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
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