PRE-CHECK
SYMPTOMS
SUMMARY
PRE-CHECK
SYMPTOMS
SUMMARY
Summary of your Baby’s information
This is the summary of your Baby’s information and symptoms recorded on Pre-CoMiSS™. This information may help your HCP to decide if your Baby has cow’s milk allergy or not. Always speak to your HCP if you are worried about anything regarding the health of your Baby or symptoms that your Baby is experiencing.
Information about my Baby
How old is your baby now?
Less than 6 months
What milk is your baby currently taking?
Cow’s milk-based formula
Has your baby started eating solid foods?
Yes
Does your baby have any of the following? Blood in poo/stools, obvious infection/fever, poor growth
No
Has your baby had an immediate reaction on feeding e.g., swollen lips/eyelids and immediate rash?
No
Is your baby unsettled and experiencing fussiness most days?
Yes
Overall, has your family’s quality of life been impacted by your baby’s symptoms?
5 (significantly affected)
Thank you for completing this form, your data will not be automatically saved. Please make sure to download the symptom summary for your consultation with your healthcare professional.
Symptoms my Baby is experiencing
Crying
3 to 4 hours/day
Regurgitating
More than 5 episodes of around half the feed
Poo
Type 5 and 6
Skin
- Yes ( )
- Not Difficult to sleep
Respiratory
Thank you for completing this form, your data will not be automatically saved. Please make sure to download the symptom summary for your consultation with your healthcare professional.
Thank you for completing this form, your data will not be automatically saved. Please make sure to download the symptom summary for your consultation with your healthcare professional.
