Participant ID #

Below is a list of symptoms people sometimes have. For each item, mark the one answer that best describes how bothersome the symptom was during the past 4 weeks for you. Be sure to mark one answer on each line. If you did not have the problem, please mark the answer under "symptom did not occur." If you had the symptom, use the following key to indicate how bothersome it was: Mild = symptom did not interfere with usual activities. Moderate = symptom interfered somewhat with usual activities. Severe = symptom was so bothersome that usual activities could not be performed.

Symptom did not occur

Symptom was mild

Symptom was moderate

Symptom was severe

Not Answered

88.1 Bloating or gas
88.2 Constipation (difficulty having bowel movements)
88.3 Night sweats
88.4 General aches or pains
88.5 Breast tenderness
88.6 Hot flashes
88.7 Diarrhea
88.8 Mood swings
88.9 Nausea
88.10 Dizziness
88.11 Feeling tired
88.12 Forgetfulness
88.13 Increased appetite
88.14 Heart racing or skipping beats
88.15 Tremors (shakes)
88.16 Heartburn
88.17 Restless or fidgety
88.18 Low back pain
88.19 Neck pain
88.20 Skin dryness or scaling
88.21 Headaches or migraines
88.22 Clumsiness
88.23 Any trouble seeing that is uncorrected by lenses
88.24 Vaginal or irritation or itching
88.25 Difficulty concentrating
88.26 Joint pain or stiffness
88.27 Decreased appetite
88.28 Hearing loss
88.29 Swelling of hands or feet
88.30 Vaginal dryness
88.31 Upset stomach or belly pain or discomfort
88.32 Pain or burning while urinating
88.33 Cough or wheezing
88.34 Vaginal discharge

Below are some hard things that sometimes happen to people. During the past year, did any of these things happen? Mark the answer that seems best.

Over the past year:	NO	YES, AND IT UPSET ME:			Not Answered
	Did not occur	Not too much	Moderately (Medium)	Very much
89. Did your spouse or partner die?
90. Did your spouse or partner have a serious illness?
91. Did a close friend or family member die or have a serious illness ( other than your spouse or partner)?
92. Did you have any major problems with money?
93. Did you have a divorce or breakup with a spouse or partner?
94. Did a family member or close friend have a divorce or breakup?
95. Did you have a major conflict with children or grandchildren?
96. Did you have any major accidents, disasters, muggings, unwanted sexual experiences, robberies, or similar events?
97. Did you or a family member or close friend lose their job or retire?
98. Were you physically abused by being hit, slapped, pushed, shoved, punched or threatened with a weapon by a family member or close friend?
99. Were you verbally abused by being made fun of, severely criticized, told you were a stupid or worthless person, or threatened with harm to yourself, your possessions, or your pets, by a family member or close friend?
100. Did a pet die?