Article Temp Survey for Article 1 2 3 4 5 6 7 8 InitialsWhen did this symptom start?Date if KnownExact DateApproximate DateExact Date Date Format: YYYY dash MM dash DD Approximate Date Date Format: YYYY dash MM dash DD Do you still have a fever?YesNo When did this symptom end?Date if KnownExact DateApproximate DateExact Date Date Format: YYYY dash MM dash DD Approximate Date Date Format: YYYY dash MM dash DD Did you measure your temperature?YesNoWhat was your highest temperature?Did you take anything for your fever?YesNoWhat did you take for the fever?Did the medication help?YesNo Other Fever SymptomsDid you get shaking chills as well?YesNoDo you feel that you may have had an infection?YesNoUnsureWhat kind of Infection?Have any household members had recent fever?YesNoThe household member had fever because: Did you begin any new medications?YesNoEither Prescription Medication or Over The CounterWhat new medication did you take?643. Had the dosage for any prescription medications been changed before this symptom started?YesNoWhich Medication Changed? Did you seek medical attention for this?YesNoWere any tests performed?YesNoWhat tests where performed?Was a diagnosis made?YesNoWhat was the diagnosis?Did you go to the Emergency Room?YesNoWere you admitted to the hospital?YesNoYou did not seek medical attention because:you were not that concerned.the problem had already resolved.you already knew what caused it.you knew we would be checking on you.of some other reason.Please describe why you didn't seek medical attention. How long after taking study medication did this symptom occur?MinutesHoursDaysWeeksAre you to recieving more than one dose of medication?YesNoDid you stop, or were you instructed to stop, study medication?YesNoDid you re-start study medication?YesNoDid this symptom recur?YesNoWere there any associated symptoms?YesNoIdentify the associated symptom(s):Chest congestion.Burning upon urinationAbdominal painOtherIdentify the associated symptom(s):NameThis field is for validation purposes and should be left unchanged.