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HomeMy WebLinkAboutFood Service Establishment Inspection 00 (8) STATE OF CONNECTICUT DEPARTMENT OF HEALTH SERVICES BUREAU OF HEALTH PROMOTION dr. DISEASE PREVENTION NAME: Charles Vassilopoulos, R.S. DATE: April 4, 1983 ADDRESS: Memorial Building TOWN: Vernon 14 Park Place SUBJECT: Vernon, Ct; Investigation of a reported outbreak of illness possibly associated with the consumption of a commercial product. ( X ) For your information. ( ) Please note special recommendations. ( ) Follow-up report r.equesced . ( ) For necessary action. ( X j Remarks. Please note the specific comments in the enclosed report. The source of the reported illness could not be determined from the information available. Roger/Mshar, SenLor Sanitarian Environmental Health Services Section Preventable Diseases Division RM/bh cc: Pat Checko Robert Deptula, R.S. Epidemiology Section Town Hall State Department of Health Sullivan Avenue Services South Windsor, CT 06074 Phone: 566- 762 79 Elm Street 0 Hartford, Connecticut WKS 06106 An Fininl t)nnnrN.nily CONNECTICUT STATE DEPARTMENT OF HEALTH ENVIRONMENTAL HEALTH SERVICES DIVISION SUBJECT: Vernon, Ct; Investigation of a reported outbreak of Foodborne Illness occurring after the consumption of food served at a private residence on March 5, 1983 To: Thomas H. Furgalack, Program Coordinator Food Protection Program Q,,VA From: Roger Mshar, Senior Sanitarian Food Protection Program Preventable Diseases Division On March 15, 1983 this office was notified of a possible outbreak of food- borne illness involving 4 individuals. The common event was reported to be a meal served at the home of one of the above. The meal consisted of, home-prepared: Chicken L'orange, Steak Terriyaki , vegetables, wantons (ground beef stuffing) , white rice, Chicken Terriyaki and a commercial product called Kim Chee. Two of the above 4 individuals were available for interviewing and provided food history and other case history information; The characteristics of the outbreak were as follows: Onset 12--24 hours; symptoms - nausea (2) , vomiting (2) , diarrhea (2) , (one person just vomit- ing) ; - Duration - 5 hours (just vomiting) , 24 hours and 7 days (person lost 10 lbs. ) . Blood and fecal specimens were collected from the individual most ill and submitted by his private physician for analysis. Samples of the commercially jarred Kim Chee (comparison and residual ) wer6` also submitted for analysis. The product is marketed in a 16 oz. jar by the manufacturer KUMHA Industries, Long Island City, NY. It was purchased from Kims Oriental Market in Vernon, Ct. on March 5, 1983. The Vernon Health Department reported no other complaints received. The Food & Drug Administration and State Department of Consumer Protection were contacted by this office - no other complaints had been registered. Laboratory results of the analysis of the Kim Chee were negative for foodborne pathogens. The fecal specimen analysis was reported as negative for the foodborne pathogens tested, except for Clostridium perfringens which was isolated. The symptomatology (upper and-'tower gastrointes—ti—n—aT involvement, protracted duration) ; however, isn' t completely compatible with that expected for a Clostridium erfringens infection. It may be that the Clostridium fe n—een_s iso ateoriginated from the normal intestinal flora o the comp al- inant. With the information available the source of the reported illness could not be determined. If the source of the illness was foodborne (insuf- ficient informati--on provided for verification) it' s conceivable that another food item may have been involved. RM/cw F��.