FSIS_14-07_Interim4_Redacted_PlusCover.pdf#_ga=1.106999616.330874689

From: Defibaugh-Chavez, Stephanie - FSIS 

Sent: Tuesday, October 29, 2013 11:32 AM 

To: Leskowsky, Robert - FSIS; (b) (6) - FSIS; Atkinson, Richard - FSIS; Pihkala, Nora - FSIS; Shaw, 

William - FSIS; Vetter, Danah - FSIS; Robertson, Kis - FSIS 

Cc: Kissler, Bonnie - FSIS; Green, Alice - FSIS; Dessai, Uday - FSIS 

Subject: Continued Intensified Sampling Update 

Importance: 

High 

Just a quick update for continued intensified sampling (Phase 2) results for the 5 establishments currently being 

sampled: 

Total Collected # Neg # Pos % Pos # In progress 

M33901-P33901 35 23 0 0.0 12 

M6137-P6137 63 47 4 7.8 12 

P33900-V33900 35 27 0 0.0 8 

P6137A 63 44 4 8.3 15 

P7632 63 47 1 2.1 15 

There are 9 positive samples so far just for the continued (Phase 2) sampling at these establishments. There is not any 

subtyping information (serotype/PFGE) available yet, but unofficially I have heard that there are two Heidelbergs 

identified, and PFGE is still pending for these isolates. I am hoping to get that info in the next two days and will send 

an update as soon as I do. 

Please share within your program areas as necessary. 

-Stephanie 

Stephanie Defibaugh-Chávez, Ph.D. 

Microbiologist 

Science Staff, Office of Public Health Science 

Food Safety and Inspection Service 

United States Department of Agriculture 

202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 

email: stephanie.defibaugh@fsis.usda.gov 

Stay Connected with USDA: 

 

(b) (6) 

From: 

- FSIS 


To: Green, Alice - FSIS 

Subject: RE: More Costco shopper records to request 

(b)(6) 

(b)(6) 

(b)(6) 

The card number for , " " is incorrect as there is only 11 digits and Costco card 

(b) (6) 

numbers have 12. 

(b) (6) 

file:///Z|/All%202014%20FOIA's/01%20-%2050/14-07/from%20OPHS/14-07/AG/2013%20Foster%20Farms.txt[12/6/2013 3:31:24 PM]

Compliance Investigator 

USDA/FSIS/OIEA/CID 

19110 Bothell Way NE, Suite #201 

Bothell, WA 98011 

Office: 

Cell: 

(b) (6) 

(b) (6) 

Fax: (425) 483-3492 

(b) (6) 

fsis.usda.gov 

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unauthorized interception of this message or the use or disclosure of the information it contains may violate the law 

and subject the violator to civil or criminal penalties. If you believe you have received this message in error, please 

notify the sender and delete the email immediately." 

From: Green, Alice - FSIS 

Sent: Friday, October 25, 2013 1:28 PM 

To: Atkinson, Richard - FSIS; (b) (6) - FSIS 

Cc: Khroustalev, Allison - FSIS 

Subject: FW: More Costco shopper records to request 

Please forgive me if I've missed any of these, but I didn't see them in the IR. Do these need to be requested from 

Costco? 

Thank you! 

Alice L. Green, MS, DVM 

Public Health and Epidemiology Liaison 

Office of Public Health Science | Food Safety and Inspection Service | U.S. Department of Agriculture 

Butler Square West | 100 North 6th Street, Suite 420-C | Minneapolis, MN, 55403 


(b) (6) 

Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: 

Alice.Green@fsis.usda.gov 

| Fax: 612-370-2070 | Email: 

From: Peralta, Vi (CDPH-CID-DCDC-IDB) [mailto:Vi.Peralta@cdph.ca.gov] 

Sent: Thursday, October 24, 2013 8:19 PM 

To: Green, Alice - FSIS; Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB) 

Subject: More Costco shopper records to request 

Hi Alice, 

I've had a chance to go through all the records....whew! Thank you! 

These are all the ones for which we don't have any records yet (the last two are new). 

Talk to you tomorrow morning! 

PulseNet ID 

CDC ID 

Onset Date 

Cluster pattern 

SourceCounty 

Reported Chicken Exposures from Interview 

Store1 

Costco Shopper Card # 

(b) (6) 

(b) (6) 

7/28/2013 

JF6X01.0041 


San Diego 

Foster Farms chicken livers (used as bait for fishing several time during week prior to illness onset) purchased from 

Stater Bros; Stater Bros brand chicken thighs; Sprouts natural chicken brand thighs 

Costco 

(b) (6) 

(b) (6) 

(b) (6) 

9/1/2013 

JF6X01.0045 

San Mateo 

Foster Farm chicken tenderloins, frozen raw (Costco) consumed 8/26-8/28 

Costco 

(b) (6) 

(b) (6) 

(b) (6) 

8/29/2013 

JF6X01.0022 

San Diego 

Costco/Kirkland thighs and maybe rotisserie chicken. Legs (Vons/Ralphs) 

Costco 

(b) (6) 

(b) (6) 

(b) (6) 

9/23/2013 

JF6X01.0045 

Santa Clara 


chicken bake 9/21/13 from Costco food court 

Costco 

(b) (6) and (b) (6) 

(b) (6) 

(b) (6) 

9/14/2013 

JF6X01.0258 

Riverside 

Maybe had Foster Farms breaded boneless skinless chicken, looks like strips (Costco). Maybe had pre-cooked 

rotisserie (Stater Bros) 

Costco 

(b) (6) 

(b) (6) 

9/11/2013 

JF6X01.0258 

San Francisco 

Costco rotisserie chicken purchased and consumed 9/11/13 

Costco 

(b) (6) 

(b) (6) 


JF6X01.0258 

San Mateo 

Buys Foster Farms chicken every week from Costco. Reports Foster Farms whole chicken, fresh raw, consumed 

9/11/13. Foster Farms thighs, fresh raw, consumed within week before onset 


Costco 

(b) (6) and (b) (6) 

From: Green, Alice - FSIS [mailto:Alice.Green@fsis.usda.gov] 


To: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC- 

IDB) 

Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Nakao, Jolene H. 

(CDC/OID/NCEZID); Allen, Latasha - Commissioned Corps - FSIS; Robertson, Kis - FSIS 

Subject: shopper records 

Hi Vi- 

I believe I've covered all the records in your request. There might be some duplicates-I wanted to include all versions 

of shopper histories in case some are more complete than others. 

Please let me know if I've omitted any of the ones you gently reminded us about. J 

Thanks much, 

Alice 





(b) (6) 





This electronic message contains information generated by the USDA solely for the intended recipients. Any 



notify the sender and delete the email immediately. 

From: Dessai, Uday - FSIS 


To: Kissler, Bonnie - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSIS 

Cc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh- 

Chavez, Stephanie - FSIS; Holt, Kristin - FSIS 

Subject: RE: Positive chicken sample for S. Heidelberg patient 

Thanks Bonnie! 

(b) (6) 

Kis and SDC - We may need to mention this at OPHSLT, unless we have additional information from David. 

Thanks much! 

Uday 

From: Kissler, Bonnie - FSIS 


To: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSIS 

Cc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh-Chavez, 

Stephanie - FSIS; Holt, Kristin - FSIS 


(b) (6) 

CDC is planning a web update this week (could be as early as tomorrow). If we decide to move forward with a recall, 

CDC will likely wait until after the recall before doing the web update. 

Bonnie Kissler 

Senior Epidemiologist 

USDA, FSIS, OPHS, AES 

c/o Centers for Disease Control and Prevention 


1600 Clifton Road, NE, MS A-38 

Building 24, Room 10203 

Atlanta, GA 30329 

Office: 404.639.5012 

Blackberry: 404.661.6640 

Fax: 404.718.2126 

Email: Bonnie.Kissler@fsis.usda.gov 


Sent: Monday, October 28, 2013 3:17 PM 


Cc: Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - 

FSIS; Defibaugh-Chavez, Stephanie - FSIS 


(b) (6) 

Also here are summary points from SDC email from Friday: 

About case-patient ( traceback and FSIS intensified sampling: 

The specific product identified is a boneless skinless chicken thigh product. It was collected at P6137A but was 

produced from source materials that originated from P7632 (slaughtered on 9/9/2013). StephanieDC had suggested in 

her Friday’s email to consider recalling all chicken products (including parts and whole chicken!) produced from birds 

slaughtered on 9/9/2013 at P7632 . This was based on the fact that 11 total product –positives were produced from 

source materials that originated from P7632 (slaughtered on 9/9/2013 and includes a variety of parts and 

whole/rotisserie chicken. 

Thanks much! 

Uday 

(b) (6) 


Sent: Monday, October 28, 2013 8:57 AM 

To: Goldman, David - Commissioned Corps - FSIS; Kause, Janell - FSIS 




(b) (6) 


HI David 

Stephanie, Alice and Aphrodite are looking at the following two issues and here are our initial thoughts: 

1) OIEA has established a compelling link in the Foster Farms illness outbreak investigation. Here are the details 

from 

(b) (6) 

This revolves around The case patient shopper data and intensified sampling conducted at the three Foster 

farms facilities in California was utilized. The linkages are detailed below: 

(b) (6) 

(b) (6) 

· tested for positive for PFGE 045, and the like sample collected on the same date, sample form ID 

number 100583269, as one of the pack dates is PFGE 045, which is the same PFGE pattern. 

· The product purchased by the case patient and the like sample, Foster Farms boneless, skinless thighs, were 

slaughtered at P-7632 on 9/9/2013 and were processed/packed at P-6137A on 9/9/2013. 

· There are other multiple sample positives for PFGE 45 at p-7632 and P-6137A on 9/9/2013, both parts and 

whole birds. 

· SDC will look into this further…. 

2) P6137A PFGE pattern JF6X01.0122 (5/10 subs positive), additional 2 being tested for PFGEs; case patient has 

PFGE type 45 

· Although: 

o during the specpgm_02 Sept sampling there was a single positive with pattern .0122 from the same establishment 

o the fact that mixed PFGE patterns can be found in the same sample 

o There may be overwhelming indirect evidences.. 

o We cannot make a conclusive claim that there is a link between the patient and chicken samples recovered from the 

patients home 

---------- 

o A close examination of the two band difference between 0122 and 45 shows that - these are distinctly different 

PFGE types (on the gel) 

o We are awaiting the final results from the additional 2 PFGEs 

o We are analyzing the hospitalization rate for the two PFGE types 

o Etc. 

Thanks much! 


Uday 

Yes, I would say that these two patterns are significantly different. 

Aphrodite Douris 


Outbreaks Section, Eastern Laboratory 


The United States Department of Agriculture 

Russell Research Center 

950 College Station Road 

Athens, GA 30605-2720 

aphrodite.douris@fsis.usda.gov 

PHONE: (706) 546-2330 FAX:(706)546-3144 

Privileged Communications: This transmission (and/or the documents accompanying it) may contain confidential 

information belonging to the sender. The information is intended only for the use of the individual or entity named in 

the distribution. If you are not the intended recipient, you are hereby notified that any disclosure, copying, distribution 

or the taking of any action in reliance on the contents of this information is strictly prohibited. If you have received 

this transmission in error, please notify us by telephone to arrange for the return of the documents. 

_____________________________________________ 




Cc: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSIS 

Subject: RE: Heidelberg similarity matrix 

Thx much Alice and Douris. 

2 bands different (~ 200 and ~ 80 region) as I see it on the picture. 


Douris – does the ~ 200 region band constitute a real diffence ! ( I would imagin yes!) 

Thanks 

What remains to be done 

 

Hello, 

We have a compelling link in the Foster Farms illness outbreak investigation. This revolves around The 

case patient shopper data and intensified sampling conducted at the three Foster farms facilities in California was 

utilized. The linkages are detailed below: 

(b) (6) 





· There are other multiple sample positives for PFGE 45 at p-7632 and P-6137A on 9/9/2013, both parts and whole 

birds. 

I have attached invoice 6002696219 that shows the link in commerce between Foster Farms and the COSTCO store 

where the case patient purchased the product. I have also attached a spreadsheet titled “original Spreadsheet Special” 

that demonstrates the linkages between (b) (6) and the samples collected at Foster farms, and finally, I have 

attached the sample data spreadsheet that represents all samples collected at the three Foster farms facilities. 

About the other CPs, are not as compelling: 

(b) (6) 

(b) (6) 

Case patients 

– We could not make a connection between FSIS sampling dates for Est. 7632 & Est. 

6137 for product comprising the load distributed to Costco, part of which may have been consumed by both case 

patients. Product from Est. 33900 was also included in the load to Costco. 

(b) (6) 

Case patients 

– Product (Rotisserie Chicken) available on the purchase day consisted of seven Foster 

Farms invoices to Costco with several different slaughter and pack dates from Est. 7632, 6137, 6137A, and 33900. 

Positive test results, PFGE pattern 258, from FSIS sampling with slaughter dates of; 9/7, 9/9, 9/10, 9/11, and 9/17, 


taken at Est. 6137 and 6137A made up part of the product included on the invoices. 

Case patient 

Case patient 

(b) (6) 

(b) (6) 

– OIEA is still waiting on California for membership card information. 

- OIEA is still waiting on California for additional purchase dates. 

(b) (6) 

Case patients 

– Product (Rotisserie Chicken) available on the day of purchase consisted of a single 

invoice from Foster Farms to Costco. Product represented on the invoice originated from Est. P-7632 and P-33900. 

Positive test results, PFGE pattern 258, from FSIS sampling with a slaughter date of 9/9 from Est. 7632 comprised part 

of the load. 

The CCMS patient in NV: 

OPHS spoke with complainant as did OIEA’s investigator. Review labs – CBC- WNL, Chemistry Profile – Elevated 

liver enzymes, Stool Sample negative for Salmonella, Shigella and Campy. He might give us some of the sample but 

not all of it. We are concerned about how we would do that. 

Alice and SDC pl: 

Isolate numbers 

Types of parts, production/analysis dates and PFGEs 

PFGE Types 

P1 

P2 

P3 

P4 

P5 

whole 

Patient info 

1? 

NA 


NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 

Note: Same or different PFGE types can be found in a given sample. And the prevalence of a PFGE type in the 

enriched medium, does not in any fashion or manner indicates absence of other PFGE types in the product. 

