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During the past 4 weeks, how much have you been bothered by any of the following problems?
1
Stomach pain
Not bothered at all
Bothered a little
Bothered a lot
2
Back pain
Not bothered at all
Bothered a little
Bothered a lot
3
Pain in your arms, legs, or joints (knees, hips, etc.)
Not bothered at all
Bothered a little
Bothered a lot
4
Menstrual cramps or other problems with your periods (women only)
Not bothered at all
Bothered a little
Bothered a lot
5
Headaches
Not bothered at all
Bothered a little
Bothered a lot
6
Chest pain
Not bothered at all
Bothered a little
Bothered a lot
7
Dizziness
Not bothered at all
Bothered a little
Bothered a lot
8
Fainting spells
Not bothered at all
Bothered a little
Bothered a lot
9
Feeling your heart pound or race
Not bothered at all
Bothered a little
Bothered a lot
10
Shortness of breath
Not bothered at all
Bothered a little
Bothered a lot
11
Pain or problems during sexual intercourse
Not bothered at all
Bothered a little
Bothered a lot
12
Constipation, loose bowels, or diarrhea
Not bothered at all
Bothered a little
Bothered a lot
13
Nausea, gas, or indigestion
Not bothered at all
Bothered a little
Bothered a lot
14
Feeling tired or having low energy
Not bothered at all
Bothered a little
Bothered a lot
15
Trouble sleeping
Not bothered at all
Bothered a little
Bothered a lot
15 questions remaining