�:Is•I:�x i•�x ors N,rl DATE AND HOUR -1 c, 4' • q OF ro 471 NAME AMADDRESS AGE ONSET a� t a C= COMMENTS 6—111 J 86thv� Ltrt w 1 Inr a-Rer vw t 6-tg GLPPx•Izk.-s �d Qe�ow trF�ri NtvFi�' W45 et vC vr0�.�. t�ollcr no addt+to'.af S ha o C r V•0. die.^ �-f ivS f'lll 71 ems''/ kiit/ Pike -Is A', Badim, _ CG� FORM APPROVED OMB NO.68-R557 INVESTIGATION OF A FOODBORNE OUTBREAK 1. Where did the outbreak occur? 2. Date of outbreak: (Date of onset I st case) State (1,2) City or Town _County (3-8) 3. Indicate actual (a)or estimated(a)numbers: 4. History of Exposed Persons: 5. Incubation period!hours): No.histories obtained (18-20) Shortest (40-42) Longest (43-45) Persons exposed 19 111 No.persons with symptoms (21-23) Approx.for majority (46-48) Persons ill (12-14) Nausea (24-26) Diarrhea (33-35) Vomiting (27-29) Fever (36-38)6. Duration of Illness(hours): Hospitalized (15-16) Cramps (30-32) Other,specify_ Shortest (49-51) Longest (52-54) Fatal lases (17) (39) 1 Approx.for majority (55-57) 7. Food-specific attack rates: (58) Food Items Served Number of persons who ATE Number who did NOT eat specified food specified food Not Not III III Total Percent III III III Total Percent III InOro 8. Vehicle responsible(food item incriminated by epidemiological evidence): (59,60) 9. Manner in which incriminated food was marketed: (Check all applicable) 10. Place of Preparation of 11. Place where eaten: (66) Contaminated Item: (65) (a) Food I.ndustry (61) (c) Not wrapped ..........❑1 (63) Restaurant .........❑1 Restaurant ......❑ 1 Raw ...........❑1 Ordinary Wrapping......❑2 Delicatessen ••••••••El 2 Delicatessen .....El 2 Processed .......❑2 Canned...............❑3 Cafeteria ...........❑3 Cafeteria........❑ 3 Home Produced Canned--Vacuum Sealed..❑4 Private Home........El 4 Private Home ....❑ 4 Raw ...........❑3 Other-(specify).........❑5 Caterer.............El 5 Picnic ..........❑ 5 Processed .......❑4 Institution: Institution: (62) School ...........El School.........❑ 6 (b) Vending Machine...El (d) Room Temperature .....❑1 (64) Church ❑7 Church ........❑ 7 Refrigerated...........❑2 Camp . ...........❑8 Camp .........❑ 8 Frozen................El3 Other,specify ...,....❑9 Other,specify ....❑ 9 Heated...............❑4 If a commercial product,indicate brand name and lot number DEPARTMENT OF HEALTH, EDUCATION,AND WELFARE PUBLIC HEALTH SERVICE Health Services and Mental Health Administration CENTER FOR DISEASE CONTROL EPI DEMI OLOGY PROGRAM ATLANTA,GEORGIA 30333 HSM 4.245(CDC) REV.3-71 (Over) LQI Cole X14k., C OC-15e e -cvtee,(�- --colt 0-tou'Ne- 6'cxt,dy Gvbtlev- HL CL(Lw- ON cl ` DM ,r CONNECTICUT STATE DEPARTME T OF HEALTH Phone 566-2536' LABORATORY DIVISION 10 Clinton Street P.Q. Boa 1689, Hartford, Conn. 06101 • REPORT OF LABORATORY EXAMINATION Jl1N Reported 'V J Specimen No. 255-258 Collector's A1"4 Town of South Windsor Report of Examination of Ham,- Roast Beef, .Cole slab,, A. cheese For Food poisoning microorganisms Source Comla7.ai1�axlt �� Collected by Robert De_ptizl,j_ Report to: Sidney Curtis, M.D. SOUt'• f , . Collected on 6-21-79 hr. M. Rec'd. 6-21-79 hr. M. Reason for Examination Alleged illness (5 people) The examination gives the folloN ing results: t On June 21., 1979, the following samples were received at ambient temperature. Specimen No. 's Type of Food Results 255 Ham (approx. 