Ebner, University of Florida, Department of Psychology Email: natalie.ebner@ufl.edu Jillian M

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Electronic Supplementary Material #2 Symptom Checklist for Adverse Event Reporting

Article: Safety and tolerability of chronic intranasal oxytocin in older men: Results from a randomized controlled trial.

Journal: Psychopharmacology

Authors: Rung, J. M., Horta, M., Tammi, E. M., Perez, E., Ojeda, M. C., Lin, T., Harris, G., Somerville, J., Salmeron, D., Beltz, S. E., Sandesara, B., Feifel, D., & Ebner, N. C.

Corresponding Authors:

Natalie C. Ebner, University of Florida, Department of Psychology Email: natalie.ebner@ufl.edu

Jillian M. Rung, University of Florida, Departments of Epidemiology and Psychology Email: jrung@ufl.edu, rung.jillian@gmail.com

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ID__________ Date__________________ Time_____________

Weekly Check In Call – Symptoms Checklist

Check off in the table whether participant experienced that symptom. If so, record whether it was mild, moderate, or severe and any accompanying comments (e.g. how long it lasted, feelings or discomfort it caused, etc.).

Did you experience any other side effects aside than the ones already mentioned? Please describe any such effects:

______________________________________________________________________________

Are there any other comments you would like to add?

______________________________________________________________________________

Symptom Severity

Rating:

Mild/Moderate/

Severe

Comments

Light Headedness Drowsiness

Fainting Heart Rate

Changes/Palpitations Shortness of Breath Fever

Sore Throat Dry Throat Hoarseness

Cough with Phlegm Stuffed-up Nose Sneezing

Nasal Irritation Runny Nose

Tearing of the Eyes Nausea

Abdominal/Stomach Pain