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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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|
Violation:
No information was recorded in the underlying illness column for a passenger who reported to medical on 22 December 2024 with AGE symptoms. The underlying illness question was asked and documented as 'no' in the patient's electronic medical record, but this was not transferred to the electronic/paper AGE log.
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Recommendation:
Ensure the AGE surveillance log includes a header containing the following information about the voyage: (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? or similar wording. Comments may also be added to the log in this column after the information about underlying illness. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Acute Gastroenteritis (AGE) Log
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|
Violation:
No questions referring to the underlying illness were recorded in the 'underlying illness' column of the AGE log for two of the four AGE cases on the voyage from 17 October 2024 to 6 November 2024. The underlying illness question did not show up in the patients' electronic medical record. One case's previous medical history was documented in the electronic medical record, while the other case had no history documented.
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Recommendation:
Ensure the AGE surveillance log includes a header containing the following information about the voyage: (20) presence of underlying medical conditions that may affect interpretation of AGE. If none, write ?none,? ?not applicable,? ?N/A,? or similar wording. Comments may also be added to the log in this column after the information about underlying illness. Ensure the AGE surveillance log contains the above information in the exact order and is entered in the template in Annex 13.2.2. Ensure that the log data is exported in the exact order as in the example template in Annex 13.2.2 with analyzable formats such as Excel or Access. Ensure that any additional data fields are entered only outside of the form margins when exported to VSP.
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Item No.:
02
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Site:
Medical-Specimen Collection Media
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|
Violation:
The ship's specimen collection media expired on 17 December 2024. Medical staff provided documentation for an order of specimen collection media placed on 21 October 2024. Crew identified this order was supposed to be delivered on 9 December 2024; however, it was not and is now expected on 13 January 2025.
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Recommendation:
Ensure the medical staff maintains a supply of at least 10 clinical specimen collection containers for both viral and bacterial agents (10 for each), as well as a shipping container that meets the latest shipping requirements of the International Air Transport Association (IATA) and U.S. Department of Transportation for Biological Substances, Category B designated shipments (or higher).
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Item No.:
02
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Site:
Medical-Public Vomit/Public Diarrhea Incident (PVI/PDI) Log
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|
Violation:
There was no documented medical follow up for a PDI/PVI in a stateroom occurring on 17 November 2024. Crew were unable to determine if this met the acute gastroenteritis (AGE) case definition.
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Recommendation:
Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24 hour period or what is above normal for the individual. See section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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Item No.:
07
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Site:
Potable Water-Distribution System Disinfection Records
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|
Violation:
After wet dock, the ship's entire potable water system was disinfected. Disinfection started on 12 November 2024 at 2227 and ended on 13 November 2024 at 0025. Photos showed the chlorine concentration measured between 100 200 mg/L (PPM), but not above 200 mg/L (PPM). Documentation and the ship's disinfection instructions identified disinfection should occur by circulating 50 mg/L (PPM) chlorine for 4 hours, and not the emergency procedure. There was no variance or exemption provided to disinfect the entire distribution system for 1 hour and 58 minutes at a free chlorine residual concentration between 100 to 200 mg/L (PPM).
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Recommendation:
Disinfect after potential contamination by increasing the free residual halogen to at least 50 mg/L (ppm) throughout the affected area and maintain this concentration for 4 hours or by way of another procedure submitted to and accepted by VSP.
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Item No.:
08
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Site:
Potable Water-Distribution System Disinfection Records
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|
Violation:
After wet dock, the ship's entire potable water system was disinfected. Disinfection started on 12 November 2024 at 2227 and ended on 13 November 2024 at 0025. Photos showed the chlorine concentration measured between 100 200 mg/L (PPM), but not above 200 mg/L (PPM). Documentation and the ship's disinfection instructions identified disinfection should occur by circulating 50 mg/L (PPM) chlorine for 4 hours, and not the emergency procedure. There was no variance or exemption provided to disinfect the entire distribution system for 1 hour and 58 minutes at a free chlorine residual concentration between 100 to 200 mg/L (PPM).