45 gms.) No food poisoning microorganisms found. 256 Roast Beef (approx. 40 gms.)No food poisoning microorganisms found. 257 Cole slay (approx. 90 gms.) No food poisoning microorganisms found. 258 American cheese (approx. 50 gms.) No food poisoning microorganisms found. soh Form OL-2UC John J. Redys Mrector 1,2 l� iA -- aA a 6> - - — -___._-��s�2 --ate _ - — -- ----- ---- --- - -- — --- - — -- ---- -- -- ------------------- —- ------ -��_�-�^=''`'� __Lbw soy. -------- --------- � ----- --------- ---- --- ---------. ------- ------- ---- --cam,- -------�-----��.`"�'- ------- - --- A4 cek:6�--o-d-ZA-I- --- l AW :JAEMRJ_,TX'1:-�Y DIVISION P. 'Do E,)"r 1689 jj.fa"--q T-reftj in ok 6-!g 7Crw1�kD, (Y3 ?'1..2:CiICUi' 06101 Phone: 56F._271 7 MR MOD PO-IrS0111: C SESC�?•iENS Sp eci"Len of: C b�� .S (lGy Date Obtained _6 a./=7 g �. Collettor8 s Naamie No. � 3 Collector'i Tel.: L;zboratoxy Report to be senU to Cor_s°xor or complainant -AAdress Ted.. YJa.s Pry,si clan. sees? Yes No If yes, Physician's nw-e Address ?:as parson k oupitalizod? hospital Mdress Tovm If patient i-ras hospitalized, indicate on reverse side whathvr clinical s-pec3.�r�ans ;fir r8 obtai.�aed aid the r�tu.�°s of the labcrwte;a^,y rLs~a.1.ts. bete anal hoots- food consu,ed Late and hour of onset of illness SWgnsand Zyimtons (chock appropriate ite=) Burning sensation a.L- M- uth Md-ballic taste Nausea Voxelltin:t itching Prostration A.Aominal crates Headache Chills Rash Weakness DeYw&mtion um esa Di:so inaso Bluz°r:d or doable --ision Del.ir-�u.,i Pe rs3s c Die rive (i=actoristics: bloo y, rrzcus, zaterj.$ 13o.dd a3r) Fever Duration of s_.yera 'was food con sued? 1lw1P?ber of persons consLndmg saris ite-na NT12 ter° of per-ons who becarn .ill � . (111ote: For each person wm' bec-ante ill. •prepare a hi.stor7 of all foods con.=ned rur-I g tha prior hours, indicatlng the uitm- and place of cons=aptione) 1 vpe of sad_ple (chock id,.ore appropriate): 13aaled Unscaled i Not in original .container Canned Bottlad Fro-M-1 Coimplainant sawaple C parison sarp1Q Other sample information LAhn-,Q4,'1C7«f pITTI S10a3 P. 0, B-1-- 168; RARTIT'C 0, CO "�'CT1GW 06,101 Phone: 566-271 7 �ra-eexkt ®e°� �� C�pl FOR FOOD PG1�C27�iG SP�C�� S - .. o.�. � ��� P�'� pate Obtained- - - Sy men ec� �°� Collector's Nam & No. Collec.tor's Tel.; Laborato-.7 Report to bo sent to Cons -per or coTM:plainar_, Mdress Tel. 1,ra.s rsi clan seen? Yes No if yes, P17siciant s na�r� Address V'as person ho pitalized? Hospital Address To m If patient i-ra.s hospitalized, indict�te on reverse side whether clinical specarans Mre obta ied and the natur�a o.L the laboratory results. Date and hour food cons-.rred pats and I-Lour of onset of illness Si gas and q7nptorts (check apprepriaLe i° ) Psr:�i-, se ation in routs"-i I Y..al1=c taste Nausea Voi tiz2 Itching Prostration .Abdvzinal, cramps Iieaddachie Chills Fah ' Weakness Dehydration iau?rhne--o Dissinoss B u:-.ed or double -eisior- Deliri -Vn Pa alysis Corgi, it arrhoa (cl-mra.^toristicso bloocy9 tracus,, watenyg Nlo./d ) a r 3.aration of Nv ber oersme sa-� iter tr:E�7.'e food C.+O_"1L�'L�"d? tu+q 1f° persons consu P. ei° air persorw •,aria becar 2—I � . (;Tote- .For each person ufho became ills prepare a history of all foods cow a d ,during t`r_a prior 4-8 hours., indicating the uine and place of con.s=ption®) ype of saw:Ow (check Tvgaere appropriate): Sealed Unso-al ed Not in original container Canned Bottled Frozen .. Cormla.:ir-ant sa.,ple Coriparison. sarmle Other sample information ")Fl17 77 1d�:,1.J�.tl P. oZ A'3 .3S v, F_ , (�Gi?