From: Goldman, David - Commissioned Corps - FSIS 



To: Dessai, Uday - FSIS 

Cc: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; 

Bennett, Patty - FSIS; Kause, Janell - FSIS 

Subject: Re: Positive chicken sample for S. Heidelberg patient 

(b) (6) 

Good idea(s). We do need to figure this one out--I think I heard that FDA will sequence these strains. I would 

appreciate a separate discussion so that I understand how much we can learn about the genetic profile and phenotypic 

expression from this sequencing. 

David P. Goldman, M.D., M.P.H. 

Captain, USPHS 

Assistant Administrator 

Office of Public Health Science 


USDA 

Room 341-E, Whitten Bldg. 

1400 Independence Ave, SW 

Washington, DC 20250 

202-720-2644 (o) 

202-690-2980 (f) 

david.goldman@fsis.usda.gov 

On Oct 25, 2013, at 1:34 PM, "Dessai, Uday - FSIS" wrote: 

Good point SDC 

Just a thought: 

Looks like there is a lot happening I Heidelberg genome.. 

For instance in the heidelbergs associated with this O/B, the virulence factors may be (just may be) up regulated 

for some reason... 

Alice and team: is it possible to tabulate rate of hospitalization for different PFGE types (if numbers are 

available!) 

Thx 




To: Green, Alice - FSIS; Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS 

Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS 


(b) (6) 

Can we also follow-up with CDC to see if they included pattern 0041 in the cluster because of similarity to 0122? 

An alternative way of asking that is David’s original question of whether they would consider those two patterns the 

same strain. As Uday pointed out, sometimes lack of or additional bands in the lower molecular weight region (i.e. 





(b) (6) 





Sent: Friday, October 25, 2013 11:46 AM 


Cc: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; 



(b) (6) 

Thanks for the latest on the PFGE similarity. I am confused about the leftover products--I just assumed that the 

health dept picked any "suspect" product (meaning something eaten by the case and so a possible exposure). Given 

that 2 of the samples were negative, what other possibility is there except that the positive product led to the illness? Is 

CA aware of other chicken exposures that might complicate the picture? 

If need be, would CDC say that these 2 patterns are so close that they may represent the same pathogen in this 

instance? 






USDA 




202-720-2644 (o) 

202-690-2980 (f) 




Thx Alice! 

The Two bands (I would imagine in low molecular weight region!) may need to be considered a method 

artifact in this instance – given both are very close and part of the OB. 

Cheers! 

Uday 

FSIS 



To: Dessai, Uday - FSIS; Goldman, David - Commissioned Corps - FSIS; Defibaugh-Chavez, Stephanie - 



(b) (6) 

Hi Uday— 

You are correct! I do want to emphasize that both are outbreak strains, and pattern 122 and pattern 41 are 

94.4% similar, differing in only two bands. 

Alice 







(b) (6) 






To: Goldman, David - Commissioned Corps - FSIS; Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - 



(b) (6) 

Hi Alice 

It is interesting that although we have pattern O122 in the product, we are not sure of the three products, 

which one was consumed by the patient! 

So we have diffferent patterns between patient and product and we are not sure which product (1/3 positive) 

was consumed – right! 

Thx! 



To: Green, Alice - FSIS; Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS 



(b) (6) 

Thanks Alice--just want to clarify; were all 5 subs pattern 122? If so, then are there more isolates to test? 

David Goldman, MD, MPH 

CAPT, USPHS 

Chief Medical Officer 


USDA-FSIS-OPHS 

202-720-2644 

-------------------------- 

Sent from my BlackBerry Wireless Handheld 



To: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS 


Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; Kause, Janell - FSIS; Goldman, 

David - Commissioned Corps - FSIS 

Subject: FW: Positive chicken sample for S. Heidelberg patient 

(b) (6) 

FYI— 

PFGE table for tested products is below. 

(b) (6) (b) (6) 

is the appropriate lab contact ( Pictures have use-by date of 03-29-2014. 

Product is frozen Kirkland Signature boneless skinless chicken tenders (mis-stated as chicken breast in my previous 

email). 

Thanks much, 

Alice 







(b) (6) 


From: Higa, Jeffrey (CDPH-CID-DCDC-IDB) [mailto:Jeffrey.Higa@cdph.ca.gov] 


To: Green, Alice - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSIS; Allen, Latasha - Commissioned 

Corps - FSIS; lax2@cdc.gov; fvg8@cdc.gov; hvq4@cdc.gov; dlx9@CDC.GOV; cxx4@cdc.gov 

Cc: Needham, Michael (CDPH-DFDRS FDB); Hernandez, Michael (CDPH-DFDRS); Kennelly, Pat 

(CDPH-FDB); Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Gilliss, Debra (CDPH- 

CID-DCDC-IDB) 

Subject: Positive chicken sample for S. Heidelberg patient 

(b) (5) 

Hello USDA and CDC colleagues, 

On 10/9/2013, 3 open packages of Kirkland Signature Boneless, Skinless Chicken Tenderloins were 


(b) (6) 

collected from the home of S. Heidelberg pattern 0041 patient 

Our Food and Drug 

Lab tested chicken from all 3 packages. Chicken from one of packages was positive for Salmonella: 

FDLB Sample ID 

Product 

Establishment # 

Result 

PulseNet Isolate # 

184100913-P001 

Kirkland Signature boneless, skinless Chicken tenderloins 

P33901 

negative for Salmonella 

n/a 

184100913-P002 


P6137A 

(best by 3/29/2014) 

· positive for Salmonella group B 

· 5 of 10 subs positive 

· PFGE pattern JF6X01.0122 

CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 


n/a 


Attached are pictures of the package for the positive chicken sample. The chicken isolate was pattern 0122 

and the patient had pattern 0041. Unfortunately, all 3 packages were open and the specific package the patient had 

chicken from prior to illness onset could not be determined. 

FDB, please correct me if any of the information above is inaccurate. 

-Jeff 

Jeffrey Higa, MPH 

California Department of Public Health 

Infectious Diseases Branch 

Disease Investigations Section 

19300 S. Hamilton Ave., Suite 140 

Gardena, CA 90248 

310-217-6906 

310-217-6911 (fax) 

jeffrey.higa@cdph.ca.gov 

NOTICE of CONFIDENTIALITY: This E-mail is the property of the California Department of Public 

Health and contains information that may be PRIVILEGED, CONFIDENTIAL or otherwise exempt from disclosure 

by applicable law. It is intended only for the person(s) to whom it is addressed. If you receive this communication in 

error, please do not retain or distribute it. Please notify the sender immediately by E-mail at the address shown above 

and delete the original message. 




Cc: Green, Alice - FSIS; Robertson, Kis - FSIS; Bennett, Patty - FSIS; Douris, Aphrodite - FSIS; Defibaugh- 

Chavez, Stephanie - FSIS; Holt, Kristin - FSIS 


(b) (6) 

CDC is planning a web update this week (could be as early as tomorrow). If we decide to move forward with a recall, 

CDC will likely wait until after the recall before doing the web update. 









Office: 404.639.5012 


Fax: 404.718.2126 








(b) (6) 









Thanks much! 

Uday 

(b) (6) 








(b) (6) 

HI David 



from 

(b) (6) 



(b) (6) 

(b) (6) 






whole birds. 



PFGE type 45 

· Although: 





patients home 

---------- 





o Etc. 


Thanks much! 

Uday 









Athens, GA 30605-2720 








_____________________________________________ 










Thanks 


 

Hello, 




(b) (6) 






birds. 






(b) (6) 

(b) (6) 

Case patients 





(b) (6) (b) (6) 

Case patients 





Case patient 

Case patient 

(b) (6) 

(b) (6) 



(b) (6) 

Case patients 




of the load. 








PFGE Types 

P1 

P2 

P3 

P4 

P5 

whole 


Patient info 

1? 

NA 

NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 










(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 









available!) 


Thx 






(b) (6) 




The health department picked up 3 packages of FF product. There were no other suspect products noted. I’ll seek 

guidance from OSEL on pattern similarity between patterns 41 and 122. 





(b) (6) 










(b) (6) 






instance? 






USDA 





202-720-2644 (o) 

202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 







(b) (6) 

Hi Uday— 



Alice 








(b) (6) 








(b) (6) 

Hi Alice 





Thx! 






(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 









(b) (6) 

FYI— 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 







(b) (6) 








CID-DCDC-IDB) 


(b) (6) 




collected from the home of S. Heidelberg pattern 0041 patient (b) (6) 

). Our Food and Drug 



Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 



n/a 





-Jeff 







310-217-6906 

310-217-6911 (fax) 









To: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS 

Cc: Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS 

Subject: RE: Heidelberg Pct Hospitalized by PFGE 


HI Alice 

Thanks for following up on this request. Nice work… 

Here are some additional thinks to consider.. 

· While the medial age is around 20, do the distributions for each PFGE type look any different (some weighted, 

skewed toward older or younger populations) 

· Also, does the extent of hospitalization vary significantly by the product type 

This info may be important from the pathogen view point (some level of age and/or product signal) as well as nature 

of the product (processing to handling and consumption). 

If (and only if) there are any type of trends etc, we might be able to focus on additional sampling in that direction and 

may want to provide additional information/guidance to consumers etc. 

Thx mch! 

Uday 



To: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS 


Subject: Re: Heidelberg Pct Hospitalized by PFGE 

Yes, it has been difficult.. 

However, I think product MPNs in the IIT will provide some insight into final product distributions..possibly! 



To: Dessai, Uday - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS 



We have MPNs on the products we collected. Requesting MPNs on patient leftovers has never worked out because the 


products are rarely stored in a manner that would make MPNs informative. 

Stephanie 

-------------------------- 

Stephanie Defibaugh-Chavez, Ph.D. 

USDA-FSIS, Office of Public Health Science 

Science Division 

Sent using BlackBerry 



To: Robertson, Kis - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS 



Ah, ha.. That is an important consideration! 

The illness rates at times may be impacted by the type of commodity, processing and handling etc.. 

SDC and team - if/when implicated product is available, can we run some MPNs please.. 

Thx 

From: Robertson, Kis - FSIS 


To: Dessai, Uday - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS 



I like this discussion. 

An important consideration is that a big chunk of the 258 patients were victimized by the rotisserie chicken. If the 

level of contamination on the rotisserie was lower than the level on raw products, the severity of illness could be also 

be lower. 

Kis Robertson, DVM, MPH, DACVPM 

Commander, U.S. Public Health Service 

Acting Director 

USDA/FSIS/OPHS/Applied Epidemiology Staff 

Stop 3766, PP 3, 9-210B 

1400 Independence Avenue, SW 


Office Phone: (202) 772-9000 


Blackberry phone: (202) 379-6648 

Email: kis.robertson@fsis.usda.gov 

_____________________________________________ 



To: Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS 

Cc: Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS 


On the dot SDC, I was also wondering about the same.. 

Alice, can you remind us if thediference is in the region below 80…. 

If it is, there must be a highly virulent mobile element/plasmid that is getting transfered within Heidelbeg populations 

under some sort of selection pressure.. 

We will need to look into this further (FDA collaboration…) 

Thx 

_____________________________________________ 



To: Green, Alice - FSIS; Dessai, Uday - FSIS 



I think it’s interesting that although 258 and 45 are highly similar in PFGE pattern, they appear to have vastly different 

hospitalization rates (almost double for 45). To me, this particular difference in hospitalization rates indicates the 

likelihood of some sort of plasmid that is making some of these strains more virulent than others. 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 




> > > 

_____________________________________________ 




Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Douris, Aphrodite - FSIS 


Hi Uday— 

Here is today’s update to the requested information. 

Based on Aphrodite’s work last summer, patterns 258 and 45 are the most closely related in the cluster at 99% similar 

with one band differing. Patterns 122 and 672 are about 97% similar with one band difference. Pattern 22 is 90% or 

less similar to all other patterns. 

California was keeping track of this information separately early on in the investigation. It is interesting to revisit now 

that the number of case-patients has increased. I am not detecting any clear patterns. Please let me know what you 

think. Thanks! J 

Pattern % hospitalized (n) Median Age % Male 

22 42% (21/50) 20 yrs (n=55) 45% 

41 44% (14/32) 20 yrs (n=49) 43% 

45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





(b) (6) 




_____________________________________________ 





Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS 


This is very neat Alice J! 

Although the lower numbers will be heavily influenced by the denominator, we may be able to divide these into atleast 

two categories based on % hospitalizations. (note: qualifying criteria could be something like we should have atleast 10 

total illnesses to be counted in the categories) 

1) 35% and below – 122, 258, 326 

2) 35% and above – 22, 41, 45, 122, 672 (just 2 cases – does not qualify)) 

The next part will be to see if PFGEs in these categories have any commonality/similarity etc. If not all, atleast hose at 

the extreme ends of hospitalization.. 

Also, in your table, do if we add the columns for demographics (age, sensitive population etc.. if available, would that 

be useful to see..!) 

Again, nice work Alice J! 

_____________________________________________ 




Cc: Defibaugh-Chavez, Stephanie - FSIS 

Subject: Heidelberg Pct Hospitalized by PFGE 

Pattern % hospitalized (n) 

22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 





(b) (6) 







To: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Green, Alice - FSIS 



Yes, it has been difficult.. 

However, I think product MPNs in the IIT will provide some insight into final product distributions..possibly! 








Stephanie 

-------------------------- 













Thx 










be lower. 





Stop 3766, PP 3, 9-210B 



Office Phone: (202) 772-9000 



_____________________________________________ 











Thx 

_____________________________________________ 















202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 

email: stephanie.defibaugh@fsis.usda.gov 


> > > 

_____________________________________________ 






Hi Uday— 







think. Thanks! :-) 


22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 


672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





(b) (6) 




_____________________________________________ 






This is very neat Alice :-)! 




1) 35% and below – 122, 258, 326 






Again, nice work Alice :-)! 

_____________________________________________ 








22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 





(b) (6) 











Stephanie 

-------------------------- 













Thx 










be lower. 





Stop 3766, PP 3, 9-210B 



Office Phone: (202) 772-9000 



_____________________________________________ 











Thx 


_____________________________________________ 














202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



> > > 

_____________________________________________ 






Hi Uday— 










22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





(b) (6) 




_____________________________________________ 










1) 35% and below – 122, 258, 326 








_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 





(b) (6) 






To: Robertson, Kis - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Green, Alice - FSIS; Bennett, Patty - FSIS 



Team 

I have included patty on this distribution. 

