My Relapse Report

The information entered by you into the My Relapse Report is for your personal health records only. It is in no way monitored or stored by Mallinckrodt.


You have completed My Relapse Report. Print a copy to share with your healthcare team at your next visit. You can also email a copy of your report. If you close My Relapse Report without printing, your information will be lost. In order to protect your privacy, your information is not saved on this website.

Everyone experiences MS symptoms differently. Speak to your healthcare team about all symptoms you are having, including those related to MS, and the medications you are taking.

My Relapse Report



(new or worsening)
Started Effect on Function
(0=Not at all, 10=Severely)

Relapse History

How many days/months ago was your last MS relapse (attack, exacerbation) prior to this current episode?