°: C'w'ice' Phone: 56.'_271 7 l�/6s Cad w/W le FOR FGOD P0IS0z3j:°G SPrC�" ,tS Spo c awn of o ea.} c� Date Obtained (a'-a� ? o/ Collector's Nary No Collec tor's Tel e a LaboratorY Report to La son; to Con ter or cor: lain v P.zldress Tel® ,-as Rw ician veen? ges UP,, If •Yes9 p17sician's r wiw Ac?dress I.ias person hosp1_UL izad? - Howpita'l. Mdress Tow= If patient ums hospita7.ized, indicate on reverse side whether c1 ical specimmns here obtained and the nature of the iab;=r 11y re salts e Date and hour food con.—,amed Late and hour of onset of illness Sign.s and Z,-Lmtons (check appropriate itens) Duz°?l ng sensation in Mut:-1 Ie-call.ic taste Nausea Vordting ?tct7 z Pro:;uw a:vicn A:dorm al cr=ps Iaead.ache Chills Rash Weabness Del ration I z,e;;3 izziross Mu--zed or cdoifole vision Delirium Paralysis Co sy Diarncca, �(c1mracteriVticsv bloody, rxacus, water-, 1o./day) fiver ' Duration 0 '.Taere was food cons=mcd? I3=ber of persons con.smdJng sm;o it en Ti e r of person-- :_tlo becare ill (Note: For each person. w.o became ill t,. ry , prepare a his��ax°�- of a7.�, focdv con.3�.�d du$`��o t c� D.. Qr 0P IiOLLr° , indica ti7.nx Gi18 u11 dc`. and place Q of C.°Q 1a5tffi 7t3 O3Lm, yr T,me of sarpl.e (check idiere appropriate)- .Sealed Unsoaled Not in original .contain.er Canned Bottled l+`rozei Corm lairiant sale Gozrpas°wson say le Other sample 3nforp.ation R� Y 114 yam_ y ed v I _vim o-lf� °"' a I I Ls - O To k I `L Date - � Time WHILI YOU WERE OUT c�c Mof 14 1 Phone,,,,- Area �2� '�'�'`�' Code Number Exteneion x W LEASE CALL ILL CALL AGAIN /2 ZRGENT CALL �Eivv�kew X Message- 44 472� Operator Campbell 09301 CONNECTdCUT STATE DEPARTMENT OF HEALTH L. 566-2536 § LABORATORY DIVISION R�ET P.O. BOX 1689. HARTFORD. CON . $TTriDEP T E REPORT ON MISCELLANEOUS S,dCJNS :cimen No. 4703, 4704, 4705 APR — 31979 Nanny Cavallaro 195 Hilton Drive, Sout Wdsnr (Patient's Name and Address 3/22/79 Discard Date____.___�__e, ._ _.._ { Sgugg�e Date of Collection t,tk :cimen of Sample# 1 from porkliver a--maple It _ i-- chinogsis—,, Dr. -Brink Preventive Disease 79 Elm Street Hartford, _ - CONNECTICUT cc. Alan Buzzetti EHS 79 Elm Street Date Hartford ��19 P APR ,)-eived March 23 1979 Reportedr RESULT OF THE EXAMINATION examination of the specimen gives the following results: Specimen'#r Sample # Sonrce of meat Result in sausage h703 1 Pork liver Trichinella spiralis larvae found. h704 2 Pork butt Trichinella spiralis larvae not found. 4705 3 Pork butt Trichinella spiralis larvae not found. lav-,,�r Director s CL-20A (4-70) 15M e, 6 r 6 y,-3`:;3) _ JJ y - - J� v %liw .r0►.�� AL M, A,. _ �6a GG/jer�n I`J�.eS� g C'6/07-�� st!/,� �i+-cc�yrY't,Gt ce c � 1q-� Lam, 3 033 _ Q`)w,.� ^l-�w�,�L"/` f �' �v�OG�8rhe /�R�K a�°G�.✓P' - ------ 3 7 �-,�� --- --_ �j� GEORGE A. DAGON TELEPHONE MAYOR (203)289-2781 "FOUN OF EAQ..-T TIAR rFORD C�aa� s onnec&xd 0616W April 23, 1980 Mr. Roger Mshar Dept. of Health Services Food Service Division 79 Elm Street Hartford, Conn. 06115 Dear Mr. Mshar, On April 7, 1980, a phone call was received from Mrs. James Cox 724 Quarry Brook Road „ South Windsor, Connor * stating that she had;purchasedrozenSram�p gd frozen sole from an itin- erant vendor on Governor Sheet in :.East°1jart'ford on April 4, 1980 while on her way home. She..thawed portions of the f�.•sh and shrimp for consumption at 7:30 p.m. that evening ,� On April 5. 