1. In the last 6, 24 hours, I threw up ( ) times. | No | 1−2 | 3−4 | 5−6 | >7 |
2. In the last 6, 24 hours, from retching and dry heaves, I have felt ( ) distress. | No | Mild | Moderate | Great | Severe |
3. In the last 6, 24 hours, from vomiting or throwing up, I have felt ( ) distress. | No | Mild | Moderate | Great | Severe |
4. In the last 6, 24 hours, I have felt nauseated or sick to my stomach. | No | ≤1 hr | 2−3 hr | 4−6 hr | >6 hr |
5. In the last 6, 24 hours, from nausea/sickness to my stomach, I have felt ( ) distress | No | Mild | Moderate | Great | Severe |
6. In the last 6, 24 hours, each time I threw up, I produced a ( ) amount. | No | Small | Moderate | Large | Very large |
| | (<1/2 cups) | (1/2−2 cups) | (2−3 cups) | (>3 cups) |
7. In the last 6, 24 hours, I have felt nauseated or sick to my stomach ( ) times. | No | 1−2 | 3−4 | 5−6 | >7 |
8. In the last 6, 24 hours, I have had periods of retching or dry heaves without bringing anything up ( ) times. | No | 1−2 | 3−4 | 5−6 | >7 |
Total experience score: sum of all scores | | | | | |