FIP Side Effects Pictogram Survey Paper version

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Pregnancy A B C D E F G
Please mail completed survey to: Dr Régis Vaillancourt Director of Pharmacy Children's Hospital of Eastern Ontario 401 Chemin Smyth Road Ottawa, ON K1H 8L1 Canada Tel/tél: (613) 737-7600 Ext. 2231 Fax/téléc: (613) 738-4206 E-mail/courriel: rvaillancourt@cheo.on.ca
Page 1 and 2: FIP Side Effects Pictogram Survey P
Page 3 and 4: 1. 2. Participant Information What
Page 5 and 6: 6. Participant Information Please s
Page 7 and 8: Rash A B C D E F
Page 9 and 10: Fatigue A B C D E F G H
Page 11 and 12: Weight Gain A B C D E F G H
Page 13 and 14: Constipation A B C D F G H I E J x
Page 15 and 16: Nausea A B C D E F G H
Page 17 and 18: Muscle Pain A B C D E F G H
Page 19 and 20: Insomnia A B C D E F G H
Page 21 and 22: Tremor A B C D E F G H
Page 23 and 24: Confusion A B C D F G H I E
Page 25 and 26: Dizzy When Getting Up A B C D E F G
Page 27 and 28: Ringing In Ears A B C D E F G H
Page 29 and 30: Seek Medical Advice (Developing Cou
Page 31 and 32: Coughing A B C D G H I J E F K
Page 33: Do Not Drive A B C D

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