19 80'beginn�ngt p 5 30 ¢ m_ er, il�y� became ill with symptoms of vomiting, chills, }rictus , tonac r , s arr and general weakness. This condition continzecl ""EYaruo Apra= , hen she placed the call to , Mr. Robert Deptula, 8qutTN i' dso, ,San ar , obt fined leftover portions of the shrimp and sole ah7Msulit tt}ed ' N RI State Laboratory (copy of re- port enclosed) . Feca7;ak `were' efhCox's to submit. The State Laboratory reported that--tbe kk wer,e eceived as of April 23, 1980. The shrimp truck was inspected on April 10, 1980 by the East Hartford Health Department. The operation was extremely good. The truck is a step- side van with three freezer chests. Each is operated, while the truck is in motion, by a gasoline generator and by an electric connection to a building when the truck is stationary. Each week the operator travels to New York to pick up prepackaged, prefrozen products for sale in East Hartford. The packages are sold intact only, The owner of the truck is: Mr. Salvatore Chilone 134-B Central Avenue East Hartford, Conn. 06108 Mr. Roger Mshar of the Department of Health Services was asked to check the supplier in New York to ascertain if it is an approved source. The supplier is: W.B. Frank Enterprises 509 W. 16th Street New York, New York. Conclusions and findings: 1) The Laboratory report on the food was negative for food poisoning organisms. 2) Mr. Chilone appeared to be operating a very well controlled business. 3) Since no fecals were submitted and the Cox's did not see a physician, no conclusions can be drawn as to why they were sick. Very truly yours, John N. Gallivan, M.D. Director of Health Raym J. Quinn Sanitarian RJQ/jp 1 Enclosure r CONNECTICUT STATE. DEPARTMENT OF HEALTH Phone 566-2536 LABORATORY DIVISION 10 Clinton street P.O. Box 1689, Hartford, Conn. 06101 REPORT OF LABORATORY EXAMINATION Reported April 15, 1980 Specimen No. 102 104 Collector's No. Town of South Windsor Report of Examination of Shrimp & Sole ---- For Food poisoning microorganisms Source Complainant SoutIT n s eal -T-eptartment. Collected by R. Deptula Report to:. 1540 Sullivan Ave., South Windsor Collected on 4-8•-80 hr. FYI Rec'd. 4-10-80 hr. 14I: Reason for Examination Alleged illness The examination gives the foilonving results: Uri April 10, 1980, the following foods were received: Frozen shrimp breaded and cooked (approx. 65 gms. ) not in original container. Frozen Sole, raw, wrapped in store paper (approx. 320 gms), Cooked (frozen) Shrimp and Sole wrapped in store paper (approx. 520 gms)„ It was alleged that four people became ill after consuming same items at .home. The samples were analyzed microbiologically. No food poisoning microorganisms found. AJ,M:cam Jesse Zucker, Form QL-20C Dlrccter . f:.�.� wJ..T.','lJ1 c• iLa a!�.;.: x iJ`.i fJI` dL�.`.+��`l.ii L Fn—R.Trl Y DIV!S10I1 P. O. 2-))Te 1680, FOR FOOD .OISON'I `x 817-EC FIT Speci=n'of: 5, Date Obtained �1-�- a'a Collector's Nam No. Collcc"nor t s Tol G: 6(-/y.2 s j/ , YZ Laboreuo,-7 r spor t to b3 scent to Consumer or co.m-ladr,1?nt 'AAd ess Tel. llas xP} s:i.ci.an --fall? Yes No If es Physician's ties °47 �' v y' s IZ3 /) C� Address etas parlor_ how taSiRod? Hospital duress Town if pwty cent -mas hospitalized, in dime on rover-se side whathar clin ca? spacer s I-rr8 obtaLned and the nature of the labo=atoxy results. Da ue hour food cods.-ed Y �/� $� '7' A Date and Your of onset of illness S�gno and (check appw-opriate itens) Bunning sensevion in rmutn Iietall.ic t-.