Current Page 1 Preview Personal Information on this form is collected under the authority of Section 31 of the Freedom of Information and Protection of Privacy Act, R.S.P.E.I. 1988, Cap.F-15.1. If you have any questions about the collection, or use of this personal information, you may contact: Chief Public Health Office at 902-368-4996 or outbreak@ihis.org.The Chief Public Health Office (CPHO) is investigating reports of gastrointestinal illness following attendance at the PEI International Shellfish Festival. Identification Providing your name and contact information is optional but will allow CPHO to follow-up with you if necessary. Your name and contact information will not be shared with anyone outside of CPHO and Public Health Nursing. First Name Last Name Telephone Number For example: 902-555-5555 Email Address Age (optional) Gender - Select -MaleFemaleOtherPrefer not to answer Symptoms Which of the following symptoms did you have? Check all that apply. Nausea Vomiting Diarrhea Fever Abdominal Pain Blood in Stool Other, please specify Other, please specify. Approximately what date and time did you first develop symptoms? Date Time Did you seek medical care? - Select -YesNo Did you provide a stool sample? - Select -YesNo Are you feeling better now? - Select -YesNo When did you start to feel better? Date Time Food History While at the PEI International Shellfish Festival, which of the following did you eat? I did not eat while at the PEI International Shellfish Festival. Vendor: Olde Dublin Pub Check all that apply. Seafood chowder Lobster baked potato Baked potato, no lobster Smashed burger Vendor: Island Favourites Check all that apply. Mini lobster roll Lobster nachos Traditional nachos Donuts Vendor: Peake's Quay Check all that apply. Steamed mussels Fried bar clams Fish cakes Nachos in a bag Poutine Fries Vendor: Raspberry Point Oysters and PEI Shellfish Association Check all that apply. Oysters Quahogs Demo Samples Check all that apply. Chowder Oysters Mussels Lobster Any other foods, please specify: Maximum 250 characters. PEI International Shellfish Festival Attendance Details What date(s) and time(s) did you attend the PEI International Shellfish Festival? Check all that apply. Thursday’s Feast & Frolic (Sept. 19) Friday (Sept. 20) afternoon (anytime between 12pm and 5pm) Friday (Sept. 20) evening (anytime between 5pm and 11pm) Saturday (Sept. 21) afternoon (anytime between 12pm and 5pm) Saturday (Sept. 21) evening (anytime between 5pm and 11pm) Sunday (Sept. 22) Acceptance Filling out this questionnaire does not necessarily mean that the Chief Public Health Office (CPHO) will contact you for follow-up, but we very much appreciate your assistance and taking the time to respond. I agree to the disclaimers. CAPTCHA