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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5554

2. Registrant Information.

Registrant Reference Number: PROSAR Case 1-15137935

Registrant Name (Full Legal Name no abbreviations): HACCO, Inc.

Address: 110 Hopkins Drive

City: Randolph

Prov / State: Wisconsin

Country: USA

Postal Code: 53956

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.


Prov / State: UNKNOWN

6. Date incident was first observed.


Product Description

7. a) Provide the active ingredient and, if available, the registration number and product name (include all tank mixes). If the product is not registered provide a submission number.


PMRA Registration No.       PMRA Submission No.       EPA Registration No. 61282-46

Product Name: Ramik Green - EPA: 61282-46

  • Active Ingredient(s)
      • Guarantee/concentration .005 %

7. b) Type of formulation.


Application Information

8. Product was applied?


9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Renal System
    • Symptom - Blood in urine
  • Nervous and Muscular Systems
    • Symptom -
    • Specify - Unable to hold up Head
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Other / Autre

specify Unknown Exposure Route

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

History: Caller states that two days ago the dogs had gotten into the product. "Sasha" = 25lb, 5 mo, Very thin "Lolo"= >50lb, 1.5 yo, healthy She states that now "Sasha" is very lethargic, can not hold head, is vomiting, and they have noticed some blood in the urine. "Lolo" is ASX. The owner is wondering what she can do to help. Caller is wondering who is going to pay for the vet bills Assessment: With the history that you have given me it is very important that you bring "Sasha" to the Veterinarian ASAP. I would recommend that you bring "Lolo" with to be evaluated also. This product caused animals to lose their ability to clot blood, and if you do not go into the veterinarian there could be some serious consequences. When you go the DVM bring the packaging with you. 7/25/07 Follow-Up information Sasha was taken to the DVM but died (not euthanized) today. She states it was too late for any treatments. Lolo was also taken to the DVM but no treatment was given. Has remained ASX.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here