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1. Drowsiness _________________________________________________________
2. Irritability or jitteryness ________________________________________________
3. Incoordination _______________________________________________________
4. Inability to concentrate ________________________________________________
5. Frequent mood swings ________________________________________________
6. Headaches__________________________________________________________
7. Dizziness/loss of balance _____________________________________________
8. Pressure above ears, feeling of head swelling _____________________________
9. Tendency to bruise easily _____________________________________________
10. Chronic rashes or itching _____________________________________________
11. Psoriasis or recurrent hives____________________________________________
12. Indigestion or heartburn_______________________________________________
13. Food sensitivity or intolerance__________________________________________
14. Mucus in stools _____________________________________________________
15. Rectal itching _______________________________________________________
16. Dry mouth or throat __________________________________________________
17. Rash or blisters in mouth _____________________________________________
18. Bad breath _________________________________________________________
19. Food, hair or body odor not relieved by washing ___________________________
20. Nasal congestion or post nasal drip _____________________________________
21. Nasal itching _______________________________________________________
22. Sore throat _________________________________________________________
23. Laryngitis, loss of voice _______________________________________________
24. Cough or recurrent bronchitis __________________________________________
25. Pain or tightness in chest _____________________________________________
26. Wheezing or shortness of breath _______________________________________
27. Urinary frequency urgency or incontinence _______________________________
28. Burning on urination __________________________________________________
29. Spots in front of eyes or erratic vision ____________________________________
30. Burning or tearing of eyes _____________________________________________
31. Recurrent infections or fluid in ears ______________________________________
32. Ear pain or deafness _________________________________________________
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