Thx 










Thx 









be lower. 





Stop 3766, PP 3, 9-210B 



Office Phone: (202) 772-9000 



_____________________________________________ 











Thx 


_____________________________________________ 














202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



> > > 

_____________________________________________ 






Hi Uday— 










22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





(b) (6) 




_____________________________________________ 










1) 35% and below – 122, 258, 326 








_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 





(b) (6) 












Thx 










be lower. 





Stop 3766, PP 3, 9-210B 



Office Phone: (202) 772-9000 



_____________________________________________ 











Thx 

_____________________________________________ 















202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



> > > 

_____________________________________________ 






Hi Uday— 









22 42% (21/50) 20 yrs (n=55) 45% 



45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





(b) (6) 




_____________________________________________ 










1) 35% and below – 122, 258, 326 







_____________________________________________ 








22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 





(b) (6) 












be lower. 





Stop 3766, PP 3, 9-210B 



Office Phone: (202) 772-9000 



_____________________________________________ 












Thx 

_____________________________________________ 














202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



> > > 

_____________________________________________ 







Hi Uday— 









22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 





Tel: 612-659-8632 | Blackberry: 202-441-4752 | Cell: (b) (6) | Fax: 612-370-2070 | Email: 

Alice.Green@fsis.usda.gov 

_____________________________________________ 










1) 35% and below – 122, 258, 326 








_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 

















Thx 

_____________________________________________ 















202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



> > > 

_____________________________________________ 






Hi Uday— 









22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 


Alice 







_____________________________________________ 










1) 35% and below – 122, 258, 326 







_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 












Thank you very very much Alice. 

I could not make time yesterday to review the table carefully. 

I am going to look at this later in the AM today. 

(b) (6) 

Talk to you later. 

Uday 





(b) (6) 

Uday-- 

Just wanted you to know that I will get you the additional information you requested before I leave today. Thanks! J 

Alice 






(b) (6) 










(b) (6) 









Thanks much! 

Uday 

(b) (6) 








(b) (6) 

HI David 



from 

(b) (6) 



(b) (6) 

(b) (6) 






whole birds. 



PFGE type 45 

· Although: 





patients home 

---------- 






o Etc. 

Thanks much! 

Uday 









Athens, GA 30605-2720 








_____________________________________________ 










Thanks 


 

Hello, 




(b) (6) 






birds. 






(b) (6) 

Case patients 

(b) (6) 





(b) (6) 

Case patients 





Case patient 

Case patient 

(b) (6) 

(b) (6) 



(b) (6) 

Case patients 




of the load. 








PFGE Types 

P1 

P2 

P3 

P4 

P5 

whole 


Patient info 

1? 

NA 

NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 










(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 









available!) 


Thx 






(b) (6) 










(b) (6) 










(b) (6) 






instance? 






USDA 





202-720-2644 (o) 

202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 







(b) (6) 

Hi Uday— 



Alice 








(b) (6) 








(b) (6) 

Hi Alice 





Thx! 






(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 









(b) (6) 

FYI— 


(b) (6) (b) (6) 

is the appropriate lab contact Pictures have use-by date of 03-29-2014. 


email). 

Thanks much, 

Alice 







(b) (6) 








CID-DCDC-IDB) 


(b) (6) 








Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 



n/a 





-Jeff 







310-217-6906 

310-217-6911 (fax) 









To: Kissler, Bonnie - FSIS; Green, Alice - FSIS; Vetter, Danah - FSIS; Atkinson, Richard - FSIS 

Subject: FYI... 


Came across this today: 

http://fosterfarms.com/docs/Foster_Farms_Overview.pdf 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



 














202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



 

_____________________________________________ 






Hi Uday— 










22 42% (21/50) 20 yrs (n=55) 45% 


45 52% (28/54) 22 yrs (n=77) 54% 

122 33% (8/24) 23 yrs (n=31) 52% 

258 29% (22/76) 18 yrs (n=117) 56% 

326 25% (4/16) 20 yrs (n=25) 50% 

672 50% (1/2) 9 yrs (n=2) 50% 

Alice 







_____________________________________________ 










1) 35% and below – 122, 258, 326 








_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 







From: Gieraltowski, Laura (CDC/OID/NCEZID) [lax2@cdc.gov] 


To: Green, Alice - FSIS; Nakao, Jolene H. (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, 

Bonnie - FSIS; Robertson, Kis - FSIS 

Cc: Schwensohn, Colin A. (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID) 

Subject: RE: NARMS chicken sample postive for S. Heidelberg 

Alice – 

I just talked to Jeff and he is going to follow-up with Vi. CDC is willing to try to interview these patients and it sounds 

like the local health department is willing to let us. We’ll let you know when we receive the patient contact 

information and if we’re able to reach any of them. 

Thanks, 

Laura 



To: Nakao, Jolene H. (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie 

- FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSIS 


Cc: Schwensohn, Colin A. (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID) 


A check-in question—has CA been in touch with CDC regarding possible assistance with several Alameda/Berkeley 

interviews of case-patients with recent illness onsets? This was mentioned to me as a possibility last week and I 

wanted to follow up. 

Thanks much, 

Alice 





(b) (6) 




From: Nakao, Jolene H. (CDC/OID/NCEZID) [mailto:fvg8@cdc.gov] 


To: Green, Alice - FSIS; Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, 


Cc: Schwensohn, Colin A. (CDC/OID/NCEZID) 


Yes! J 

Apologies again, Alice. I need to put you on all of my list distribution emails. 

Jolene 

From: Green, Alice - FSIS [mailto:Alice.Green@fsis.usda.gov ] 

Sent: 28 October 2013 15:52 

To: Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; 


Robertson, Kis - FSIS 

Cc: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID) 


J That reminds me...does CDC have an updated linelist for this cluster? 

Thanks much, 

Alice 





(b) (6) 




From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:lax2@cdc.gov ] 


To: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; Robertson, Kis - FSIS 


Subject: Re: NARMS chicken sample postive for S. Heidelberg 

Thanks, Alice. This isolate was uploaded to PulseNet today. 


Sent: Monday, October 28, 2013 03:20 PM Eastern Standard Time 

To: Defibaugh-Chavez, Stephanie - FSIS ; Kissler, Bonnie - FSIS ; Robertson, Kis - FSIS 

Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. 

(CDC/OID/NCEZID) 

Subject: FW: NARMS chicken sample postive for S. Heidelberg 

FYI. 






(b) (6) 




From: Lofy, Kathy H (DOH) [mailto:Kathy.Lofy@DOH.WA.GOV ] 



Cc: Melius, Beth J (DOH); Stewart, Laurie K (DOH) 

Subject: NARMS chicken sample postive for S. Heidelberg 

Hi Alice, 

I want to let you know that routine meat testing in Washington for the NARMS program detected S. Heidelberg in a 

chicken sample. The label of this chicken sample is attached. It appears this chicken sample was processed at plant P- 

6137A (CA FF plant). The PulseNet PFGE pattern is not yet in our Washington database but I believe the pattern is 

XbaI JF6X01.0122. The isolate number is WA_19012. 

Let us know if you need additional information. 

Thanks 

Kathy 

Kathy Lofy, M.D. 

Medical Epidemiologist 

Washington State Department of Health 

Office of Communicable Disease Epidemiology 

Phone: 206-418-5500 


Public Health--Always Working for a Safer and Healthier Washington 







To: Nakao, Jolene H. (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Barton Behravesh, Casey 

(CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Williams, Ian (CDC/OID/NCEZID) 

Cc: Kissler, Bonnie - FSIS; Green, Alice - FSIS 

Subject: Foster Farms response on their website 

FYI 

http://www.fosterfarms.com/docs/Foster_Farms_Overview.pdf 

Laura B. Gieraltowski, PhD, MPH 

LCDR, US Public Health Service 

Doctoral Epidemiologist 

Outbreak Response and Prevention Branch 

Division of Foodborne, Waterborne and Environmental Diseases 

National Center for Emerging and Zoonotic Infectious Diseases 

Centers for Disease Control and Prevention 

1600 Clifton Road, MS A-38 


Phone: (404)639-3868 

Fax: (404)718-2126 

From: Nakao, Jolene H. (CDC/OID/NCEZID) [fvg8@cdc.gov] 


To: Green, Alice - FSIS; Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, 


Cc: Schwensohn, Colin A. (CDC/OID/NCEZID) 


Attachments: CDC MLL S Heidelberg 2013 clusters_comprehensive, 10-28-13.xlsx 


Yes! J 

Apologies again, Alice. I need to put you on all of my list distribution emails. 

Jolene 


Sent: 28 October 2013 15:52 

To: Gieraltowski, Laura (CDC/OID/NCEZID); Defibaugh-Chavez, Stephanie - FSIS; Kissler, Bonnie - FSIS; 

Robertson, Kis - FSIS 



J That reminds me...does CDC have an updated linelist for this cluster? 

Thanks much, 

Alice 





(b) (6) 




From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:lax2@cdc.gov] 









To: Defibaugh-Chavez, Stephanie - FSIS ; Kissler, Bonnie - FSIS ; Robertson, Kis - FSIS 




FYI. 





(b) (6) 




From: Lofy, Kathy H (DOH) [mailto:Kathy.Lofy@DOH.WA.GOV ] 





Hi Alice, 






Thanks 


Kathy 





Phone: 206-418-5500 










Thx Alice.. 

(b) (6) 





(b) (6) 

Uday-- 

Just wanted you to know that I will get you the additional information you requested before I leave today. Thanks! J 

Alice 






(b) (6) 










(b) (6) 









Thanks much! 

Uday 

(b) (6) 








(b) (6) 

HI David 



from 

(b) (6) 



(b) (6) 

(b) (6) 






whole birds. 



PFGE type 45 

· Although: 





patients home 

---------- 





o Etc. 


Thanks much! 

Uday 









Athens, GA 30605-2720 








_____________________________________________ 










Thanks 


 

Hello, 




(b) (6) 






birds. 






(b) (6) 

(b) (6) 

Case patients 





(b) (6) 

Case patients 





Case patient 

Case patient 

(b) (6) 

(b) (6) 



(b) (6) 

Case patients 




of the load. 








PFGE Types 

P1 

P2 

P3 

P4 

P5 

whole 

Patient info 


1? 

NA 

NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 










(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 









available!) 

Thx 







(b) (6) 










(b) (6) 










(b) (6) 






instance? 






USDA 




202-720-2644 (o) 


202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 







(b) (6) 

Hi Uday— 



Alice 








(b) (6) 








(b) (6) 

Hi Alice 





Thx! 






(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 









(b) (6) 

FYI— 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 







(b) (6) 








CID-DCDC-IDB) 


(b) (6) 




collected from the home of S. Heidelberg pattern 0041 patient (b)(6) 

). Our Food and Drug 



Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 


n/a 






-Jeff 







310-217-6906 

310-217-6911 (fax) 
















To: Defibaugh-Chavez, Stephanie - FSIS ; Kissler, Bonnie - FSIS 

; Robertson, Kis - FSIS 




FYI. 





(b) (6) 




From: Lofy, Kathy H (DOH) [mailto:Kathy.Lofy@DOH.WA.GOV] 





Hi Alice, 






Thanks 


Kathy 





Phone: 206-418-5500 




















Thanks much! 

Uday 

(b) (6) 

(b) (6) 








(b) (6) 

HI David 



from 

(b) (6) 



(b) (6) 

(b) (6) 






whole birds. 



PFGE type 45 

· Although: 





patients home 

---------- 






o Etc. 

Thanks much! 

Uday 









Athens, GA 30605-2720 








_____________________________________________ 










Thanks 


 

Hello, 




(b) (6) 

(b) (6) 






birds. 







(b) (6) 

Case patients 




(b) (6) 

Case patients 





Case patient 

Case patient 

(b) (6) 

(b) (6) 



(b) (6) 

Case patients 




of the load. 








PFGE Types 

P1 

P2 


P3 

P4 

P5 

whole 

Patient info 

1? 

NA 

NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 










(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 










available!) 

Thx 






(b) (6) 






To: Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS 

Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; 

Kause, Janell - FSIS 


(b) (6) 







(b) (6) 










(b) (6) 






instance? 







USDA 




202-720-2644 (o) 

202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 







(b) (6) 

Hi Uday— 




Alice 







(b) (6) 








(b) (6) 

Hi Alice 





Thx! 






(b) (6) 




CAPT, USPHS 




202-720-2644 

-------------------------- 








(b) (6) 

FYI— 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 







(b) (6) 









CID-DCDC-IDB) 


(b) (6) 



collected from the home of S. Heidelberg pattern 0041 patient (b)(6) 




Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 






CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 


n/a 





-Jeff 







310-217-6906 

310-217-6911 (fax) 








From: Peralta, Vi (CDPH-CID-DCDC-IDB) [Vi.Peralta@cdph.ca.gov] 



Cc: Higa, Jeffrey (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC) 

Subject: RE: One Costco shopper history, etc. 

Hi Alice, 

Yes, I finally have hot water again and it’s been glorious! 

Thank you for the record. As for an update call, unfortunately Tuesday will not work for us as there is a conference 

that all 3 of us will be attending/participating in at various times of the day. We’ve got a few meetings on Wednesday 

as well. Thursday morning may work. Do you want to send us specific times on Wednesday and Thursday that you can 

do and maybe we can choose among those options? 

Also, FYI, I spoke to my contact at Ralphs (part of the Kroger family) on Friday because one of our cases granted us 

written consent to obtain their records (however it was on our form and asked Ralphs to release the records to me) and 

the Ralphs representative said that Krogers is now very strict about releasing records. They indicated that since the 

chicken recall, Krogers is requiring that consent forms must be notarized and that they will not release records except 

under a court order or subpoena. 

Vi 



To: Peralta, Vi (CDPH-CID-DCDC-IDB) 

Cc: Higa, Jeffrey (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC) 

Subject: One Costco shopper history, etc. 

Hi Vi— 

Good morning! I hope you have hot water at home. 


I checked in with our investigators regarding the most recent outstanding shopper history list. Apparently this is the 

only one we’ve received and the others are still pending or need to be requested. 