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Recommendation:
Maintain documentation of all inspections, maintenance, cleaning, and disinfection for 12 months and ensure it is available for review during inspections. Ensure records include a method of disinfection, concentration and contact time of the disinfectant, and a halogen value of less than or equal to 5 ppm before the tank is put back into service. Document the free halogen residual level. If the alternative potable water tank cleaning and disinfection procedure described in this section is used, ensure it is only used for routine cleaning and disinfection and not for known or suspected contaminated tanks. Accomplish disinfection by increasing the free residual halogen to at least 50 mg/L (ppm) throughout the tank and maintaining it for 4 hours. Maintain a pH value of 7.8 or less. Document the disinfection concentration and contact time. Verify that the free residual halogen level is less than or equal to 5.0 mg/L (ppm) before placing the tank back into service and document the measured level.
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Item No.:
08
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Site:
Potable Water-Pipe Disinfection Records
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|
Violation:
The free halogen residual level after flushing was documented as the following values, which were either above 5 mg/L (PPM) or not the specific halogen residual value after flushing:
?50? on the potable water pipe disinfection record for 12 November 2024.
?<5? for the hot water line disinfected on 10 November 2024.
?<5? for the pump suction line on 7 November 2024.
?<5? for the coffee machine installation on 29 October 2024.
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Recommendation:
Accomplish disinfection by increasing the free residual halogen to at least 50 mg/L (ppm) throughout the tank and maintaining it for 4 hours. Maintain a pH value of 7.8 or less. Document the disinfection concentration and contact time. Verify that the free residual halogen level is less than or equal to 5.0 mg/L (ppm) before placing the tank back into service and document the measured level. Flush the disinfected parts of the system with potable water or otherwise dechlorinate until the free residual halogen is less than or equal to 5.00 mg/L (ppm). Document the free halogen test result.
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Item No.:
08
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|
Site:
Potable Water-Tank Maintenance Disinfection Records
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|
Violation:
Six records for tank disinfection did not have a specific value recorded for the halogen residual level prior to placing them back in service. The tank disinfection record was updated during June 2024. All records after June 2024 recorded a specific value for the halogen residual following flushing.
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Recommendation:
Maintain documentation of all inspections, maintenance, cleaning, and disinfection for 12 months and ensure it is available for review during inspections. Ensure records include a method of disinfection, concentration and contact time of the disinfectant, and a halogen value of less than or equal to 5 ppm before the tank is put back into service. Flush the disinfected parts of the system with potable water or otherwise dechlorinate until the free residual halogen is less than or equal to 5.00 mg/L (ppm). Document the free halogen test result. Ensure the empty tank cleaning and disinfection procedure is only used for routine cleaning and disinfection It is not approved for known or suspected contaminated tanks. Ensure the following steps are followed: 6) Refill the tank and verify the free residual halogen is less than or equal to 5.0 mg/L (ppm) before placing the tank back into service. Document the free residual halogen level.
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Item No.:
08
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|
Site:
Recreational Water Facilities-Pool and Whirlpool Spa Equipment Room
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|
Violation:
The return line from the whirlpool spas was striped blue/green/blue for potable water.
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|
Recommendation:
Stripe or paint potable water lines either in accordance with ISO 14726 (blue/green/blue) or blue only. Stripe or paint distillate and permeate lines directed to the potable water system in accordance with ISO 14726 (blue/gray/blue). Ensure no other lines have the above color designations. Stripe or paint these lines at 5 meters (15 feet) intervals and on each side of partitions, decks, and bulkheads, except where decor would be marred by such markings, including potable water supply lines in technical lockers.
