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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2684

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16025317

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.

15-APR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

15-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.

Product Name: Ramik Green (non-specific)

  • 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?

Yes

9. Application Rate.

Unknown

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

Site: Res. - Out Home / Rés - à l'ext.maison

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

The dog was found on 4/15/08 with symptoms of profuse bloody diarrhea, vomiting blood, and a painful distended abdomen. An empty package of the product was found near-by (under a porch). No witnessed exposure.

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4.5

7. Weight (provide a range if necessary )

30

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 - Bloody diarrhea
    • Symptom - Bloody vomit
    • Symptom - Stomach pain
    • Specify - Painful, distended abdomen
  • 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 No witnessed exposure; an empty package of the product was found near-by the symptomatic dog

17. Provide any additional details about the incident

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

1-16025317: The reporter, a veterinarian, called on 4/15/08 to report a 4.5 year old female dog may have been exposed to a rodenticide containing the active ingredient Diphacinone 3.5 days ago. There was no witnessed exposure, but an empty package of the product was found near-by the symptomatic dog. The dog was presenting to her with profuse bloody diarrhea, vomiting blood, a painful, distended abdomen, and a Packed Cell Volume (PCV) of 60%. The toxicity of long acting anti-coagulants was discussed, along with recommendations to give vitamin K1 plus whole blood or fresh frozen plasma. A follow-up call on 4/16/08 revealed that the dog had passed away before the veterinarian could perform a transfusion. A recommendation was made to check the Total Protein (TP) as well as the PCV in future acute blood loss situations, as the TP will decrease much more quickly than the PCV when an animal is hemorrhaging.


To be determined by Registrant

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

Death

19. Provide supplemental information here