Would you guys like to try and schedule an update call for tomorrow or Wednesday? Also I am not sure the forms I 

sent last week really addressed your questions regarding Sam’s and Raley’s. Maybe we can chat a bit about that 

tomorrow too. When I responded to you last Wednesday, I was kind of muddled after the long Tuesday revolving 

around the MN Costco ground beef recall. 

Thanks much, 

Alice 





From: Lofy, Kathy H (DOH) [Kathy.Lofy@DOH.WA.GOV] 





Attachments: F13-486.JPG 

Hi Alice, 






Thanks 

Kathy 






Phone: 206-418-5500 


From: 



To: Green, Alice - FSIS; Leskowsky, Robert - FSIS; Atkinson, Richard - FSIS 

Cc: Kissler, Bonnie - FSIS 

Subject: RE: 

Okay, will do 

(b) (6) 





Office: (b) (6) 

Cell: (b) (6) 

Fax: (425) 483-3492 

fsis.usda.gov 

(b) (6) 

(b) (6) 

(b) (6) 






_____________________________________________ 



To: Leskowsky, Robert - FSIS; (b) (6) - FSIS; Atkinson, Richard - FSIS 

Cc: Kissler, Bonnie - FSIS 

Subject: CDC_067 

Hi 

(b) (6) 

Let me modify that last email. I've renamed the shopper history for 

(b) (6) 

. Can you please redact and 


upload it to the IR? I want to be sure you guys have the numbers you need. 

Thank you, 

Alice 

(b) (6) 

> 









To: Robertson, Kis - FSIS; Allen, Latasha - Commissioned Corps - FSIS; Green, Alice - FSIS 

Subject: FW: Foster Farms system wide strategy 

FYI -- sorry if this is duplication. 








Office: 404.639.5012 


Fax: 404.718.2126 


From: Gomez, Thomas M. (CDC/OID/NCEZID) [mailto:tmg1@cdc.gov] 


To: Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Barton Behravesh, Casey 

(CDC/OID/NCEZID); Williams, Ian (CDC/OID/NCEZID); Tauxe, Robert V. (CDC/OID/NCEZID); Braden, Chris 

(CDC/OID/NCEZID); Liang, Arthur P. (CDC/OID/NCEZID); Kissler, Bonnie - FSIS; Basu, Pat - FSIS; 

krh7@cdc.gov; Goldman, David - Commissioned Corps - FSIS; Annelli, Joseph F - APHIS; Rooney, Jane A - APHIS; 

McCluskey, Brian J - APHIS 

Cc: tmg1@cdc.gov 

Subject: Foster Farms system wide strategy 

All - FYI, the following was provided today by Dr. Richard Breitmeyer, Director, California Animal Health and Food 

Safety Laboratory System -- 


Tom, this was in Friday's Meatingplace, an industry newsletter: 

In an interview with Meatingplace, Dr. Robert O'Connor, Foster Farms senior vice president of technical services, 

detailed the changes the company is making at every level, from the breeder flocks through growout and processing. 

* The company has vaccinated its breeder flocks at the pullet level since 2006, he said, but has switched to a vaccine 

that is more specific for Salmonella heidelberg, the strain that is responsible for the recent outbreak. He said that Dr. 

Charles Hofacre of the University of Georgia, who has published research on vaccination to control Salmonella in 

chickens, is serving as a consultant to the company. 

* "Competitive exclusion" products are being used in both water and feed for both breeders and broilers to help fill 

their systems with benign microorganisms and crowd out potentially pathogenic bacteria. 

* The company is requiring its supplier of replacement breeder pullets to certify that they are Salmonella-free. Foster 

has had this as a general rule for some years but is now putting the specification into contracts with the supplier, 

O'Connor said. 

* Treatments are being used to try to reduce the prevalence of Salmonella and other microorganisms in the barns on 

the company-owned ranch on which broilers are raised to market weight, focusing on the litter that covers the floors of 

the structures. 

"We are acidifying the bedding to make it less hospitable to the Salmonella organism," O'Connor said. The bedding is 

replaced after every third flock, he said. The birds' drinking water is also being treated with an acidifier to discourage 

bacterial growth, he added. 

* In the processing plants, equipment, food contact surfaces, knives, workers' gear, and other places where 

contamination might occur are being subjected to "enhanced sanitization" and cleaned more frequently. 

"We're putting a very heavy emphasis on operational sanitation," O'Connor said. He said the company aims to make 

the slaughter processing area of the plants "more like a ready-to-eat (product) environment" in terms of microbial 

status. 

* The company is also implementing interventions to reduce microbial contamination of the carcasses as they move 

through processing. 

"We are enhancing the sanitization of bird throughout the process," O'Connor said. "Where we have the opportunity to 

erect a hurdle, we are erecting a hurdle. We are enhancing sanitation across the board." 

O'Connor said changes are being made in all five of the company's processing plants: three in California, one in 

Louisiana, and one in Washington. 

"We are not going to stop at one plant," he said. 

USDA's Food Safety & Inspection Service had threatened to withdraw its inspectors from the three California plants, 

effectively suspending their operations, unless changes were made. 

## 

_______________ 


Thomas M. Gomez DVM, MS 

USDA, APHIS, Veterinary Services Liaison to CDC 

One Health Coordination Office, USDA:APHIS:VS 

1600 Clifton Road, NE Mailstop A-38 

Building 24, room 10105 


office: 404-639-3233 

cell: 

(b) (6) 

e-mail: TGomez@cdc.gov 



To: Atkinson, Richard - FSIS; Green, Alice - FSIS 

Cc: (b) (6) - FSIS; Leskowsky, Robert - FSIS 

Subject: RE: Week of October 28, 2013 

I’ll try to get an update to you on Phase 2 positives today so you guys know what we’ve got so far… 

-Stephanie 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



 

_____________________________________________ 

From: Atkinson, Richard - FSIS 



Cc: (b) (6) - FSIS; Leskowsky, Robert - FSIS 

Subject: Week of October 28, 2013 


Hello, 

I will be out of the office this week. Robert Leskowsky will cover for me, and 

FF illness outbreak. 

Any results from Phase Two FF sampling? 

Thank you. 

(b) (6) 

is still the lead for the 

Richard Atkinson 

Supervisory Investigator 

CO, NM, WY, MT, ID, UT, NV, WA, AK 

USDA, FSIS, OIEA, CID 

Denver Sub-Region 

1 Denver Federal Center 

Building 45, S-3 

Mail: 

P.O. Box 25387 

Denver, Colorado 80225-0387 

Office 303-236-9860 

Fax 303-236-9858 

Cell 303-618-5006 

PREDECISIONAL NOT FOR COPY OR FURTHER DISTRIBUTION 

This electronic message contains information generated by the 

USDA solely for the intended recipients. Any unauthorized 

interception of this message or the use or disclosure of the 

information it contains may violate the law and subject the violator to 

civil or criminal penalties. If you believe you have received this 

message in error, please notify the sender and delete the email 

immediately. 



To: FSIS - OPHS/HHSD; Fore, Sandra - FSIS 

Subject: Investigations Team Daily 10/28/2013 

In the Office (at meeting): LA, AG, TI, BK, KR, KS, PW 

Out of Office Plans: 

BK: 11/20/13-11/22/13 

Investigations (active investigation; possible involvement of FSIS-regulated product): 

* Multistate Salmonella Heidelberg cluster associated with chicken, FDIB# 2013-14 - Alice Green 

* 349 case-patients from 20 states and PR (1-AK, 1-AR, 14-AZ, 257-CA, 6-CO, 1-CT, 4-FL, 3-ID, 1-KY, 3-MI, 


5-MO, 1-NC, 2-NM, 9-NV, 9-OR, 1-PR, 11-TX, 2-UT, 2-VA, 15-WA, 1-WI) 

* Case definition: Person with Salmonella Heidelberg infection, with illness onset (or isolation, if onset date 

unknown) on 3/1/13 - present, and with isolate matching PFGE XbaI pattern JF6X01.0258, JF6X01.0045, 

JF6X01.0041, JF6X01.0672, JF6X01.0122, or JFX601.0326, or CA case-patient with PFGE pattern JF6X01.0022 

* Onset dates: 3/2/13 - 10/7/13* 

* Hospitalizations: 97/257 (38%) 

* Deaths: 0 

* Exposure: 134/190 (71%) consumed chicken prepared at home 

* NARMS (clinical): Results available on 5 JF6X01.0258 clinical isolates (3-MDR; 2-pansusceptible); results 

available on 3 pattern JF6X01.0045 clinical isolates (2-MDR, 1-pansusceptible) 

* NARMS (retail): 3 CA company A (establishment A1) retail chicken isolates from 2013 with PFGE patterns 

JF6X01.0258, JF6X01.0041, and JF6X01.0022 are MDR 

* Leftover product: WA collected leftover chicken from 2 case-patients' homes for testing; results are negative for 

1; 2nd WA leftover chicken product for which shopper card has been shared with OIEA is confirmed positive for 

Salmonella Heidelberg, PFGE is indistinguishable from case-patient's (JF6X01.0672). CA collected leftover chicken 

from 3 case-patients' homes for testing; results are negative. One product (from establishment A4 in Louisiana) was 

most likely consumed several weeks prior to illness onset. Leftover rotisserie chicken collected from CA case-patient 

tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258. 

* FSIS AMR results: 2 CA company A (establishments A2 and A3) ground chicken isolates from 2013 with 

PFGE pattern JF6X01.0258 are MDR; 2 CA company A (establishment A2) chicken parts isolates from 2012 with 

PFGE pattern JF6X01.0326 are pan-susceptible 

* FSIS intensified testing: Ongoing data collection and summarization in progress 

* CDC cluster code: 1306MLJF6-1 

* PFGE patterns (ranking as of 6/30/13): JF6X01.0258 (not in top 10), JF6X01.0045 (ranked 9th), JF6X01.0041 

(ranked 7th), JF6X01.0672 (new), JF6X01.0022 (ranked 1st), JF6X01.0122 (ranked 3rd), JFX601.0326 (ranked 6th) 

* FIMS number: 20130703-01 

* Recall: FSIS-RC-058-2013; recall expansion 10/17/13 

Summary: Currently, there are 349 case-patients from 20 states and PR. PFGE patterns JF6X01.0258, JF6X01.0045, 

JF6X01.0041, JF6X01.0672, JF6X01.0022, JF6X01.0122, and JFX601.0326 have been combined by CDC as 1 cluster; 

97 case-patients have been hospitalized; 134/190 (71%) consumed chicken prepared at home prior to illness onset. On 

9/30/13, CA identified sub-clusters of 50 illnesses (36 lab confirmed) possibly linked to rotisserie chicken in San 

Mateo. Sampling at 4 Company A establishments completed on 9/23/13; 3 establishments were issued NOIEs on 

10/7/13. FSIS issued a public health alert on 10/7/13. Leftover rotisserie chicken collected from CA case-patients 

tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258. Costco's El Camino Real store in South 

San Francisco, CA recalled 9,043 units (approximately 39,755 lbs.)of rotisserie chicken products on 10/12/13. Retail 

product collected by CA tested positive for Salmonella Heidelberg with PFGE pattern JF6X01.0258, a recall expansion 

(14,093 units) based on these results was issued 10/17/13. 

FSIS: Continue sampling at 5 Company A establishments; analyze sampling results; work with CDC and states to 


gather epidemiologic and product information; traceback ongoing 

* Tennessee University Chattanooga Salmonella Enteritidis and Campylobacter jejuni outbreak possibly associated 

with ground chicken product, FDIB# 2013-18 - Latasha Allen 

* 25 (9 lab confirmed) case-patients 

* Case definition: Pending 

* Onset dates: 8/20/13 - 8/29/13 

* Hospitalizations: 0 

* Deaths: 0 

* Exposure: 23 students and 2 staff members reported being ill after eating at the food service facilities on 

campus; 7 cases reported consumption of a stuffed pepper meal 

* Product: Chicken dish was prepared with ground chicken; positive for SE and Campy with PFGE patterns 

matching outbreak strain 

* CDC cluster code: N/A 

* PFGE: JEGX01.0021 and JEGX01.0023 (Salmonella Enteritidis), both are common patterns; pattern for 

Campylobacter jejuni is DBRS16.0218 

* MLVA: N/A 

* FIMS number: 20130920-01 

* Recall: N/A 

Summary: There are 25 reported ill persons who were patrons of the food service facilities on the Tennessee 

University (UTC) campus in Chattanooga, TN. Epidemiologic information indicates that stuffed peppers containing 

ground chicken was served and consumed by 7 patrons to the cafeteria. 4/9 case-patients have been confirmed to be 

co-infected with Salmonella Enteritidis and Campylobacter jejuni; 3/9 case-patients are only infected with Salmonella 

Enteritidis; 2/9 case-patients are only infected with Campylobacter jejuni. Two PFGE patterns, JEGX01.0021 and 

JEGX01.0023, are from Salmonella Enteritidis isolates. The PFGE pattern for Campylobacter jejuni is DBRS16.0218. 

TN Health Department collected an intact chub chicken (ground chicken) sample from the cafeteria for testing and 

results are positive for Salmonella Enteritidis PFGE pattern JEGX01.0021 and Campylobacter jejuni PFGE pattern 

DBRS16.0218 and DBRS16.0008. Traceback information shows that the ground chicken chub tested was produced by 

Establishment B in Sedalia, MO. OIEA investigation determined that this product was distributed to UTC on 8/9/13 

and 8/16/13 and used to prepare the stuffed peppers on 8/20/13. USDA (Buffalo Style Chicken Sausage) sample 

collected on 8/13/13 from Establishment C, in Woburn, MA tested positive for Salmonella Enteritidis with PFGE 

pattern JEGX01.0021, matching one of the outbreak patterns. USDA (ground chicken) sample collected on 8/7/13 

from Establishment D, in Waco, TX tested positive for Campylobacter jejuni with PFGE pattern DBRS16.0008, 

matching one of the patterns seen in the positive intact product. Environmental assessment conducted by TN showed 

potential for cross-contamination. 