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Item No.:
08
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|
Site:
Potable Water-Testable Backflow Prevention Device Records
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|
Violation:
There were no test results recorded for the testable reduced pressure zone (RPZ) backflow prevention assembly installed at the deck 3 portside bunker station on the 2024 testable device log. Staff stated the backflow prevention device was not tested because it was failing, and would be replaced soon. A replacement RPZ was first ordered during December 2023. The RPZ was received, replaced, and tested during December 2024.
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Recommendation:
Inspect and test backflow prevention devices requiring testing (e.g., reduced pressure backflow prevention devices and pressure vacuum breakers) with a test kit after installation and at least annually. Maintain test results showing the pressure differences on both sides of the valves.
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Item No.:
16
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|
Site:
Galley-Deck 10 - Aqualina Starboard Warewashing Area
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|
Violation:
Crew stated the raw bacon and raw steak inside the metal container on the time control counter were on time control, but crew incorrectly applied time control for holding/service of these raw food items. Crew could not demonstrate these food items had an initial temperature below 41F or above 135F prior to placement on time control. Crew identified these raw foods would be cooked prior to service.
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Recommendation:
If time only?rather than time in conjunction with temperature?is used as the public health control for a working supply of potentially hazardous food before cooking, or for ready-to-eat potentially hazardous food that is displayed or held for service for immediate consumption, ensure the food (1) Has an initial temperature of 5C (41F) or less or 57C (135F) or greater before placement on time control. (2) Is not to be placed on temperature control again.
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Item No.:
16
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|
Site:
Galley-Deck 4 - Starboard Meat Preparation Area, Walk-In Refrigeration Unit # 4.6
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|
Violation:
Walk in refrigeration unit # 4.6 (333) was unable to maintain the internal temperature of raw meat under 41F. The ambient temperature of this unit measured 48F with a calibrated thermometer. The internal temperatures of the following time/temperature control for safety raw meats measured above 41F, including:
-A plastic container of 30 beef tenderloins, prepared on 4 January: 45F.
-A plastic container of 12 beef filets, prepared on 4 January: 47F.
-One lamb chop inside a plastic container, prepared on 4 January: 46F.
-A metal container of 6 ground lamb patties, prepared on 3 January: 45F.
-A plastic container of approximately 100 pieces of cubed beef, prepared on 4 January: 45F.
-A plastic container of 13 lamb kabobs with peppers, prepared on 4 January: 45F.
Crew initiated corrective action and removed all raw meat items from the walk in refrigeration unit.
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|
Recommendation:
Except during preparation, cooking, or cooling, or when time is used as the public health control, maintain potentially hazardous foods at 57C (135F) or above, except that roasts may be held at a temperature of 54C (130F); or 5C (41F) or less.
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Item No.:
19
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|
Site:
Buffet-Deck 9 - Windows Cafe Aft Buffet Line
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|
Violation:
No serving utensil was provided for the bowl of vegan cheese out for self-service. Crew initiated corrective action.
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|
Recommendation:
Provide food-dispensing utensils for each container displayed at a consumer self-service unit such as a buffet or salad bar.
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Item No.:
20
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|
Site:
Galley-Deck 9 - Starboard Galley
|
|
Violation:
The edges of the cutting board resting on the service counter were frayed and in disrepair, creating difficult-to-clean surfaces.
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|
Recommendation:
Materials used in the construction of multiuse utensils and food contact surfaces of equipment must be: (1) durable, corrosion resistant, and nonabsorbent; (2) sufficient in weight and thickness to withstand repeated warewashing; (3) finished to have a smooth, easily cleanable surface; and (4) resistant to pitting, chipping, crazing, scratching, scoring, distortion and decomposition. Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices; (4) Finished to have smooth welds and joints.
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Item No.:
20
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|
Site:
Galley-Deck 9 - Starboard Galley
|
|
Violation:
The metal panel, located in the food-splash zone over stored ice inside the ice machine, was damaged and peeling - creating difficult to clean surfaces.