-ve Nausea z,1'17c.ell'tin;4 c--l' Ruching Fxostrat-ion '-'orlaial crams L,-111'eadaciie✓Chills,--Sash Weakness �Vdmtion a� ii'w', �3us D:� .tzinoss cd or doable vision Delirium Coma 1�'Ta' ^ e c: ractc sc�cJt blooms, rmems ten 1o.JdoZr) Q .s ever --- .tion of--mom mooa� a.sn:�aas teas �6-as food conzur=d? .�. 2 Nlur�ber of persons conssL'3i1ing same ite_- Y • hiT�++ of perooi..i i no be,- ,,3 'ill— . L, te: For ea--h pew son 4�Y2f1 e�f3^..e"iT°ifi illy �3�"E'pa$°e c� hZ� � foods r.... (�` to of all oods co,..��:zi-nd Ll" "I tho T??^i®r b-OuT`:3, indicat ails u?3Y?£h' plaC; ofeQ:3t20na) Type of Smaxse (dieck tdlere appropriate): Sealed Unscaled Not in orig ,nal •container C=r_od Bottled Frozen Co l.a n nt szmzmle Comparison sa mple father sample infomation CONNECTICUT STATE DEPARTMENT OF HEALTH Phone 566-2536 LABORATORY DIVISION 10 Clinton Street P.O. Box 1689, Hartford, Conn. 06101 REPORT OF LABORATORY EXAMINATION Reported April 15, 1980 Specimen No. 102 - 104 Collector's No. Town of South Windsor Report of Examination of Shrimp & Sole For Food poisoning microorganisms Source Complainant South Windsor HUZMth Imp-totmefft Collected by R. Deptula Report to: 1540 Sullivan Ave., South Windsor Collected on 4_8-$0 hr. M. Rec'd. 4_10-80 hr. M. Reason for Examination Alleged illness The examination gives the following results: On April 10, 1980, the following foods were received: Frozen shrimp breaded and cooked (approx. 65 gms.) not in original container. Frozen Sole, raw, wrapped in store paper (approx. 320 gms). Cooked (frozen) Shrimp and Sole wrapped in store paper (approx. 520 gms),, It was alleged that four people became ill after consuming same items at home. The samples were analyzed microbiologically. No food poisoning microorganisms found. a� AJM:cam Jesse Tucker, Form CL-20C Director i111J.-' r P. 1. L Csv3, �i'v'n t�3 Gt3w' G�3.Ol Phone : 56/_271 7 ..._..�..._......W.W......,._M _ ,mow"-_...... <.,;.;: . •_n of 1rLw2, -5AL Eatti Obtained .1w� ��.�.. «o.mrAo.rwr C'oUector;S Nmrra & IIo„ cl, YS ~/^.v'•_ 5q j.^ mW..m®•�iy.�taAys��.i•'�u.9svr .Awls :.�'?� :.e:. o�.�: ��'Y��•-rl Laboratory Rom to wo Scout,� '- . 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Y.wus'au Vmiatii+aV � vxwLKaP um.'s'wu !IrCA'.an yYC� wC,!•arV.�mmpsaaF.tSamnf _.....::..r„•r..� ij•qu....... e�i '' L1�..I.�.i'"r.vl� d �'o� v�d 4.1s on. :%Jali.1-..t.ml � '�'•'•'4wLt��:.Wes' (JL,:.e:'.'. "�• v>w. n n T y^,.•a lc.L't•a= S_y t•.•L.L .1:<:.� �" �':Ic •1 :ry .s v. cus 0 0 o<sy., w4 S y 1 ` o n rcr L' _...�_._. aw,�•.«:...m.ca. c.z....�.�.::,.:.oa""'�'."'.:_v..::•"""""'"..,• ,....n.�w4:,..c...w..w.. �:.m,n..c. ,.R .r�•,..•.wen.e.-. ..•cap-..s.•.v..�.®...=.�-y:e....-.a• •--...,..-,.r.•-�arW fCOd Cor:XMCd? X=ber Of pvrsorz a4'6' - ! ♦g Cinzm ' •dwat:ma'L' .v:cu4'aiF♦a.�C�:�._.._.....�W --_ - ��..�..._._ _ _ orc y,� ,,P.,�,.,.. _rl i ? , "� T' v �o itr.:.a b~✓,,,...,wt� 1. , 3_ ciZ°ca . h. scoff o' a2-1 food,- co:.az* • ..1.......:4.,. o'_:. Yi .�vo aJ :'ilo �,. uJ.l.:1 / ` 1 ° ear. �.�'r�r nranwe n ^ •F` yt�•t tir. 4..r.v j';.i-S.ow ,.i1 1'.0111 w"ti 1.:tl k.w;.Ti�r''.�' tiiQ 4 Yf: ,,?? ''tt a 3 •" rt•:•t L yp ' .a.m=w•�+.a..r.wm...w...s�.ewr_-n ..c*..w..ua.mer+• .,ebmu y�a•ca•-.ncm• xo.�vxoao amu.cwu••eea+�..mvv..:.va.vnna.ore..rr-nw:aavoaarx.-•..—._unwti*sarnovamw-x�.w.m.®smaors.r.m,.u,...w..m�.�s.nwwu+�.. +.:n..r...+M..u...»..u.r.w.wa+wwr.w.r.neYmwas...ar.aua.....___ �........w.u,.a,,. ._....,,,;:+.a-srw:.:c..e..w..:.•wrs.a:.ura«..._..__.. _.+:+.,:..,._...._......wxv..xrw+:.w..« r.r•-- _.__ _._,..__.____. _ ,.,,,x•.___..�.._ ...:.._-.n...-*i...r•,.vVar. � Pa of , laic �G:icG'C .