OPHS: Work with state and CDC to gather additional detail epidemiologic information 


* Minnesota E. coli O157:H7 illness associated with ground beef consumption, FDI# 2014-03 - Alice Green 

* 1 case-patient 

* Onset date: 9/29/13 

* Hospitalization: 0 

* Death: 0 

* Exposure: Ground beef purchased from a wholesale chain on 9/6/13; product was 88/12 ground beef, as 

documented by the purchase receipt 

* CDC cluster code: N/A 

* PFGE: EXHX01.0074/EXHA26.0569, common 

* MLVA: Pending 

* FIMS number: N/A 

* Recall: FSIS-RC-060-2013 

Summary: There is one case-patient with illness onset 9/29/13. Tested leftover ground beef is positive for E. coli 

O157:H7 matching the outbreak strain. A Costco in Coon Rapids, MN issued a retail recall of 838 units 88% lean fresh 

ground beef products on 10/22/13. This illness has the same PFGE pattern combination as a multistate cluster for 

which CDC is currently gathering epi information. 

OPHS: Work with CDC and state to gather additional epidemiologic information 

Watches (following public health partner investigation; not sure if FSIS-regulated product is involved): 

* Multistate Salmonella Typhimurium cluster possibly associated with beef, FDI# 2014-01 - Latasha Allen 

* 28 case-patients in 8 states (8-CA, 3-ID, 1- IA, 1- MN, 2-NE, 1- NC, 7-OR, 5-UT) 

* Case definition: Person with Salmonella Typhimurium infection with an onset date after 7/13/13 (or isolate date 

after 7/20/13 if onset date information is not available), and Isolate matching PFGE Xbal pattern JPXX01.2350 

* Onset dates: 7/19/13- 10/7/13* 

* Isolation dates: 7/22/13 - 10/10/13 


* Deaths: 0 


* Exposure: 2/8 (25%) report carne asada; 5/8 (63%) report beef, 2/5 (40%) report fresh killed whole cow from 

farm, 3/8 (38%) report exposure to farm animals 

* Product/animal: 2 ground beef isolates from OH (8/13/13 and 8/20/13); 1 isolate from OR was stool from a 

dairy cow (9/6/13) 

* CDC cluster code: 1310MLJPX-1 

* PFGE: JPXX01.2350 (comprises 0.38%, 9348/91616) 

* MLVA: N/A 


* Recall: N/A 

Summary: There are 28 ill persons reported in 8 states possibly associated with the consumption of beef carne asada. 

2/8 report carne asada, 5/8 case-patients report consumption of beef, 2/5 report fresh killed whole cow from farm, 3/8 

farm animal exposure, 3/8 watermelon, and 3/8 banana. There are two ground beef isolates that tested positive for 

Salmonella. Preliminary epidemiologic information indicated that food items containing beef are possibly associated 

with the outbreak. OPHS has been in contact with CDC, who is following this cluster of illnesses, and additional 

epidemiologic information is pending. 

OPHS: Work with CDC to gather additional epidemiologic information 

* Ohio Salmonella I 4, [5],12:i-: cluster possibly associated with an Ohio restaurant, FDI# 2014-02 - Latasha Allen 

* 27 case-patients (18 lab confirmed) 

* Case definition: Pending 

* Onset dates: 9/10/13 - 9/18/13 


* Deaths: 0 

* Exposure: Prime rib with au jus served at the restaurant (au jus is similar to gravy) 

* Product: Prime rib sample tested positive for Salmonella, 2 samples taken from restaurant tested positive 

* CDC cluster code: 1210OHJPX-1 

* PFGE: JPXX01.0026 

* MLVA: N/A 


* Recall: N/A 

Summary: There are 18 lab confirmed case-patients who became ill after dining and consuming prime ribs at a Fulton 


County, OH restaurant. The age range for case-patients is between 24 and 79 years. A leftover food sample (prime rib 

w/ au jus) collected from a case-patient's refrigerator tested positive for Salmonella matching the outbreak strain. 

Neither prime rib without au jus nor au jus without prime rib were available for testing alone and the two could not be 

separated in the data analysis as all prime rib is served with au jus poured on top. A case-control study conducted by 

the state using well meal companions as controls revealed the prime rib and the au jus were statistically significant for 

illness association. 

OPHS: Work with state to gather additional epidemiologic information 

*CDC last estimated onset date = 3 days before the isolation date 








Office: 404.639.5012 


Fax: 404.718.2126 


From: Elliott, Jerry - FSIS 


To: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Atkinson, Richard - FSIS; Hori, David - FSIS; 

Leskowsky, Robert - FSIS 


Subject: RE: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak 

I am looping in the team from the Western Region to see if they are still looking at this info for non-FF related Sal. 

Jerry L. Elliott DVM 

Director - Compliance and Investigations Division 

USDA, FSIS, OIEA, CID 

Acting Director Import Inspection Management Division 


USDA, FSIS, OFO, IIMD 

1400 Independence Ave SW Rm 2149 

Washington DC 20250 

Office 202-720-3781 

jerry.elliott@usda.gov 



To: Elliott, Jerry - FSIS; Defibaugh-Chavez, Stephanie - FSIS 

Subject: FW: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak 

Jerry and Stephanie- 

I know there's been some interest in non-Foster Farms follow-up. Please let me know how you'd like to proceed. 

Thanks, 

Alice 





(b) (6) 




From: Bidol, Sally (DCH) [mailto:bidols@michigan.gov] 

Sent: Thursday, October 24, 2013 2:14 PM 

To: 'Gieraltowski, Laura (CDC/OID/NCEZID)'; Green, Alice - FSIS 

Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Nakao, Jolene H. 

(CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH) 

Subject: chicken salad - RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak 

Hi Laura and Alice, 


The case household did not have any purchase receipts for the chicken salad but we have obtained the shopper card 

information from the household. This has been shared with our State Ag partners (MDARD). Is there anyone else 

within FSIS that should be looped in on this? 

Regarding leftover product testing, the household did have some leftover chicken salad in the original deli container 

which is being collected for testing at our state lab. We'll share photos of the container once we get them. Our lab 

plans to set the sample up for testing on Monday, unless you feel that it needs to be tested over the weekend; please let 

us know your thoughts about the urgency of the testing. 

Based on some preliminary followup by MDARD at the Kroger store, this outlet uses either of the following for its 

rotisserie chicken salad: 

1) rotisserie chicken breast meat-savory fully cooked from Kroger distribution but originating from Good Heart 

Specialty Foods 11122 Nacogdoches Rd San Antonio Tx, 78217 USDA Plant P20481A 

2) raw chicken from Kroger distribution that originates from Pilgrim's Pride, Greenly, Co 80634 

--Sally 

From: Gieraltowski, Laura (CDC/OID/NCEZID) [mailto:lax2@cdc.gov] 

Sent: Wednesday, October 23, 2013 10:37 AM 

To: Bidol, Sally (DCH); Nakao, Jolene H. (CDC/OID/NCEZID) 

Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Wise, Matthew E. (CDC/OID/NCEZID); Schwensohn, Colin A. 

(CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH) 

Subject: RE: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak 

Thanks, Sally. 

I think you should go ahead and get the shopper card information and receipt now. We know that Kroger stores receive 

FF chicken. It might be useful for FSIS to have the shopper card in order to verify whether or not the MI Kroger stores 

use FF for their rotisserie. 

Thanks! 


Laura 

Laura B. Gieraltowski, PhD, MPH 


Doctoral Epidemiologist 

Outbreak Response and Prevention Branch 



Centers for Disease Control and Prevention 

1600 Clifton Road, MS A-38 


Phone: (404)639-3868 

Fax: (404)718-2126 

From: Bidol, Sally (DCH) [mailto:bidols@michigan.gov] 

Sent: Wednesday, October 23, 2013 10:33 AM 

To: Nakao, Jolene H. (CDC/OID/NCEZID) 

Cc: Barton Behravesh, Casey (CDC/OID/NCEZID); Gieraltowski, Laura (CDC/OID/NCEZID); Wise, Matthew E. 

(CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Arends, Katherine (DCH); Bohm, Susan (DCH) 

Subject: new MI match: Salmonella Heidelberg 1306MLJF6-1 outbreak 

Hi Jolene, 

Wanted to give you a heads up that we have a new match to pattern JF6X01.0045: 

MI_CL13-174980 (stool coll 10/8); 81 yo F with symptom onset 10/2/2013, hosp x 7D. She reported eating rotisserie 

chicken salad on 10/1 from a local Kroger store in the Detroit metro area. We've advised our State Ag partners. 

If it should be determined that the store uses FF chicken for their rotisserie chicken, we can see whether the household 

has any purchase receipts or uses a Kroger shopper card. We're also checking to see if the patient may have any 

leftover chicken salad for possible testing at our lab. 


Other thoughts or suggestions? 

Thanks, --Sally 

From: Nakao, Jolene H. (CDC/OID/NCEZID) [mailto:fvg8@cdc.gov] 

Sent: Thursday, October 17, 2013 10:54 AM 

To: Jeffrey.Higa@cdph.ca.gov; akiko.kimura@cdph.ca.gov; Vi.Peralta@cdph.ca.gov; Rosen, Hilary (CDPH-CID- 

DCDC-IDB; Linda Gladden - AR; Stewart Matthews; Joli.Weiss@azdhs.gov; Carmon Greene; Rashida Hassan; Selam 

Tecle; Jennifer.Sadlowski@state.co.us; nicole.comstock@state.co.us; Cronquist, Alicia (CDC state.co.us); 

nicholanna.prince@ct.gov; jessica.brockmeyer@ct.gov; Diana.VonStein@idph.iowa.gov; 

Kristen.Obbink@idph.iowa.gov; Hahn, Christine G. (CDC dhw.idaho.gov); tengelse@dhw.idaho.gov; Bohm, 

Susan (DCH); Bidol, Sally (DCH); Arends, Katherine (DCH); nicole.lee@dhhs.nc.gov; jeanmarie.maillard@dhhs.nc.gov; 

Rick Sowadsky; 'Chen, Lei'; Keene, Bill (CDC epilinks.com); Julie Hatch - OR; 

Borders,Julie (DSHS; Leos,Greg (DSHS; venessa.cantu@dshs.state.tx.us; krdavis@utah.gov; cburnett@utah.gov; 

beth.melius@doh.wa.gov; kathy.lofy@doh.wa.gov; Traci DeSalvo - WI; 'Justin R - DHS Kohl'; rachel.klos@wi.gov; 

Martinek, Karen (CDC alaska.gov); ginger.provo@alaska.gov; Jamie_DeMent@doh.state.fl.us; 

Dean_Bodager@doh.state.fl.us; Kraig.Humbaugh@ky.gov; jasie.logsdon@ky.gov; TracyL.Vaughn@ky.gov; 

JoAnn.Rudroff@health.mo.gov; Eden.Dietle@health.mo.gov; marguerite.adams-ca@state.nm.us; 

chad.smelser@state.nm.us; Jessica.Watson@vdh.virginia.gov; seth.levine@vdh.virginia.gov; 

Krisandra.allen@vdh.virginia.gov; ehassan@salud.pr.gov; Terry.Eslahi@health.mo.gov 


(CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Robertson, Kis - FSIS 

(Kis.Robertson@fsis.usda.gov); Allen, Latasha - Commissioned Corps - FSIS (Latasha.Allen@fsis.usda.gov) 

Subject: RE: conference call tomorrow, Thursday, October 17, 2013 at 1pm EST - Salmonella Heidelberg 

1306MLJF6-1 outbreak 

Colleagues, 

The updated line list as of today is attached. 

New cases: CA (9), AZ (1). 

Jolene 

From: Nakao, Jolene H. (CDC/OID/NCEZID) 

Sent: 16 October 2013 16:46 

To: 'Jeffrey.Higa@cdph.ca.gov'; 'akiko.kimura@cdph.ca.gov'; 'Vi.Peralta@cdph.ca.gov'; 'Rosen, Hilary (CDPH-CID- 

DCDC-IDB'; 'Linda Gladden - AR'; 'Stewart Matthews'; 'Joli.Weiss@azdhs.gov'; 'Carmon Greene'; 'Rashida Hassan'; 

'Selam Tecle'; 'Jennifer.Sadlowski@state.co.us'; 'nicole.comstock@state.co.us'; Cronquist, Alicia (CDC state.co.us); 

'nicholanna.prince@ct.gov'; 'jessica.brockmeyer@ct.gov'; 'Diana.VonStein@idph.iowa.gov'; 

'Kristen.Obbink@idph.iowa.gov'; Hahn, Christine G. (CDC dhw.idaho.gov); 'tengelse@dhw.idaho.gov'; 'Susan 

Bohm - MI'; 'Sally Bidol - MI'; 'Katie Arends - MI'; 'nicole.lee@dhhs.nc.gov'; 'jean-marie.maillard@dhhs.nc.gov'; 


'Rick Sowadsky'; 'Chen, Lei'; Keene, Bill (CDC epilinks.com); 'Julie Hatch - OR'; 'Borders,Julie (DSHS'; 'Leos,Greg 

(DSHS'; 'venessa.cantu@dshs.state.tx.us'; 'krdavis@utah.gov'; 'cburnett@utah.gov'; 'beth.melius@doh.wa.gov'; 

'kathy.lofy@doh.wa.gov'; 'Traci DeSalvo - WI'; 'Justin R - DHS Kohl'; 'rachel.klos@wi.gov'; Martinek, Karen (CDC 

alaska.gov); 'ginger.provo@alaska.gov'; 'Jamie_DeMent@doh.state.fl.us'; 'Dean_Bodager@doh.state.fl.us'; 

'Kraig.Humbaugh@ky.gov'; 'jasie.logsdon@ky.gov'; 'TracyL.Vaughn@ky.gov'; 'JoAnn.Rudroff@health.mo.gov'; 

'Eden.Dietle@health.mo.gov'; 'marguerite.adams-ca@state.nm.us'; 'chad.smelser@state.nm.us'; 

'Jessica.Watson@vdh.virginia.gov'; 'seth.levine@vdh.virginia.gov'; 'Krisandra.allen@vdh.virginia.gov'; 

'ehassan@salud.pr.gov'; 'Terry.Eslahi@health.mo.gov' 


(CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Robertson, Kis - FSIS 

(Kis.Robertson@fsis.usda.gov); Allen, Latasha - Commissioned Corps - FSIS (Latasha.Allen@fsis.usda.gov) 

Subject: conference call tomorrow, Thursday, October 17, 2013 at 1pm EST - Salmonella Heidelberg 1306MLJF6-1 

outbreak 

Dear colleagues, 

We would like to invite you to a conference call tomorrow, Thursday, October 17, 2013 at 1pm EST to discuss updates 

in the Salmonella Heidelberg 1306MLJF6-1 outbreak investigation and to confirm case counts in each state. The 

conference call information is below. 

