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Larimer County | Health & Environment LARIMER COUNTY | HEALTH & ENVIRONMENT 1525 Blue Spruce Drive, Fort Collins, Colorado 80524, 970.498.6700, Larimer.org/health January 17, 2019, Dear Michelle Passater, You have requested the following information for Zachary Shirley: 1) Completed case investigation form 2) Completed reportable disease form 3) All enteric and molecular laboratory test results 4) Any document that identifies the source of our client’s infection 5) Any document that links our client’s illness to Salmonella Please find the attached documentation in response to your Colorado Open Records Request. Please let me know if you have any concerns. Sincerely, Katie O’Donnell Public Information Officer Larimer County Department of Health and Environment CEDRS DepartmentColorado ofElectronic Public Health Disease Environm Reportent ingSystem & Event Number: 482119 Salmonel losis bemographics tl■lt..___ _ ______ Last Name: First Name: Middle Name: DOB: Gender: Male Ethnicity: Unknown Race: """".;.;..;;.;......aa..;;; Event County: ""Larimer CO_____ _ Industry Type: Occupation: __________ Employer: kvent Information "-- Diagnosis Salmonellosis Onset Date _8/_1_1/_2_0_18 ------ Event Address ll!ll!!!�l!!!!!!l!l!!EFoQ!rtigC:20!!!111.!]:ns�.JC�02..§8Q052� 8� L___ _____________________ Living in institution at time of event? _N_o __ If yes, institution type _______ Name Institution Phone biagnosis Details .._'""'--- Age At Diagnosis Outcome '"'Alive ------ Acquired InState _ln_S_ t_a_te____________ _ ..a""".;..;."'""'"""''--- Report to Public Health Date 8/31/2018 CaseStatus .aConfirmed ----------------- Dr Details Core Data Approved Approved Reason Returned ------------ Core Data Ok'd By Susma Dahal Reporting Agency Larimer County Health Department Other Agency Person Reporting ------------ Phone _______ Entered By Agency Susma Dahal Entry Method ELR Entry Date 8/31/2018 base Investigation Primary Agency Assigned Larimer County Health Department Primary Assigned To Kim Meyer-Lee Primary Assigned Date 8/31/2018 Secondary Agency Assigned Reg Epi Northeast Secondary Assigned To Secondary Assigned Date __8/ __ 3_1__/2 __ 0 1_8__ ____ _ Investigation Status Closed InvestigationStart Date Followup Type Followup Outcome Followup Date I Phone I Message Left/Sent 08/30/2018 bDPHE Reviews Reviewer ApprovalStatus Case Counted (WNV) No Date Counted Surveillance Forms Received No Surveillance FormsSent Date Environmental Investigation Reviewed No Printed by: Kim Meyer-Lee Printed Date: 1/7/2019 9:28: 51 AM CEDRS Colorado Electronic Disease Reporting System Department of Public Health & Environment Salmonellosis Reason/s Returned SI &!$ �mployment/School I Employer/School Name Occupation Category , Occupation Not Employed I roviders Has one of the providers or offices been notified that the Health Dept. may contact patient? 1 Provider Full Name Phone Number Practice Name I Address Type I 1 I (970) 498-6763 I Larimer County Health Department - butbreak ••• L Outbreak Yes----- CDC NORS Number 282732 CDPHE Outbreak ID/Name "'"201'- ""'8---3'""'5---01'- ""'5______ ______________________ Outbreak Type Unknown bospltallzatlon Hospitalized: No !Hospital !Admission Date I Discharge Date I labs State Lab Specimen !Collection jTesting Lab Originating Lab !Test ID# ,Date I Count 1808230096 Stool 8/21/2018!CDPHE - State Lab I 4 Test Result .Result Value Result Date Serotype (Salmonella) Uaviana I Salmonella ser. Javiana- 8/23/2018 Culture at state lab Positive I Salmonella spp. isolated, not S. Typhi- Serogroup (Salmonella) D Group D, I 9,12:l,z28:1,5- PFGE Result Result is Text 10-I �otes Note Entry Date :case was dining companion and friend of former LaLuz employee. Dined at LaLuz 8/9. 