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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2683

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16013238

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.

13-APR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

06-APR-08

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.

Active(s)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 61282-48

Product Name: Ramik Green Bait Packs

  • Active Ingredient(s)
    • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM SALT)
      • Guarantee/concentration .005 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Unknown

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?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.42

7. Weight (provide a range if necessary )

22

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Other
    • Specify - Foreign body or obstruction
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify The reporter found a mouse in the dog's emesis and believed the dog ingested it after the mouse died from eating the bait.

17. Provide any additional details about the incident

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

1-16013238: The reporter called on 4/13/08 to report her 5 month old puppy had been vomiting for 1 week. She had not witnessed an exposure to a rodenticide product containing the active ingredient Diaphacinone, but she had found a whole mouse in the dog's emesis and believed the dog ingested it after the mouse died from eating the bait. The dog had been evaluated by a veterinarian on 4/10/08, and had been given injections for suspected intestinal parasites. The vomiting continued, so the reporter called to inquire if the product could cause persistent vomiting. The safety profile of the product was discussed, and a recommendation was made to have the dog re-evaluated in light of continuing symptoms. A follow-up call on 4/18/08 revealed that the dog had been taken back to a veterinarian on 4/15/08, but had died on 4/16/08. A foreign body (rag/towel) had been seen on x-ray.


To be determined by Registrant

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

Death

19. Provide supplemental information here