Attached is the master line list updated as of yesterday. A total of 329 cases have been reported from 20 states and 

Puerto Rico, with the great majority (74%) in CA: AK (2), AR (1), AZ (13), CA (243), CO (4), CT (1), FL (4), ID (2), 

KY(1), MI (2), MO (5), NC (1), NM (2), NV (9), OR (9), PR (1), TX (9), UT (2), VA (2), WA (15), WI (1). Casepatients 

range in age from

Thank you and best regards, 

Jolene 

Conference line: 

Passcode: 

(b) (6) 

(b) (6) 

________________________________ 

Jolene Nakao, M.D., M.P.H. 


Epidemic Intelligence Service Officer 

Enteric Diseases Epidemiology Branch 



U.S. Centers for Disease Control and Prevention 

1600 Clifton Road, MS-A38 

Atlanta, Georgia 30333 / USA 

jnakao@cdc.gov 

404-718-1151 (w) 

(b) (6) 

(c) 

404-718-2126 (f) 







Subject: 

RE: Positive chicken sample for S. Heidelberg patient 

(b) (6) 

HI David 



from 

(b) (6) 



(b) (6) 

(b) (6) 






whole birds. 



PFGE type 45 

· Although: 





patients home 

---------- 





o Etc. 

Thanks much! 


Uday 









Athens, GA 30605-2720 








_____________________________________________ 










Thanks 


 

Hello, 




(b) (6) 






birds. 






(b) (6) 

(b) (6) 

Case patients 





(b) (6) 

Case patients 





Case patient 

Case patient 

(b) (6) 

(b) (6) 



(b) (6) 

Case patients 




of the load. 








PFGE Types 

P1 

P2 

P3 

P4 

P5 

whole 

Patient info 


1? 

NA 

NA 

NA 

NA 

NA 

NA 

Product info 

5 each (!) 

OB/PFGE types 










(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 









available!) 

Thx 







(b) (6) 










(b) (6) 










(b) (6) 






instance? 






USDA 




202-720-2644 (o) 


202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 







(b) (6) 

Hi Uday— 



Alice 








(b) (6) 








(b) (6) 

Hi Alice 





Thx! 






(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 









(b) (6) 

FYI— 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 







(b) (6) 








CID-DCDC-IDB) 


(b) (6) 








Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 



n/a 





-Jeff 







310-217-6906 

310-217-6911 (fax) 












Subject: 

RE: Heidelberg Pct Hospitalized by PFGE 





1) 35% and below - 122, 258, 326 

2) 35% and above - 22, 41, 45, 122, 672 (just 2 cases - does not qualify)) 






_____________________________________________ 







22 42% (21/50) 

41 44% (14/32) 

45 52% (28/54) 

122 33% (8/24) 

258 29% (22/75) 

326 25% (4/16) 

672 50% (1/2) 







From: Higa, Jeffrey (CDPH-CID-DCDC-IDB) [Jeffrey.Higa@cdph.ca.gov] 



Cc: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC) 

Subject: Any possibility of recall this weekend? 

Hi Alice, 


I hope you made it home and did not get stuck at the office. 

Just one quick question…..after the flurry of activity this morning regarding the positive chicken sample from the San 

Jose patient’s home, is there any possibility of a recall this weekend? 

Okay, two quick questions…..did Stephanie get a chance to talk with 

(b) (6) 

with Food and Drug Lab? 

Thanks, 

Jeff 







310-217-6906 

310-217-6911 (fax) 


NOTICE of CONFIDENTIALITY: This E-mail is the property of the California Department of Public Health and 

contains information that may be PRIVILEGED, CONFIDENTIAL or otherwise exempt from disclosure by applicable 

law. It is intended only for the person(s) to whom it is addressed. If you receive this communication in error, please do 

not retain or distribute it. Please notify the sender immediately by E-mail at the address shown above and delete the 

original message. 


Sent: Friday, October 25, 2013 4:07 PM 


To: Goldman, David - Commissioned Corps - FSIS 


Bennett, Patty - FSIS; Kause, Janell - FSIS; Cook, Victor - FSIS 


Hi David 

Douris, SDC, Alice and I have gone back and forth on this issue and I will send a summary of our 

discussion/situation. 

About geeting the PFGE types in question and sequencing - SDC will follow-up and provide you an update. 

Cheers! 

(b) (6) 







(b) (6) 









USDA 




202-720-2644 (o) 

202-690-2980 (f) 









available!) 

Thx 







(b) (6) 


An alternative way of asking that is David's original question of whether they would consider those two patterns the 


The health department picked up 3 packages of FF product. There were no other suspect products noted. I'll seek 






(b) (6) 










(b) (6) 






instance? 






USDA 





202-720-2644 (o) 

202-690-2980 (f) 



Thx Alice! 


artifact in this instance - given both are very close and part of the OB. 

Cheers! 

Uday 







(b) (6) 

Hi Uday- 



Alice 








(b) (6) 








(b) (6) 

Hi Alice 




was consumed - right! 

Thx! 






(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 









(b) (6) 

FYI- 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 







(b) (6) 








CID-DCDC-IDB) 


(b) (6) 








Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 


P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 



n/a 





-Jeff 







310-217-6906 

310-217-6911 (fax) 







(b) (6) 

From: 



To: Green, Alice - FSIS; Atkinson, Richard - FSIS 



Subject: 

RE: More Costco shopper records to request 

Alice, we have 

(b) (6) (b) (6) 

Costco shopping history already. The rest are new and we will need them. 

(b) (6) 

(b) (6) 





Office: 

Cell: 

(b) (6) 

(b) (6) 

Fax: (425) 483-3492 

(b) (6) 

fsis.usda.gov 








To: Atkinson, Richard - FSIS; (b) (6) - FSIS 


Subject: FW: More Costco shopper records to request 

Please forgive me if I've missed any of these, but I didn't see them in the IR. Do these need to be requested from 

Costco? 

Thank you! 






(b) (6) 






To: Green, Alice - FSIS; Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC-IDB) 

Subject: More Costco shopper records to request 

Hi Alice, 

I've had a chance to go through all the records....whew! Thank you! 

These are all the ones for which we don't have any records yet (the last two are new). 

Talk to you tomorrow morning! 

PulseNet ID 

CDC ID 

Onset Date 

Cluster pattern 

SourceCounty 

Reported Chicken Exposures from Interview 

Store1 

Costco Shopper Card # 

(b) (6) 


(b) (6) 

7/28/2013 

JF6X01.0041 

San Diego 

Foster Farms chicken livers (used as bait for fishing several time during week prior to illness onset) purchased from 

Stater Bros; Stater Bros brand chicken thighs; Sprouts natural chicken brand thighs 

Costco 

(b) (6) 

(b) (6) 

(b) (6) 

9/1/2013 

JF6X01.0045 

San Mateo 

Foster Farm chicken tenderloins, frozen raw (Costco) consumed 8/26-8/28 

Costco 

(b) (6) 

(b) (6) 

(b) (6) 

8/29/2013 

JF6X01.0022 

San Diego 

Costco/Kirkland thighs and maybe rotisserie chicken. Legs (Vons/Ralphs) 

Costco 

(b) (6) 

(b) (6) 


(b) (6) 

9/23/2013 

JF6X01.0045 

Santa Clara 

chicken bake 9/21/13 from Costco food court 

Costco 

(b) (6) and (b) (6) 

(b) (6) 

(b) (6) 


JF6X01.0258 

Riverside 

Maybe had Foster Farms breaded boneless skinless chicken, looks like strips (Costco). Maybe had pre-cooked 

rotisserie (Stater Bros) 

Costco 

(b) (6) 

(b) (6) 

9/11/2013 

JF6X01.0258 

San Francisco 

Costco rotisserie chicken purchased and consumed 9/11/13 

Costco 

(b) (6) 

(b) (6) 



JF6X01.0258 

San Mateo 

Buys Foster Farms chicken every week from Costco. Reports Foster Farms whole chicken, fresh raw, consumed 

9/11/13. Foster Farms thighs, fresh raw, consumed within week before onset 

Costco 

(b) (6) and(b) (6) 



To: Peralta, Vi (CDPH-CID-DCDC-IDB); Kimura, Akiko (CDPH-CID-DCDC); Higa, Jeffrey (CDPH-CID-DCDC- 

IDB) 

Cc: Gieraltowski, Laura (CDC/OID/NCEZID); Schwensohn, Colin A. (CDC/OID/NCEZID); Nakao, Jolene H. 

(CDC/OID/NCEZID); Allen, Latasha - Commissioned Corps - FSIS; Robertson, Kis - FSIS 

Subject: shopper records 

Hi Vi- 

I believe I've covered all the records in your request. There might be some duplicates-I wanted to include all versions 

of shopper histories in case some are more complete than others. 

Please let me know if I've omitted any of the ones you gently reminded us about. J 

Thanks much, 

Alice 






(b) (6) 










To: Green, Alice - FSIS; Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSIS 

Subject: Re: Heidelberg similarity matrix 

Excellent point and adds to our rationale.. 

I do understand where SDC is coming from given our experience with this... Case. 



To: Defibaugh-Chavez, Stephanie - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSIS 


Good catch. I goofed. Thanks! 





(b) (6) 






To: Green, Alice - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSIS 



Wait… I have that the pattern 0122 isolate has a slaughter date of 9/27 at P6137, but that the sample was collected at 

P6137A… 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 



USDA In Facebook USDA In Twitter USDA In 

Youtube 



To: Douris, Aphrodite - FSIS; Dessai, Uday - FSIS 



Thanks Aphrodite. It looks like the product is Simple Truth Organic, boneless skinless chicken breast, slaughter date 

9/9/13. The case-patient’s illness onset date is 9/12/13. 






(b) (6) 




From: Douris, Aphrodite - FSIS 


To: Dessai, Uday - FSIS; Green, Alice - FSIS 



Also, during the specpgm_02 Sept sampling we had a single positive with pattern .0122 and it is my understanding that 

this product tested is from the same establishment. Alice, is this correct? 








Athens, GA 30605-2720 










To: Douris, Aphrodite - FSIS; Green, Alice - FSIS 



Yep, I agree.. 

so, no point asking CDC to relook at this, right! 

In that case: 

I think our focus should be that: 

1) Finding Salmonella in the product is relatively a rare event 

2) Finding Heidelberg in the product is even more rare 

3) Hence it is sufficint that we have case and product positive for Heidelberg 


4) The fact that although the PFGE patterns are different, are part of the O/B and very closely related (about 95% 

similar) - strengthens our conclusion about the link. 

Note: in this case PFGe should be used as added informance in establishing the link 

Team - is this a fair argument given the circumstances around this O/B! 

Thx 














Athens, GA 30605-2720 

aphrodite.douris@fsis.usda.gov 







_____________________________________________ 







Yep 2 bands different (~ 200 and ~ 80 region) as I see it on the picture. 


Thanks 


_____________________________________________ 





Subject: Heidelberg similarity matrix 

Importance: High 

This is the series of tables Aphrodite created in regards to this investigation back in July. Band comparisons for 

patterns 122 and 45 are on pages 4 and 5. The small bands appear to be low molecular weight. 

> 

Thanks, 

Alice 





(b) (6) 










(b) (6) 









USDA 




202-720-2644 (o) 


202-690-2980 (f) 









available!) 

Thx 






(b) (6) 





 

 



To: Goldman, David - Commissioned Corps - FSIS; Dessai, Uday - FSIS 

Cc: Defibaugh-Chavez, Stephanie - FSIS; Robertson, Kis - FSIS; Kissler, Bonnie - FSIS; Bennett, Patty - FSIS; 

Kause, Janell - FSIS 


(b) (6) 







(b) (6) 










(b) (6) 






instance? 







USDA 




202-720-2644 (o) 

202-690-2980 (f) 



Thx Alice! 



Cheers! 

Uday 






Subject: RE: Positive chicken sample for S. Heidelberg patient (b) (6) 


Hi Uday— 



Alice 







(b) (6) 








(b) (6) 

Hi Alice 





Thx! 







(b) (6) 



CAPT, USPHS 




202-720-2644 

-------------------------- 








(b) (6) 

FYI— 


(b) (6) (b) (6) 



email). 

Thanks much, 

Alice 








(b) (6) 








CID-DCDC-IDB) 


(b) (6) 







Product 


Result 


184100913-P001 


P33901 


n/a 

184100913-P002 



P6137A 





CA2__CA2F13M00985PP2A1 

184100913-P003 


P33901 


n/a 





-Jeff 







310-217-6906 


310-217-6911 (fax) 









To: Green, Alice - FSIS; Douris, Aphrodite - FSIS; Dessai, Uday - FSIS 


Wait… I have that the pattern 0122 isolate has a slaughter date of 9/27 at P6137, but that the sample was collected at 

P6137A… 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 




Youtube 













(b) (6) 


















Athens, GA 30605-2720 
















In that case: 









Thx 














Athens, GA 30605-2720 









_____________________________________________ 









Thanks 

_____________________________________________ 









> 

Thanks, 

Alice 





(b) (6) 









Remind me… product was 0122 and patient was 41? 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 




Youtube 













(b) (6) 









Also, during the specpgm_02 Sept sampling we had a single positive with pattern .0122 and it is my understanding 

that this product tested is from the same establishment. Alice, is this correct? 








Athens, GA 30605-2720 















In that case: 










Thx 














Athens, GA 30605-2720 








_____________________________________________ 









Thanks 


_____________________________________________ 









> 

Thanks, 

Alice 





(b) (6) 




From: bounce@newsletters.meatingplace.com on behalf of Meatingplace Editorial 

[news@newsletters.meatingplace.com] 



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From: (b) (6) - FSIS 



Cc: Atkinson, Richard - FSIS 

Subject: RE: Safeway shopper card records 

Alice, 

(b) (6) 

The only one that is new to me is . This is the first time I have seen that number. Can you convert this to a 

CDC number? I already have Safeway shopping histories for (b) (6) and they should be in 

the IR. I have Costco histories but not Safeway shopping histories for (b) (6) 

and have not seen them 

(b) (6) 

in the IR. 