8/31/2018 1 Printed by: Kim Meyer-Lee Printed Date: 1/7/2019 9:28:51 AM 1/7/2019 Labs CEDRS Colorado Electronic Disease Reporting System &Y Department of Pl.lblic Health & Environment Home Search New Event Line Lists ReportS JiM essages Resources Administration Log Out EventID• r 8 Kim Meyer-Lee� @ _________ 0 Birth Date Sex Male County Larimer Profile ID 1011894 Event ID 482119 l Diagnosis Salmonellosis Profile History Labs All Notes itJ Expand All Events Add New Specimen Refresh Labs Test Specimen ID State Lab ID# Specimen Collection Date Testing Lab Originating Lab Actions I I Count Surveillance Form I I I I I Documents 500232 1808230096 Stool 8/21/2018 CDPHE - State Lab 4 - -. - . Sharing 7 Add New Test Refresh 1 Event Print Test ID j Test j Result j Result Value j Result Date I Actions 690797 PFGE Result Result is Text 10-1 689484 Serogroup (Salmonella) D Group D, I 9, 12:l,z28:1,5- -· 689483 Culture at state lab Positive Salmonella spp. isolated, not S. Typhi- I Edit 689482 Serotype (Salmonella) Javiana Salmonella ser. Javiana- 8/23/2018 � 1 Page size: 20 1 items in 1 pages C':l:-::yrc p: -;: �:.·� Cobr�do D-€-Pa":i'le:r �-- PJ� ;c Hz.;,1;;1 0.:Erv:ri:;1m�1·,: I All R19n:s .;.,...,;:;1�ve-J. In-� S:;1t� �- (ot::,'.:,dc e"pt::ts :1,;1r tr'is •-'.':?b�1-:::? 1niori�<1ticr ,:;;:,c,w r.z.:,:::. ":'r.:·i J�, ·;1;-;"t'.11:::cKtio1� ;,r:: 5ec1.;r.:::. <111cith::it .)!I inutt:r1al ;:,::;pc>.cts 0tthe �1t:c- funct1cri prop,?rl1,1 Hc·.-:�v4:;-r thi& St.;.:� ·-'-"<�� :,:, ::::1'1 :in:·e� ,.-•,c:!=r..c-::"V-.?-rif" ':-.:.<1t1or. t::> :1-::� s:::c .;.rd •..::S:?'"'S're:.;· ...:,J':)"'l :t ,;it tt-,eir 0v..-n risk n,2 Stz:te speciiicall�.: cl1sda1mf ·.11� ,.-,�r.-<1'.itie-:; :; -�·-i:'"'!.n:.zi�ili7:·,· en:! ftri?s::; tc:- a CNt;cv!.zi1· p1.:rpose. https://efort.dphe .state.co.us/uniquesig936cf12d6a09153fb480d002e02621fde823 b9324d35936ddddede5536a9a98a/uniquesig1/CED RS_I I I/Labs/Labs.aspx?WindowSession=1ec0cfbe-b3a9-8378-2 16... 1/1 Salmonellosis Case Investigation Form Patient Name:�- � Event ID: L/�2-(t'J / Form completed by; \� Interview date: ------- �I KEY: Y = Yes I N = No I U = Unknown Demographics . Birth dat_e��-�-­ Age I DAYS) circle o�e [ ; . � _·if\-�._ ( _�_�':::s Sex: yMale Ethnicity: D Hispanic Race: D Asi�n D Black or African American D Female D Non Hispanic □ White D American Indian or Alaska Native □ D Male ---+ Female D Unknown Unknown D Native Hawaiian or Other Pacific Islander D Female ---+ Male D Refused D Other Race D Unknown : Contact Info i Address: Home phone: 10 2.'7 4- _ - City/Zip: County: Le.-,..- � Work phone: liI E ma1;·t Mobile: . Institution i Was patientliving in an institutionalsetting at time of event? If yes, what type? ! I lnsti�tion Name: . --- ------'----------Phone: Case Investigation Contact attempts: Record date(s), contact method (phone, text, letter) and outcome here: 1 ---�-----�---------�--��-�------·----····· ... ......