|
Not At All |
Mildly but it didn’t bother me much. |
Moderately - it wasn’t pleasant at times |
Severely – it bothered me a lot |
Numbness or tingling |
0 |
1 |
2 |
3 |
Feeling hot |
0 |
1 |
2 |
3 |
Wobbliness in legs |
0 |
1 |
2 |
3 |
Unable to relax |
0 |
1 |
2 |
3 |
Fear of worst happening |
0 |
1 |
2 |
3 |
Dizzy or lightheaded |
0 |
1 |
2 |
3 |
Heart pounding/racing |
0 |
1 |
2 |
3 |
Unsteady |
0 |
1 |
2 |
3 |
Terrified or afraid |
0 |
1 |
2 |
3 |
Nervous |
0 |
1 |
2 |
3 |
Feeling of choking |
0 |
1 |
2 |
3 |
Hands trembling |
0 |
1 |
2 |
3 |
Shaky / unsteady |
0 |
1 |
2 |
3 |
Fear of losing control |
0 |
1 |
2 |
3 |
Difficulty in breathing |
0 |
1 |
2 |
3 |
Fear of dying |
0 |
1 |
2 |
3 |
Scared |
0 |
1 |
2 |
3 |
Indigestion |
0 |
1 |
2 |
3 |
Faint / lightheaded |
0 |
1 |
2 |
3 |
Face flushed |
0 |
1 |
2 |
3 |
Hot/cold sweats |
0 |
1 |
2 |
3 |
| Column Sum |
|
|
|
|