(b) (6) 





Office: 

Cell: 

(b) (6) 

(b) (6) 

Fax: (425) 483-3492 

(b) (6) 

fsis.usda.gov 








To: Atkinson, Richard - FSIS; (b) (6) 

Subject: FW: Safeway shopper card records 

- FSIS; Elliott, Jerry - FSIS; Khroustalev, Allison - FSIS 

If you like I can change these to CDC pattern names and upload them to the IR (at least the ones that aren't already 

there). 





(b) (6) 








Subject: Safeway shopper card records 

Hi Alice, 

Since I've lost track of which Safeway records I have already sent, I am sending them all to you in this one email! 

Vi 

********************************** 

Vi Peralta 

Foodborne Epidemiologist 




850 Marina Bay Parkway | Building P, 2nd Floor | Richmond, CA 94804 

Phone: 510-620-3633 | Fax: 510-620-3425 | Email: Vi.Peralta@cdph.ca.gov 

CONFIDENTIALITY NOTICE WARNING: This transmission may contain confidential and proprietary information 

intended only for the use of the individual or entity to which it is addressed and may contain information that is 

privileged, confidential and exempt from disclosure under applicable law. If you have received this transmission in 

error, any disclosure, copying, distribution, downloading, uploading or the taking of any action in reliance on the 

contents of this information is strictly prohibited, and you are requested to immediately notify the above sender. 


Sent: Friday, October 25, 2013 2:07 PM 

To: Dessai, Uday - FSIS; Douris, Aphrodite - FSIS; Green, Alice - FSIS 


Uday, 


I think the problem will be saying that the product is linked to illness. If the case-patient has one pattern, and the 

product has another, I think it will be an uphill battle trying to leverage some sort of regulatory action. The firm will 

claim that since the patterns are different (and considered significantly different) that it must have been something else 

that caused the illness. I don’t know that we would be able to dispute that legally speaking. 

If the same pattern had been found, I think it would be a different story, but unless we can say these patterns are 

essentially the same (and justify it legally) then I don’t think we have anything here… Just my take on the situation. 

-Stephanie 






202-690-6042 (office) 

202-641-5540 (Blackberry) 

202-690-6364 (fax) 




Youtube 









In that case: 









Thx 














Athens, GA 30605-2720 








_____________________________________________ 










Thanks 

_____________________________________________ 









> 

Thanks, 

Alice 





(b) (6) 



















Athens, GA 30605-2720 















In that case: 









Thx 















Athens, GA 30605-2720 








_____________________________________________ 








Douris - does the ~ 200 region band constitute a real diffence ! ( I would imagin yes!) 

Thanks 

_____________________________________________ 









> 

Thanks, 

Alice 






(b) (6) 




From: Peralta, Vi (CDPH-CID-DCDC-IDB) [Vi.Peralta@cdph.ca.gov] 



Subject: Safeway shopper card records 

Attachments: Safeway_pattern0022_CA005_M13X01887.xls; Safeway_pattern0022_CA08_M13X02218.xlsx; 

Safeway_pattern0022_CA012_M13X02445.xlsx; Safeway_pattern0022_CA025_M13X02989.xls; 

Safeway_pattern0045_CA012_M13X02584_daughter.xlsx; Safeway_pattern0045_CA017_M13X03242.xlsx; 

Safeway_pattern0045_CA020_M13X03447.xls; Safeway_pattern0258_CA017_M13X03485.xls; 

Safeway_pattern0258_CA019_M13X03917_card1.xls; Safeway_pattern0258_CA019_M13X03917_card2.xls 

Hi Alice, 

Since I’ve lost track of which Safeway records I have already sent, I am sending them all to you in this one email! 

Vi 

********************************** 

Vi Peralta 

Foodborne Epidemiologist 




850 Marina Bay Parkway | Building P, 2nd Floor | Richmond, CA 94804 

Phone: 510-620-3633 | Fax: 510-620-3425 | Email: Vi.Peralta@cdph.ca.gov 

CONFIDENTIALITY NOTICE WARNING: This transmission may contain confidential and proprietary information 

intended only for the use of the individual or entity to which it is addressed and may contain information that is 

privileged, confidential and exempt from disclosure under applicable law. If you have received this transmission in 

error, any disclosure, copying, distribution, downloading, uploading or the taking of any action in reliance on the 

contents of this information is strictly prohibited, and you are requested to immediately notify the above sender. 


Case Data (For Case No 2013-0702) 

1 

CONFIDENTIAL 

CONFIDENTIAL 

CCMS II Case Report For Case # 2013-0702 Page 1 of 12 

10/30/2013 7:47:30AM

1 

Case Overview 

Case In Charge Of OPHS 

Case Type: Illness 

Alerts Were Sent To: 

CONFIDENTIAL 

Reported Date: Monday, October 14, 2013 

Entered By: 

(b) (6) 

Incident Date: 10/7/2013 

Case Status: Closed 

Entered By Agency: OFO - Alameda, CA (05) 

Complainant State: NEVADA 

Complainant District: Alameda, CA (05) 

Original Statement: 

Case Closing Reason: 

The complainant bought 1 package (net weight 6.12 lbs.) of Foster Farms leg quarters on Monday, 

Oct. 7, 2013, at approximately 0800 hours, from Food 4 Less on 8180 S. Las Vegas Blvd., Las 

Vegas, Nevada. He said that, at approximately 1000 am on that same day, he cooked and 

consumed some of the product. He said he went to sleep, and he woke up feeling muscle pains at 

around 6pm or 7pm that day. He said he also experienced the following symptoms: headache, chills, 

hot flashes, vomiting, and diarrhea. He said he also felt sluggish. He said he was experiencing these 

symptoms until Friday, Oct. 11, when the diarrhea began to stop. He said he went to the hospital on 

Sunday, October 13, for the pains he was still experiencing. He said the hospital wanted to take a 

stool sample but that he already went to the bathroom before going to the hospital, so the hospital 

took 2 blood samples (CBC,Chemistry) for diagnostics. He went to Valley Hospital Medical Center 

on 620 Shadow Lane, Las Vegas, Nevada, 89106. The hospital gave him Cipro and Norco. 

He indicated that the establishment number on the packaging is Est. P6137 with a use by/freeze by 

date of October 9, 2013. 

He said that he still has the product and packaging at his home. He is still currently experiencing 

side pains on the right side of his body. He has not been able to eat. His headache comes and goes. 

Wednesday, October 16, 2013 Not Investigated 

Alleged incident appears isolated. Case will be archived and reevaluated should a similar 

complaint be reported or additional information comes forward. Letter explaining disposition of 

case will be sent to complainant. Plant will be informed of complaint by letter. 

Tuesday, October 22, 2013 Not Investigated 

Not Lab Confirmed, Not Isolated, Possibly Connected to a Recall or Investigation 

Illness is not laboratory confirmed. This case may be associated with FSIS Recall # --- or a 

current or recent outbreak investigation. Multiple complaints have been registered in CCMS as a 

result of this recall or investigation, but the information provided in this case does not identify a 

definitive relationship to other reported cases or investigations. The case will be archived and 

reevaluated should additional information become available. No complainant address was 

provided. Establishment (if identified) will be informed of complaint by letter. 

Case Closing Remarks: 

Tuesday, October 29, 2013 Investigated, No Further Action Taken 

Not Lab Confirmed, Not Isolated, Possibly Connected to a Recall or Investigation 

Illness is not laboratory confirmed. This case may be associated with retail level recall 2013-058, 

public health alert or a current or recent outbreak investigation. Multiple complaints have been 

registered in CCMS as a result of this recall or investigation, but the information provided in this 

case does not identify a definitive relationship to other reported cases or investigations. The case 

will be archived and reevaluated should additional information become available. A letter 

explaining the disposition of the case will be sent to complainant. Establishment will be informed 

of complaint by letter. 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 

Nature of Complaints 

Is Primary Complaint Type Medical Visit Hospitalized Life Threatening Complaint Description 

Yes 

Illness Yes No No 

Case Symptoms 

Symptom Onset Time Comment 

Diarrhea 

Diarrhea - Blood In 

Pain - Muscle 

Nausea 

Vomiting 

24-72 Hours 

24-72 Hours 

8-24 Hours 

3-8 Hours 

8-24 Hours 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

Products 

CONFIDENTIAL 

Country of Origin 

Product Brand 

Product Date 

Product Name 

Species 

Est. District Name 

Processing Type 

Purchase Date 

Package 

Case Status 

Lot: 

US 

Foster Farms 

10/9/2013 12:00:00AM 

Leg quarters 

Chicken 

Alameda, CA (05) 

Raw - Not Ground 

10/7/2013 12:00:00AM 

6.12 lbs. net weight 

New 

Est. Number Est. District Role Establishment Name Primary Intl. 

06137 P 05 Processing Foster Poultry Farms Yes 

06137 P 05 Unknown Foster Poultry Farms 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 

Similar Cases 

Case # Reported On Case Type Status Compl. Dist. qi qk qik v Reason 

2013-0703 

10/14/2013 4:59:18PM Illness Closed Alameda, CA (05) 

Manually identified 

2012-0464 

9/6/2012 9:10:05AM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.11 

2013-0698 

10/11/2013 2:02:56PM Illness Closed Raleigh, NC (80) 0.00 0.00 0.00 0.11 

2013-0714 

10/17/2013 10:06:13AM Illness Closed Alameda, CA (05) 0.00 0.03 0.00 0.11 

2013-0684 

10/9/2013 2:11:08PM Illness Active Alameda, CA (05) 0.00 0.03 0.00 0.11 

2013-0672 

10/8/2013 1:46:03PM Illness Active Alameda, CA (05) 0.00 0.03 0.00 0.11 

2012-0407 

7/24/2012 4:13:49PM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.11 

2013-0680 

10/9/2013 9:11:05AM Illness Closed Boulder, CO (15) 0.00 0.00 0.00 0.11 

2013-0687 

10/9/2013 2:11:28PM Illness Closed Alameda, CA (05) 0.00 0.00 0.00 0.11 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

Case Tasks 

Brand: Foster Farms 

Product Name: Leg quarters 

CONFIDENTIAL 

Task Type 

Last 

Activity 

Initiated On 

Current Status 

Priority 

Upload Document 10/14/13 10/14/13 Complete Standard 

Instructions: 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Upload Document 10/16/13 10/16/13 Complete Standard 

Instructions: 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Upload Document 10/24/13 10/24/13 Complete Standard 

Instructions: 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Search CCMS and/or PBIS 10/16/13 10/16/13 Complete Standard 

Instructions: 

Search CCMS and/or PBIS 

Action For Task: 

Created On: 10/16/2013 9:03:05AM 

Created By: 

(b) (6) 

Task has been marked as 'Complete'. There was no follow-up Task generated. 


Created On: 10/16/2013 9:03:05AM 

Created By: 

(b) (6) 

Task Completion Report: '' 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

Note For Task: 

Created On: 10/16/2013 9:02:58AM 

Created By: (b) (6) 

Title: ccms 

CONFIDENTIAL 

[10/16/2013 9:02:58 AM] Manual review of CCMS data by establishment number revealed similar complaint(s) 

reported within the last year. 

Manual review of PBIS/PHIS data within the last 6 months revealed noncompliance (s) that may suggest a 

direct relationship between this complaint and practices in the identified plant. 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Submit Products to Lab 10/29/13 10/24/13 Cancelled Standard 

Instructions: 

Submit Products to Lab 

1. You have access to CCMS to review the case information and input notes. Here’s the link in 

case you do not have it: http://ccms.fsis.usda.gov/ccmsweb/MainPage.aspx . Please remember 

when logging in that your username should be reflected as “fsisusda\blaw” and your password is 

your network password (the one you would use to log into your computer). If you experience any 

errors logging in, please take a screen shot and call or send me an email so that I may assist you. 

2. To complete the task you will need to do the following: Make arrangements with the 

complainant to visually verify the establishment and any lot numbers from the index package, 

examine the index and like-coded product, if available, and obtain photographic evidence to include 

establishment and package coding information. Pictures of the product and packaging have already 

been uploaded to the case, but you will need to verify that this is the same product that you are 

collecting for sampling. Collect (See FSIS Directive 7355.1 and MLG Chapter 10 for guidance on 

sample seals and procedures.) the index sample and any like-coded product and send to: 

ATTN: Laboratory Supervisor, FSIS OSEL 

Russell Research Center, 950 College Station Rd, Athens, GA 30605. 

3. The following forms will need to be completed for sample collection and submission. 

a. FSIS Form 10,000-2: Domestic Laboratory Report (inspector generated). Please let me know if 

you do not have this form and we can email a copy to you. 

b. FSIS Form 8000-17: Evidence Receipt and Chain of Custody should be filled out and included 

with samples. 

c. AES CCMS Verification Report (attached) – this is form that we created to standardized the 

information collected during these investigations. If OIEA uses a different form or method of 

collecting this information, please just send us (or input the updates into CCMS tasks notes) and we 

can transfer the information to the form and upload it to CCMS. 

See the document section for the the verification report form. 

Thanks 


Created On: 10/29/2013 2:15:31PM 

Created By: 

(b) (6) 

Task has been marked as 'Cancelled' 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 


Created On: 10/29/2013 2:15:31PM 

Created By: 

(b) (6) 

Reason for cancellation: 'It was determined not to pursue the collection of the product from the consumer.' 

Task Type 

Last 

Activity 

Initiated On 


Priority 


Instructions: 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Search CCMS and/or PBIS 10/16/13 10/16/13 Cancelled Standard 

Instructions: 

Search CCMS and/or PBIS 


Created On: 10/16/2013 8:57:37AM 

Created By: 

(b) (6) 

Task has been marked as 'Cancelled' 


Created On: 10/16/2013 8:57:37AM 

Created By: 

(b) (6) 

Reason for cancellation: 'task' 

Task Type 

Last 

Activity 

Initiated On 


Priority 

Investigate: Interview Complainant 10/24/13 10/23/13 Complete Standard 

Instructions: 

Investigate: Interview Complainant 


Created On: 10/24/2013 12:45:59PM 

Created By: 

(b) (6) 

Task has been marked as 'Complete'. There was no follow-up Task generated. 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 


Created On: 10/24/2013 12:45:59PM 

Created By: 

(b) (6) 

Task Completion Report: '' 


Created On: 10/23/2013 2:23:12PM 


Title: Interview with complainant 

[10/23/2013 2:23:12 PM] Spoke with complainant - 

Purchased chicken - no receipt information 

Baked chicken - overcooked with potatoes 

Felt nauseated about 6-8 hours later 

Ate two more pieces with bread 

Started vomiting and diarrhea 12-24 hours later 

Went to the ER 5 days after symptoms started 

Was given medication. No stool sample availble. 

