigue: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Neurological Symptoms (Cluster 2)

Unusual Skin Sensitivity: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Tingling: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Cognitive and Physical Symptoms (Cluster 3)

Weakness: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Inability to Retain New Information: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Aches: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Headache: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Light Sensitivity: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Respiratory Symptoms (Cluster 4)

Shortness of Breath: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Sinus Congestion: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

General Symptoms (Cluster 5)

Cough: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Excessive Thirst: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Confusion: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Cognitive Symptoms (Cluster 6)

Memory Impairment: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Decreased Word Finding: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Cognitive Focus (Cluster 7)

Difficulty Concentrating: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Joint and Muscle Symptoms (Cluster 8)

Joint Pain: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Morning Stiffness: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Cramps: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Metabolic Symptoms (Cluster 9)

Appetite Swings: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Weight Gain: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Weight Loss: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Gastrointestinal Symptoms (Cluster 10)

Nausea: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Diarrhea: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Constipation: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Sensory Symptoms (Cluster 11)

Sensitivity to Noise: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Sensitivity to Light: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Sensitivity to Touch: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Vision and Pain Symptoms (Cluster 12)

Blurred Vision: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Eye Pain: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme General Pain: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Other Symptoms (Cluster 13)

Fever: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Chills: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme Sweating: 0 - None 1 - Mild 2 - Noticeable 3 - Moderate 4 - Severe 5 - Extreme

Total Symptoms Reported: 0

Clusters with Symptoms: 0

Symptom Summary:

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