13. CASUALTY: SSN_______________ UNIT_______________________ SEX______

14. SIGNS/SYMPTOMS: ONSET__ DURATION__

A. HEAD: FEVER___ CHILLS___ HEADACHE___ FLUSHED___ DIZZINESS___ UNCONSCIOUSNESS___ COMA___ HALLUCINATIONS___

B. EYES: SUNLIGHT SENSITIVE___ PAINFUL___ BURNING___ DROOPY EYELIDS___ DOUBLE VISION___ BLURRED VISION___ LARGE PUPILS___ PINPOINT PUPILS___

C. NOSE: RUNNY___ BLEEDING___

D. THROAT: SORE___ DRY___ SALIVATING___ BLOODY SPUTUM___ HOARSENESS___ DIFFICULTY SPEAKING___

E. RESPIRATION: DIFFICULTY BREATHING___ CHEST/PAIN DISCOMFORT___ WHEEZING (IN/OUT)___ COUGHING___ LABORED BREATHING___

F. HEART POUNDING OR RUNNING___ IRREGULAR HEARTBEAT___

G. GI: LOSS OF APPETITE___ NAUSEA___ FREQUENT VOMITING___ FREQUENT DIARRHEA___ VOMITING BLOOD___ DIARRHEA WITH BLOOD___

H. URINARY: BLOODY URINE___ UNABLE TO URINATE___