-re np��ro�ria:�o�: •Soala Upson osl• Not in or-lvpbn-�Ll •conta-inor C•rr-od o bu3ed t: v 1 Co '. '~ wdu Sammie 1if3 ©h3r $s�V18 �..}]forration "-Q^m __ uswmm:�.cw:a�.an ea+rers.e..*w•.w.*oaeo�n�v �m.r._-__-w..a�cA..�.xn,.:aw.s..ss,.:w�r>�+�.. 1 r En ZZ c N � rj y = d omi ti,.n g --- _ Abdomi.r12a2ain r 'arrbe-e _ _. ever T.os-s_af_Apn t.i i-s _ .. &� i_d_den Duration e �c F' 1e d CON CRETE PIPE COMPANY, I WAUREGAN,CONNECTICUT06387 - 203 564 co To Date oZ/ Time Z WHILE YOU WERE OUT M of Phone Q '—X7 91 AREA CODE NUMBER EXTENSION Telephoned ❑ Called to see you Please call back Will call again Message: � W f Operat r FORM No. 702-24 "RENCO QUALITY" CONNECTICUT STATE DEPARTMENT OF HEALTH Phone 566-2536 LABORATORY DIVISION 10 Clinton street P.O. Box 1689, Hartford, Conn. 06101 132 REPORT OF LABORATORY EXAMINATION Reported July 17, 1980 Specimen No. 21480 & 21481 Collector's No. Town of South Windsor Report of Examination of Swiss Cheese For R. Deptulk, 1540 Sullivan Avenue Source Collected by R. Deptula Collected on 7-2-80 hr. M. Rec'd. 7-2-80 hr. 3:15 P. m. Reason for Examination The examination gives the following results: Bio-assay 10 grams consumed 72 hr. observation period 21480 - No adverse effects noted 21481 - No adverse effects noted Copper as Cu V mg/kg 21.1{80 6.2 21481 5.0 pH 21480 5.9 21481 5.8 Conclusion: The above examinations show no--evidence of toxic chemicals in the samples of cheese submitted. B. L. Cole Jesse S. Tucker, Ph.D. Form OL-20C LYirectnr 21480 0,z-, /6Vi iKiC/ V. . �17.L i :� �,:.�..��5.1! OF r. 1• �` � ..��" J J aca�`1���T' D -V x ^r3 am �a.�i1 21481 �� S`� , G�JiC`i'ICt7T Gtlfll Phone: 566-271 7 S ecLa r, of: Date Obta-ined 7 7 — $c> Collettor's 'N.—.-a & No. Col lec'tort s Tel..: 6y fir/ gas. P bo P ort to Eo soat, to Consu,-or or ^o�J.ainmx. gv; c, ��r"ite��}c -Mdress -2 :s cvr.,d• T _ el. bs/c>L ?.as Rvslcian seen? yes :?o If Yes, Pizrsicianfs na:; Address -----�� k.yS 1r,E?r3OT`a / e' K,,SDi ta ® ..mod. Addres.`3. -- Toles If aavienv vms Y:ospitalized, indicate on roz�ersa side whether clinical specirmns mre obtainers and t..e n�:�t�-� of the 6-w?— i r,k.,�c�lic�e%, Date and hour food conic- :ed 7 Date and hour of onset of illness S19:15 and "`[F Dteill3 (c'reer, a.)p-0!)ri-!Vc9 iy�r,,) But2'Yfung sensation in muth v F.atalli.c taste I,ai:sea Voit ti" �wGl:?L " -Prot;ration ,��� �'a�-nr le c C �• DI � WaalmesS; Deh�atioll :: v::1i.�- .� .r., �J .�-vC�.i. 1�'r US' as � r. 1 t� i'Lr M,G'.^..ix,c-' or dczzIb i v dsi c?1 Dins P�u"r2a'ju�S Ci)1�2.. s� ,- .�. .,..-: �ch csb'cod o: • T Feva� - .T-iem w.-as food consizS.- d? he' N=:.ber of persons c nstL"ing s ".. of ,)erz- crs :*'io became it (Note: Fo_• each Lerson wm bec=-n—, all, prspare a histo,-7 of all focds conzx.nd dv-"=�" +'� u8 h a:�s, andtcatitig the ti*. and place of s �, ,� Ji.o p� _or io co--,,,- m.te1o. ) W �, -pe of st ip3© (cileec 3•i1L3Cre apP:".on---latte): ;x3:z?ed J Un ^tiled Nat in ormgiral container / Carr^d ttlad i zon Con Y lai.-:rat S=_Mle Ca ,-wison sale.�� Other sample infomation CONNECTICUT STATE DEPARTMENT OF HEALTH Phone 566-%536 LABORATORY DIVISION 10 Clinton Street P.O. Box 1689, Hartford, Conn. 06101 132 REPORT OF LABORATORY EXAMINATION Reported July 17,- 1980 Specimen No. 231480 & 21481 Collector's No. Town of South Windsor Report of Examination of Swiss Cheese For R. DeptuM.9 1540 Sullivan Avenue Source Collected by R. Deptula Collected on 7-2-80 hr. M. Ree'd. 7-2-80 hr. 3:15 P. M. Reason for Examination The examination gives the following results: Bio-assay 10 grams consumed - 72 hr. observation period 21480 - No adverse effects noted 21481 - No adverse effects noted Copper as Cu mg/kg 21480 6.2 21481 5.0 PH 27480 5.9 21481 5.8 Conclusion: The above examinations show no evidence of toxic chemicals in the samples of cheese submitted. B. L. Cole Jesse S. Tucker, Ph.D. Form OL-20C Mreewr �1480 � �f� ii:,V'+�ei�i± u :STi rr i��e�. ;rrT / �..11�vr'.r rV.. � err r.