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Check the symptoms you have had in the past week
No Symptom
Mild
Moderate
Severe
Muscle aches
Weakness
Painful Joints
Fatigue
No Symptom
Mild
Moderate
Severe
Difficulty concentrating
Depression
Memory Loss
No Symptom
Mild
Moderate
Severe
Fever
Chills
Day sweats
Night sweats
No Symptom
Mild
Moderate
Severe
Loose stools
Diarrhea
Gas/bloating
Abdominal pain
Nausea
Vomiting
No Symptom
Mild
Moderate
Severe
Shortness of breath at rest
Wheezing
Shortness of breath with activity
No Symptom
Mild
Moderate
Severe
Sore Throat
Painful swallowing
Mouth ulcers
White spots in mouth/thrush
No Symptom
Mild
Moderate
Severe
Numbness/tingling of arms
Numbness/tingling of hands/fingers
Numbness/tingling of legs
Numbness/tingling of feet/toes
No Symptom
Mild
Moderate
Severe
Dizziness
Headache
Heart racing
Chest pain
No Symptom
Mild
Moderate
Severe
Rectal itching
Rectal bleeding
Rectal discharge
No Symptom
Mild
Moderate
Severe
Sore/bleeding gums
Nose bleeds
Easy bruising
Blood in spit/sputum
No Symptom
Mild
Moderate
Severe
Weight gain in stomach area
Concern over weight gain
Hump on back of neck/shoulders
Skinny arms and legs
No Symptom
Mild
Moderate
Severe
Swollen glands
Swollen feet
No Symptom
Mild
Moderate
Severe
Dry mouth
Thirst
Coughing
No Symptom
Mild
Moderate
Severe
Lack of appetite
Constipation
Concern over weight loss
Flushing
No Symptom
Mild
Moderate
Severe
Rash
Itchy skin
No Symptom
Mild
Moderate
Severe
Insomnia/can't sleep
Anxious
Blurred vision
Seizures/tremors
No Symptom
Mild
Moderate
Severe
Nipple discharge
Breast pain/changes
Sores or lumps on genitals
Burning with urination
GYN-Related Problems for Women Only
No Symptom
Mild
Moderate
Severe
Vaginal discharge
Irregular period
Heavy Period
Bad cramps
Vaginal itching
Vaginal oder
Bleeding betwen periods
Pelvic pain
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©Dean Wantland MS, RN, MSN