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|
Recommendation:
Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices; (4) Finished to have smooth welds and joints. Design and construct food contact surfaces of equipment and utensils to be durable and to retain their characteristic qualities under normal use conditions. Food contact equipment must be maintained in good repair and proper adjustment: (1) Equipment must be maintained in a state of repair and condition that meets the materials, design, construction, and operating specifications of these guidelines.
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Item No.:
20
|
|
Site:
Galley-Deck 4 - Starboard Meat Preparation Area, Walk-In Refrigeration Unit # 4.6
|
|
Violation:
Walk in refrigeration unit # 4.6 (333) was unable to maintain the internal temperature of raw meats under 41F. The ambient temperature of this unit measured 48F with a calibrated thermometer. The integral thermometer measured a temperature of 10C (50F). The internal temperatures of numerous raw meats stored inside this walk-in refrigeration unit measured 45F or above with a calibrated thermometer. Crew identified they were waiting for a replacement part to repair this unit. Crew initiated corrective action.
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|
Recommendation:
Food contact equipment must be maintained in good repair and proper adjustment: (1) Equipment must be maintained in a state of repair and condition that meets the materials, design, construction, and operating specifications of these guidelines.
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Item No.:
20
|
|
Site:
Pantry-8 - Aft Pantry
|
|
Violation:
A slotted fastener was installed on the ice thickness sensor of the ice machine.
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|
Recommendation:
Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices. Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
20
|
|
Site:
Pantry-7 - Aft Pantry
|
|
Violation:
A slotted fastener was installed on the ice thickness sensor of the ice machine.
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|
Recommendation:
Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices. Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
20
|
|
Site:
Pantry-7 - Forward Pantry
|
|
Violation:
A slotted fastener was installed on the ice thickness sensor of the ice machine.
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|
Recommendation:
Ensure multiuse food-contact surfaces are: (1) Smooth; (2) Free of breaks, open seams greater than 0.8 mm (1/32 inch), cracks, chips, inclusions, pits, and similar imperfections; (3) Free of sharp internal angles, corners, and crevices. Use only low profile, nonslotted, noncorroding, and easy-to-clean fasteners on food-contact surfaces and in splash zones. Prohibit the use of exposed slotted screws, Phillips head screws, or pop rivets in these areas.
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Item No.:
21
|
|
Site:
Food Service General-Food-Service Equipment Gaskets
|
|
Violation:
Numerous gaskets throughout multiple food service areas were damaged and in disrepair, including:
Deck 10 ? Aqualina galley: The door gasket for the starboard top stacked combination oven was in disrepair and fraying, with food debris accumulating inside areas of disrepair.
Deck 10 ? Aqualina galley: The door gasket for the starboard top stacked combination oven was in disrepair and fraying.
Deck 9 ? lido galley portside: The door gaskets for the top and bottom stacked combination ovens were fraying, with food debris accumulating inside areas of disrepair.
Deck 4 ? main galley hot line: The door gasket at the bottom of the door for the large combination oven was in disrepair and detached.
Crew initiated corrective action.
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|
Recommendation:
Ensure nonfood-contact surfaces of equipment that are exposed to splash, spillage, or other food soiling or that require frequent cleaning are constructed of a corrosion-resistant, nonabsorbent, and smooth material. Design and construct nonfood-contact surfaces of equipment and utensils to be durable and to retain their characteristic qualities under normal use conditions. Ensure nonfood contact equipment is maintained in good repair and proper adjustment including: (1) Equipment maintained in a state of repair and condition that meets the materials, design, construction, and operation specifications of these guidelines; (2) Equipment components such as doors, seals, hinges, fasteners, and kick plates are kept intact, tight, and adjusted in accordance with manufacturer's specifications.
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Item No.:
22
|
|
Site:
Galley-Deck 10 - Aqualina Starboard Warewashing Area
|
|
Violation:
The wash solution inside the rack-type warewashing machine was cloudy, with pieces of yellow food debris floating throughout.
