WRIISC Health Questionnaire

2.13. cfs (CDC CFS Symptom Inventory)
CDC CFS Symptom Inventory: http://www.cdc.gov/cfs/case-definition/ 
All questions are in the public domain

Section 10: Pain and Fatigue

4. Please describe, during the PAST MONTH, how often you have the following symptoms. If you have them, please ALSO 
specify the intensity of each symptom and if it has been present for 6 months or more. 
(Fill in one answer for each category of each item.)

FREQUENCY INTENSITY:
Never
A little of the time
Some of the time
Most of the time
All of the time 

INTENSITY: Mild Moderate Severe 

PRESENT FOR 6 MONTHS OR MORE: No Yes

Prolonged fatigue or a feeling of illness, lasting longer than a day, after mild exercise
Unrefreshing sleep
Substantial problems remembering
Substantial problems concentrating
Muscle discomfort or pains/aches
Pain in joints such as elbows, knees and fingers, without redness or swelling
Sore throat
Tender glands in neck, jaw, or armpits
New types of headaches
Diarrhea
Feeling feverish
Chills
Sleeping problems
Nausea
Stomach or abdominal pain
Sinus or nasal problems
Shortness of breath
Sensitivity to light
Depression

5. To what degree has your fatigue limited your daily activity OVER THE PAST 6 MONTHS?
0% - normal overall activity: no limitations
1%-25% 
26%-49% 
50% - activity level reduced to 50% of normal
51%-75% 
76%-99% 
100% - totally disabled, bedridden constantly