By indhira.santana May 16, 2020 Share MRT Symptom Survey Welcome to your MRT Symptom Survey Name Email Fatigue (sluggish, tired) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyHyperactive (nervous energy) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyRestless (can’t relax/sit still) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDaytime sleepiness Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyInsomnia at night Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMalaise (feeling lousy) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDepression Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyAnxiety (fears, uneasiness) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMood swings (rapid changes) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyIrritability Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyForgetfulness Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyLack of concentration/Brain fog Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyLow sex drive Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyHeadache (not migraine) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMigraine Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyEarache Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyEar infection Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyRinging in ears Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyItchy ears Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDischarge from ears Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySensitivity to sound Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyBlemishes, acne Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyRashes or hives Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyEczema or psoriasis Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not apply“Rosy” cheeks Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyFlushing Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyItchy skin Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyPost nasal drip Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySinus pain Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyRunny nose Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyStuffy nose Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySneezing Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySore throat Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySwollen throat Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySwelling/burning lips/tongue Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyGagging/throat clearing Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyCanker sores Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDifficulty swallowing Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyWheezing Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyChest congestion Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDry cough Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyWet cough Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyShortness of breath Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyRed or swollen eyes Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyWatery eyes Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyItchy eyes Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDark circles or “bags” Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applySensitivity to light Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyAura Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyIncreased urinary frequency Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyPainful urination Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyBladder pain Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyBedwetting Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyJoint pains Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyStiff joints Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMuscle aches Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyStiff muscles Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyTic nervioso Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMuscle spasms Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyMuscle cramps Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyIrregular heartbeat Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyHigh blood pressure Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyHeartburn/reflux Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyStomach pains/cramps Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyIntestinal pains/cramps Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyConstipation Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyDiarrhea Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyBloating sensation Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyGas (of any kind) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyNausea Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyVomiting Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyPainful elimination Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyFluctuating weight Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyFood cravings Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyWater retention Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyBinge eating or drinking Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyPurging (all methods) Mild, 1-2 days/week Mild, 3+ days/week Severe, 1-2 days/week Severe, 3+ days/week Does not applyTime is Up!
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