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|
Recommendation:
Ensure the wash, rinse, and sanitize solutions are maintained clean.
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Item No.:
22
|
|
Site:
Galley-Deck 10 - Aqualina Starboard Warewashing Area
|
|
Violation:
Liquid steadily dripped from the bottom of the rinse compartment for the rack-type warewashing machine and accumulated on the deck below.
|
|
Recommendation:
Maintain warewashing equipment in good repair and proper adjustment, including: (1) warewashing equipment is maintained in a state of repair and condition that meets the standards of the materials, design, and construction of these guidelines.
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Item No.:
22
|
|
Site:
Galley-Deck 4 - Aft Potwash Area
|
|
Violation:
The wash solution inside the three-compartment sink was cloudy. It was not possible to see the bottom of the compartment. Crew initiated corrective action.
|
|
Recommendation:
Ensure the wash, rinse, and sanitize solutions are maintained clean.
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|
|
Item No.:
26
|
|
Site:
Galley-Deck 4 - Portside Cold Pantry, Forward
|
|
Violation:
The food-contact surface of the ice thickness sensor of the ice machine was soiled with a gray slimy residue. Crew initiated corrective action.
|
|
Recommendation:
Ensure food contact surfaces of equipment and utensils are clean to sight and touch.
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|
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Item No.:
28
|
|
Site:
Galley-Deck 4 - Hot Service Line
|
|
Violation:
Four plastic plate covers were stacked wet and unable to dry on the service line. Liquid dripped from the surfaces when removed. Crew initiated corrective action.
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|
Recommendation:
Store clean equipment and utensils in a self-draining position that allows air drying and covered or inverted.
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Item No.:
33
|
|
Site:
Food Service General-Decks, Bulkheads, and Deckheads
|
|
Violation:
The deck, deckheads, and bulkheads were in disrepair, creating difficult to clean surfaces throughout multiple food service areas, including:
-Deck 10 ? Aqualina galley: Silicon between the bulkhead panels behind the flat-top grill was peeling and in disrepair, creating a 1/4-inch gap.
-Deck 9 ? Windows Caf aft buffet line: The caulking below the handwashing sink was peeling, with dust accumulating inside areas of recess.
-Deck 9 - Windows Caf portside coffee station: No coving was present at the bottom of the employee service area of the coffee station, creating a 90 angle. Dust and residue accumulated in the sharp edge.
-Deck 9 ? lido galley starboard: Silicone between the bulkhead panels behind the stacked combination ovens was peeling and in disrepair.
-Deck 9 ? lido galley starboard: The tiles underneath the handwashing sink were chipped and damaged, with dust and debris accumulating inside areas of recess.
-Deck 9 ? smoothie bar portside: The silicone between the bulkhead and undercounter refrigeration unit # 9.5 was peeling, with black residue accumulating inside areas of recess.
-Deck 9 ? Patio outdoor galley starboard: The decorative bulkhead behind the self-service salad bar was peeling. A sticky residue accumulated over areas of disrepair.
-Deck 4 ? main galley meat preparation area, starboard: Silicon between the bulkhead panels behind the meat saw was peeling and in disrepair, creating a 1/8-inch seam.
-Deck 4 ? main galley hot preparation area: Tile grouting in front of the grooved grill was damaged and in disrepair, with food debris accumulating in areas of recess.
-Deck 4 ? main galley hot preparation area: The deck tile in front of the deep fat fryer was damaged and cracked, with food debris accumulating in areas of recess.
-Deck 4 ? main galley portside warewashing area: Silicon between the bulkhead panels behind the conveyor-type warewashing machine was peeling.
-Deck 3 ? crew galley walk-in refrigeration unit # 330: The grouting between the deck and the bulkhead was recessed, with liquid accumulating inside areas of recess.
-Deck 3 ? crew galley: The deck tile in front of the soup kettles was cracked, with dust and debris accumulating inside areas of recess.
