| Document Date: 2012-05-02 14:00:43
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Company N FOOD RISKS & EXPOSURES TRAVEL / BMAT / / Country United States / / Facility Hospital Home Other Unknown Hospital / Facility name / IndustryTerm List travel dates / meat processor / telephone review / animal products / dairy products / similar travel history / travel/residency information / wild game processing facility / patient travel / / MedicalCondition U Epididymitis / N Acute pyelonephritis / U Myocarditis / N Orchitis / U Osteomyelitis / Unknown Since disease / U Pericarditis / ever received brucellosis / disease / arthralgia / headache / orchitis/epididymitis / N Chills / U Hepatitis / U Valvular heart disease / U Diarrhea / Brucellosis / U Congenital heart disease / Cardiovascular/heart disease / Fever / U Headache / U Endocarditis / peripheral neuropathy / U Muscle aches / arthritis/spondylitis / arthralgias / Vomiting / fatigue / lymphadenopathy / N Fatigue / lymphadenitis / U Encephalitis / Brucella infection / Clinical description An illness / endocarditis / rigors / animal brucellosis / U Please describe / MedicalTreatment vaccination / antibiotic prophylaxis / / Organization ATTENTION Local Health Department / Restaurant Home Work Child Care School University/College Camp Doctor’s office / State / Position final conclusions Hospital/discharge physician / butcher / meat cutter / wholesaler / local health director / / ProvinceOrState NC City______________________________________ County / autopsy / Technology x-ray / meat processor / /
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NC Electronic Disease Surveillance System NC EDSS EVENT ID# ____________________ North Carolina Department of Health and Human Services Division of Public Health • Epidemiology Section