�.. `r �%' .L � Vr{1.t7.LV1Y 21481U_RrJTUPD _277r1- . 31 4NE:G SILCE.a 3S JUL S,ecLarn of: Date Cbta-i ed .,a S70 Collector's Nam. � ITO. Collect-o's Tei.: 6y -,�rf I,aborato:ry --Lapoxt to ha sit to or co�7�i� r, q �✓ a c e^ C d dre s s _ 7 v F✓c y7� �� S c;ii.h,1 �el. EY_ Y-&y&6 _ t',as R rsician se: i? Y(:s -ido 1f yos., PIT!sician's namic Address 41ss Person hospita U,-j d? /? HosDita`1 ?dress To; Tf atie:iv ums ho,p;italized, imlicate on roverso side whather clinical specil�^ s Tmre obtaLied and :he n�:��� o; vra szhc:a o ,� results. Er ley 6_a7— ro 6 p�- P,L, Data ,hour food cox edy 6 Date and hotf._r or onset of illness S,5a5 and Z-27DtOIrm (azckc ap-p--opx r azo 1'`iA,,.,:z) WIMI: ng sensation in muta L-�Yia G"Il lic taste ?taasca TivrrILing �� u iV\..da=)y, Pro:3ura� . „� y i r-�Pr Yer je c _:� :_., W Wee'3kmesa Do!—lyGe C.ion -c. ai.Ods., va::i"s0,.� .. �._�.,.� .�-..c.,�aL tC �il"' v "c'ti^� ^+ �� �-....- Di^_•+:•'.noso M1T•tmd or zb e Sisson � L"! i�w�zrus1 S �'fli�1 i �"!i - � 1 /�'� ...c.r'it14c.. �y .<.... 'V J'.+1...J:/-..CJO V.IoaL7Ty .Nwc ., i'::.LteiY I'30.j d'V)l Flear -�, • C .era 'ivmas food consm- i? hot-IQ Nx"zber of pew sons const=jmg`s=w Of prac:^..s ::*zo bec=a i z (? �' ac �--� . dote: cr e herUon zra here ;.s ill, prepare a history of •J1. focda cor_-=ad L.� t1:.3 iirOr :v houvs5 Lnd4Cat� .t.T'te '-it o r+. ) } '.Tl, u� u p18c0 OI CG-aW :?./ r �D.SSi�e 0-14c�ic� r3'Zpe Of (C120C_t Z•u?Ore SIT-OJ,?�t:' L_6d 1od ru.,,� Not_ T_> ^ ?�o in origirul co�tairer tlad , Z`rozan r.�. Co: �;air?.It samle Cor .Zri son samnlQ Other ample orration CID 37 Rvker4- Vrl�-I hs Sys� Our, EFAL—al DI ISY-014 HUT.KP,D, Cb"r,v'CTICU! 06101 Phone: [66.--27i7 MR FUOD POISON TG SP.C?IF,;,TS Date Obtained ro Collector s IZsm & No. ty r 7 /cam Collec-�or's Tole: �'�1�:a?S/1 borato? Report to Leo sons to orst- r or colainan v _)r-7isl� �s"i�®'l7`G P.ridzaess 3 L�1iKal ^set. T.Tas PTswcian seen? Yes No If yes, Physician's no.7me Ad dress V'a.s person: hospitalized? hospital A.dd_ress lolm If patient ;•ra.s hospitalized, indicate on reverse side whether clinicall spec s rmre obtaLned and 'ha na.ttrr s of the abor atorsr re sul is. 0- Date and hour food consmaed 46 -2 —10 7� ��j Date a.nd hour of onset of illness �� ``= ,�.,,•� l -/ Signo and stators (check dppr­_priate itw::is) Lhiming sensation in mouth +,nl le to tei Nalasea Vomiting ItC�Iois� �a J,'"itratZOTl E!'.:dc Zia,? 2'aI pS r'Ieada�^tl® C1'.?7.�a l? �'^r`1,°'�'3Easve' i L'..i.°F3.-�70T3 e.essD i_-ml css Lli<Lrred or double vision elirimn, amly;i Go, arse V(Charac Ver•isti.cs: bloody, rr.:ms: atery, I\To.ld r) 004e dam `ever Dwation oP P era was food consumed? hz,M-e- Number of persons corsysdng Sam item C,yk re btu:e , of persons vmoo became .2l . {I10,ta: For each person w�� became ill, prepare a historg of all foals cgrsvr-nied LL"_L S t1�3 prior 43 hours, indicatng the tires: and place of co., station `'YPO of sa ge (chec mikere3 appropriat€�): SealedUnsoaled Not in original container v Ca=- Bottled Frozen. Co_nml.aLnant sa4 le Comparison sample Othar sanp1e inforvation