Crew initiated corrective action.
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|
Recommendation:
Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, bars, and food and equipment storage areas are constructed and maintained for easy cleaning. Cove all bulkhead/deck, equipment/deck, cabinet/deck, and deck sink coaming/deck junctures (including galleys, pantries, buffets, bars, waiter stations, dining room work counters, provisions, food storage rooms, equipment/utensil storage rooms, and toilet rooms intended for use by galley personnel). Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary. Ensure decks, bulkheads, and deckheads in food preparation, warewashing, pantries, and storage areas are maintained in good repair.
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Item No.:
33
|
|
Site:
Galley-Deck 10 - Aqualina Starboard Warewashing Area
|
|
Violation:
Liquid accumulated on the deck beneath a steady drip from the bottom of the rack-type warewashing machine.
|
|
Recommendation:
Ensure decks, bulkheads, deckheads, and attached equipment in food preparation, warewashing, pantries, and storage areas are cleaned as often as necessary.
|
|
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Item No.:
39
|
|
Site:
Galley-Deck 4 - Bakery
|
|
Violation:
One fruit fly flew in front of the mobile trolleys storing baked goods.
|
|
Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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|
|
Item No.:
39
|
|
Site:
Galley-Deck 4 - Starboard Meat Preparation Area
|
|
Violation:
One fruit fly flew in front of the food service elevator.
|
|
Recommendation:
Effectively control the presence of insects, rodents, and other pests to minimize their presence in the food storage, preparation, and service areas and warewashing and utensil storage areas aboard a vessel.
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|
|
Item No.:
40
|
|
Site:
Galley-Deck 4 - Starboard Meat Preparation Area
|
|
Violation:
More than 12 dead houseflies accumulated on the sticky paper inside the insect-control device, located to the left of the food-service elevator.
|
|
Recommendation:
Remove dead or trapped insects, rodents, and other pests from control devices and the vessel at a frequency that prevents their accumulation or decomposition or the attraction of other pests.
|
|
|
Item No.:
41
|
|
Site:
Housekeeping-Deck 9 - Spa Changing Room
|
|
Violation:
The two secondary exits from both the men's and women's spa changing rooms did not provide paper towels or another hands-free method to open the doors. Additionally, there were no signs advising users to use a hand towel, paper towel, or tissue to open the doors.
|
|
Recommendation:
Equip passenger and crew public toilet facilities so persons exiting the toilet room are not required to touch the door handle with bare hands. Where toilet stalls include handwashing facilities, ensure the bare-hands-free contact begins in the toilet stall. Ensure that toilet facilities with multiple exits, such as spa dressing rooms, have bare-hands-free contact at each exit. Post a sign advising users of toilet facilities to use hand towel, paper towel, or tissue to open the door unless the exit is hands free. A pictogram that illustrates the correct use and disposal of paper towels may be used in lieu of a sign.
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|
|
Item No.:
44
|
|
Site:
Medical-Public Vomit/Public Diarrhea Incident (PVI/PDI) Log
|
|
Violation:
There was no documented medical follow-up for a PDI/PVI in a stateroom on November 17, 2024. Crew were unable to determine if this met the acute gastroenteritis (AGE) case definition.
|
|
Recommendation:
Investigate all public vomiting and public diarrhea incidents and ensure the ill passenger is appropriately followed-up with by medical. Document the follow-up. Ensure a reportable case of AGE is a case reported to the master of the vessel, the medical staff, or other designated staff by a passenger or a crew member; and meets the case definition based on the following symptoms: (1) Diarrhea (three or more episodes of loose stools in a 24-hour period or what is above normal for the individual (see section 4.1.2.1.3, illness symptoms); or (2) vomiting and one additional symptom including one or more episodes of loose stools in a 24-hour period, or abdominal cramps, or headache, or muscle aches, or fever (temperature of greater than or equal to 38C [100.4F]).
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