Blood, Chemistry and UA were taken 

Went back to ER for recheck. 

US of gallbladder, stool sample, UA and more blood work pending. 

Complainant feels somewhat better but is not back to normal. Mostly has a loss of appetite. 


Created On: 10/24/2013 12:45:44PM 


Title: spoke with complainant 

[10/24/2013 12:45:44 PM] Spoke with (b) (6) this am. 

Blookwork results: 

Alk P 176 (40-115) 

AST 48 (10-35) 

ALT 51 (9-46) 

U/A within normal limits 

Stool sample negative for Salmonella, Shigella and Campylobacter 

Will give us product but not the whole thing. Advised him to keep frozen, not handle the product and discuss 

with the investigator how they can get some of the product. 

He still feels naseated and just not right. 

[10/29/2013 2:19:10 PM] Spoke to complainant again that evening. Is unwilling to give the product to the 

investigator at this time as he may want to pursue litigation. 

Task Type 

Last 

Activity 

Initiated On 


Priority 


Instructions: 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 

Case Notes 


Created On: Wednesday, October 23, 2013 

Modified By: (b) (6) 

Modified On: Wednesday, October 23, 2013 

Title: conversation 

[10/23/2013 11:24:22 AM] bloodwork results 

hematology 10/13/13 

Procedure 

WBC 3.5 (l)(3.8-10.8) 

Chemistry- OK 

urinalysis done on 15th - no stool sample 

CDC with differential 

CMP 

Lipase 

MICR(s) 

US gallbladder 

Sick on yesterday, pain behind left eye -cloudy vision 

ach left thumb 

Stomach - ADR, low appetite 

Fatique 

Gall bladder-US 

[10/23/2013 2:16:23 PM] Stool sample collected on 10/18 

Will try to get US,blood, urine and stool sample results today. 

[10/23/2013 3:46:12 PM] There is no shopper card information. 

Someone contacted the complainant to pick up the product. 

He has raw product available. 

He is going to the hospital tonight to get the lab results and says he will follow-up tomorrow. 


Created On: Tuesday, October 29, 2013 


Modified On: Tuesday, October 29, 2013 

Title: public health alert for Foster Farms raw product - 

[10/29/2013 2:05:09 PM] 

http://www.fsis.usda.gov/wps/portal/fsis/topics/recalls-and-public-health-alerts/current-recalls-and-alerts/!ut/p/a1/jY_BCoJAGISfxQdY9j 

dF9CgLlpa7iGS2l1hMTdhWWa1DT5_SyUhy_tPAN_MzmOMccyWeTS2GplVCTp47F0jAMT0CEQv8AEJqBZlLtyYwZwTOM8AzJyBL2J 

4QcKm1Mr8gH_7loxUPNjomcY15J4YbalTV4rx4aF2qAemyEFL2SKgrErLUQ49PmM87wRxv7EztXUQtYPY38GP0B1he1d2P-etQpWFt 

GG85uhP2/?1dmy&current=true&urile=wcm%3apath%3a%2Ffsis-content%2Finternet%2Fmain%2Fnewsroom%2Fnews-releases-stat 

ements-and-transcripts%2Fnews-release-archives-by-year%2Farchive%2F2013%2Fpha-100713 


Created On: Thursday, October 24, 2013 


Modified On: Thursday, October 24, 2013 

Title: notes from field investigator 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

CONFIDENTIAL 

[10/24/2013 9:10:35 AM] Good Afternoon xxxxxx 

Below is a summary of information gathered for CCMS cases 2013-0702. I will be out of the office tomorrow and Friday, and will be 

back in the office Monday otherwise. Please feel free to contact me via blackberry if you should have any questions in the meantime. 

Thanks. 

2013-0702—On 10/22/13 left a message with complainant. Will follow up on 10/23/13. 

On 10/23/13 complainant indicated that he still has product and willing to share for sample collection. Not willing to provide all left over 

product because he wants to have some left for evidence, etc. Confirmed onset date of 10/7/13 and was FF leg quarters from Food 4 

Less. The complainant also indicated that he regulatory purchases, cooks and consumes poultry products daily. Prior to 10/7/13, 

complainant indicated that the regularly purchases Pilgrims Pride “ready-to-cook” whole chicken and chicken breasts from Walmart. 

These stores have no shoppercard numbers. Complainant could not provide specific dates which Walmart poultry products were 

purchased on, however, indicated that the FF product was purchased on 10/7/13 at Food 4 Less located at 8180 Las Vegas Blvd., Las 

Vegas, NV. The complainant had the following tests done: blood chemistry (no culture/sensitivity conducted) and stool sample. He will 

be provided test results later today or tomorrow morning and will let me know results tomorrow for stool sample. 


Created On: Tuesday, October 29, 2013 


Modified On: Tuesday, October 29, 2013 

Title: OIEA summary 10/23/13 

[10/29/2013 2:12:09 PM] Good Afternoon: 

Below is a summary of information gathered for CCMS cases 2013-0702. I will be out of the office tomorrow and Friday, and will be 

back in the office Monday otherwise. Please feel free to contact me via blackberry if you should have any questions in the meantime. 

Thanks. 

2013-0702—On 10/22/13 left a message with complainant. Will follow up on 10/23/13. 

On 10/23/13 complainant indicated that he still has product and willing to share for sample collection. Not willing to provide all left over 

product because he wants to have some left for evidence, etc. Confirmed onset date of 10/7/13 and was FF leg quarters from Food 4 

Less. The complainant also indicated that he regulatory purchases, cooks and consumes poultry products daily. Prior to 10/7/13, 

complainant indicated that the regularly purchases Pilgrims Pride “ready-to-cook” whole chicken and chicken breasts from Walmart. 

These stores have no shoppercard numbers. Complainant could not provide specific dates which Walmart poultry products were 

purchased on, however, indicated that the FF product was purchased on 10/7/13 at Food 4 Less located at 8180 Las Vegas Blvd., Las 

Vegas, NV. The complainant had the following tests done: blood chemistry (no culture/sensitivity conducted) and stool sample. He will 

be provided test results later today or tomorrow morning and will let me know results tomorrow for stool sample. 

CONFIDENTIAL 


10/30/2013 7:47:30AM

1 

Uploaded Documents 

CONFIDENTIAL 

Added On Added By Document Name Document Title Size (KB) 

10/14/2013 (b) (6) 

C:\Documents and 

Settings\All Users\Application 

Data\USDA\FSIS\CCMS2\\C 

CMS2TMP_f9d55494_ffc1_42 

0d_a99c_19232f9c068c.data 

10/16/2013 (b) (6) 




CMS2TMP_98c05bc2_5957_ 

48f4_83ca_155297db7e78.da 

ta 

10/24/2013 (b) (6) 




CMS2TMP_c82809d7_7234_ 

406b_9349_56444c74002a.d 

ata 





CMS2TMP_22123e8b_e77c_ 

44f1_8faa_dbf90c713900.dat 

a 





CMS2TMP_ab73b5dd_f57e_4 

c23_b59d_e15364e8968b.dat 

a 

Leg quarters package, picture 3 594.75 

est. letter 2,174.30 

verification form 516.98 



CONFIDENTIAL 


10/30/2013 7:47:30AM

United States 

Department of 

Agriculture 

Food Safety 

and Inspection 

Service 

Office of 

Public Health 

Science 

Washington, D.C. 

20250 

October 16, 2013 

To: 

Foster Poultry Farms 

1000 Davis St. 

Livingston, CA 95334 

From: Consumer Complaint Monitoring System 


Please find enclosed a copy of a consumer complaint received by the 

U.S. Department of Agriculture, Food Safety and Inspection Service (FSIS). According to the 

consumer report, the complaint involves a product produced by your establishment. FSIS has 

entered the information into the Consumer Complaint Monitoring System - an electronic 

database designed to document and track all consumer complaints received by the agency. 

FSIS has determined that no further action is necessary at this time. However, your review of the 

enclosed report may indicate that unilateral actions on your part are needed. You do not need to 

reply to this communication. 

Sincerely, 

The CCMS Surveillance Team 

Applied Epidemiology Division 

Office of Public Health Science

Case Number: 2013-0702 Date Reported: 10/14/2013 

Complainant Location: Las Vegas, NV 

Establishment: 

06137 P 


Product Brand: Foster Farms 

Package Size: 6.12 lbs. net weight 

Product Name: Leg quarters 

Codes: 

Purchase Point: 

Food 4 Less 

Date: 10/7/2013 

Primary Complaint: Illness 

Complainant Comment: The complainant bought 1 package (net weight 6.12 lbs.) of Foster 

Farms leg quarters on Monday, Oct. 7, 2013, at approximately 0800 hours, from Food 4 Less on 

8180 S. Las Vegas Blvd., Las Vegas, Nevada. He said that, at approximately 1000 hours on that 

same day, he cooked and consumed some of the product. He said he went to sleep, and he woke 

up feeling muscle pains at around 6pm or 7pm that day. He said he also experienced the 

following symptoms: headache, chills, hot flashes, vomiting, and diarrhea. He said he also felt 

sluggish. He said he was experiencing these symptoms until Friday, Oct. 11, when the diarrhea 

began to stop. He said he went to the hospital on Sunday, October 13, for the pains he was still 

experiencing. He said the hospital wanted to take a stool sample but that he already went to the 

bathroom before going to the hospital, so the hospital took 2 blood samples for diagnostics. He 

went to Valley Hospital Medical Center on 620 Shadow Lane, Las Vegas, Nevada, 89106. The 

hospital gave him Cipro and Norco. He indicated that the establishment number on the 

packaging is Est. P6137 with a use by/freeze by date of October 9, 2013. He said that he still has 

the product and packaging at his home. He is still currently experiencing side pains on the right 

side of his body. He has not been able to eat. His headache comes and goes. 

Sampling Instructions: 

NOTICE: REPORT CONTAINS UNVERIFIED INFORMATION FURNISHED BY 

COMPLAINANT

San Mateo County (CA) Salmonella Infection Cluster 

Case-Patients by Illness Onset Date, September 2013 (N=27) 

(as of 10/4/13) 

5 

4 

Probable (n=14) 

Confirmed (n = 13) 

Number of Patients 

3 

2 

1 

0 

Illness Onset Date

Persons infected with the outbreak strains of Salmonella Heidelberg and by date 

of illness onset* 

Number of persons 

6 

5 

4 

JF6X01.0672 

JF6X01.0326 

JF6X01.0258 

JF6X01.0122 

JF6X01.0045 

JF6X01.0041 

JF6X01.0022 

3 

2 

1 

0 

2/22 3/1 3/8 3/15 3/22 3/29 4/5 4/12 4/19 4/26 5/3 5/10 5/17 5/24 5/31 6/7 6/14 6/21 6/28 7/5 7/12 7/19 7/26 8/2 8/9 8/16 8/23 8/30 9/6 9/13 9/20 

*known and estimated onset date 

2013 

Date of Illness Onset

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Information reported may be incomplete and should be considered preliminary. It is subject to change as information is 

updated. More detailed information is available upon request. This information is to be considered confidential and is to 

be shared with colleagues on a strict need-to-know basis. Case-specific health information, proprietary information, and 

establishment-specific information should be carefully reviewed before further dissemination. 

(b) (5)

(b) (5)

(b) (5)

(b) (5)

CCMS II EIAO Verification Report 

CCMS Case Number Reporting Date Incident Date and Complaint Description 

Illness possibly associated with raw 

2013-0702 10/14/2013 10/07/2013 chicken product; Medical visit 

required. 

I I 

Please verify the following information when visiting with the consumer: 

EST Number 

P6137 

Use/Sell By Date 

Establishment Name and Address 


Livingston, CA 95334 

Product Name(s) and Description 

10/09/2013 Foster Farms Leg Quarters 

Lot Number 

Explanation of Product Date and Lotting 

FSIS Processing Type (Select One) 

l:l 

1. What is the condition of the index product packaging? (e.g.,intact,non-intact,puncture holes, 

etc.) 

2. What is the condition of the index product? (e.g., no abnormalities,off-color,off-odor,etc.) 

3. Description of foreign object(s),if applicable. 

Type 

Shape 

Color 

Dimensions 

4. Additional observations or notes:

5. Sampling submission instructions: 

please collect and send to: 

ATTN: Laboratory Supervisor, FSIS OSEL 

Russell Research Center, 950 College Station Rd, Athens, GA 30605. 

NOTE: FSIS Forms 10,000-2: Domestic Laboratory Report (inspector generated) and 

8000-17: Evidence Receipt and Chain of Custody should be filled out and included with 

samples. See FSIS Directive 7355.1 and MLG Chapter 10 for guidance on sample seals and 

procedures. 11 

6. Insert pictures in the spaces provided. Pictures should contain at a minimum, packaging codes, the 

product and foreign objects against an object for size comparison (e.g. coin, ruler, etc.). Double click 

above the word "Image" to add files. 

NOTE: The total file size for all pictures should be no greater than 2 MB or the system may time-out when 

attempting to upload the file. Please use a picture editing program such as Microsoft Office Picture 

Manager to compress the file sizes, if necessary. large files or extra pictures can be uploaded directly to 

the documents sections of the case. 

Image 1 Image 2 

I 

I I Reset Image 2 I 

Reset Image 1 

lmage3 

I Reset Image 3 I I 

lmage4 

Reset Image 4 I 

NOTE: When completmg th1s form, please be as descnpt1ve as poss1ble m order to g1ve the reader a clear p1cture of what 

you are relating in each response. Thank you.

FSIS_14-07_Interim4_Redacted_PlusCover.pdf#_ga=1.106999616.330874689

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