_ ... ··---- D Patient D Parent/Spouse D Refused/Unable to Contact □ Medical Record D Other: �ref�rred lan�uage: Parent/Legal guardian: I , Outbreak Is this patient part of a known/suspected outbreak? l,,>f N U 11-----------------------------�--CDPHE- Outbreak------ ID/Name---: J.oiC'�- 3,�- -� O -'-=(S"- --- I If yes, provide details: ;c___......L� C ftl2.Ad <,f='----'=-J,l-l-l"""'-'-=-.,_'-1---------------------_,J Please confirm specimen information with patient. , I Specimen source: -B"Stool D Urine D Blood D Other: Collectiondate: -- I J e1u Lab or Hospital Name: ('£)�\-\'i... \a.-b Culture: .-Pas Neg Not tested JPCR: Pos Neg Not tested Colorado Department of Public Health and Environment December 2017 Communicable Disease Branch I 4300 Cheny Creek Drive S, Denver, CO 80246 I Phone 303-692·2700 I Fax 303·782·0338 p. 1 Patient Name: Event ID: KEY: Y = Yes I N = No I U = Unknown Clinical Description 1 u '!r -Did p�tient h�v; sympto�s?- N I "1' y ..,N- Did patient have: Diarrhea N u Vomiting u I I,)(' v1 ,I Bloody Diarrhea N u Abdominal Cramps N u i.03 -"r N !l___ F�ver (max temp:-----·- u Other: .,...,,� -N u ' How many days did illness last? 1 d, :! Did patient take any antibiotics for this illness? Y N U I 1�1 ---------(see---- CEDRS list):--------------------------------------- I II !I If yes, antibiotic names I Ii ii 111 During the 30 days before illness, did patient take any antibiotics? Y N U d --- �,. 1,,,, (see CEDRS list): j J yes, Lanti " b"1ot1c . names I ! I During the 30 days before illness, did patient have any form of antacid (medications to block acid, such as those taken for heartburn, indigestion or acid reflex ? N u ::_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _) _________________Y__ __________ _____________ (see CEDRS list): �I, I If yes, antacid names ·--�- During the 30 days before illness, did the patient take a probiotic (probiotics can take the form of pills, powders, yogurts, and other 1 y I fermented dairy products, as well as anything labeled as containing "live and active cultures" or "probiotics. ")? N u y During the 6 months before illness, was patient diagnosed or treated for cancer (including leukemia/lymphoma)? N u y During the 6 months before illness, was patient diagnosed or treated for diabetes? N u : 1 ii During the 6 months before illness, did patient have abdominal surgery y N 11----(e.g., removal··--- of appendix- or gallbladder, . - or -any - surgery - ---· of the stomach or large intestine)?---- : Outcome I Hospitalization ! ,, / (RecordOutcome: patient outcome�ed on 7th day afterDiedspecimen collectionUnknown date.) I If died, date of death: ,I1' y j Did patient visit the Emergency Room? N u I y ..,I'( (ER visits only are not considered "hospitalized.") I -· ! I Was patient hospitalized? u Hospital Name: Date of admission: Date of discharge: I !I 2nd Hospital Name: Date of admission: Date of discharge: I I I I ! 'I ___________________________________________________ ! During any pa of ospital i did patient stay in an ntensive are u nit ( CU or a r tical Care u n t ( u ? N u � _ _ _ _ _ - - _ _� _ _ _�- -�- - -•- _ _ _ _ _ _ _ _ _ _ _ _ _ _l_ _ _ _ _ _ c_ _ _ _ _ _ _ _ _ I_ _ )_ _ _ _ _c_ _i _ _ _ _ _ _ _ _ _ i_ _cc_ _ _)_ _____Y __ _ _ l � � � � � � � � � _ ___ _ [: Infection� � � � Timeline _ ·I I Exposure period Communicable period '.j I Enter the onset date .7 -1 -0.25 in box, then count Days from onset: Onset date Variable, as long as Salmonella excreted in stool.
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