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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2685

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16213267

Registrant Name (Full Legal Name no abbreviations): HAACO, 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.

30-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: GEORGIA

6. Date incident was first observed.

29-MAY-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. 61282-46

Product Name: Ramik Green

  • 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

Pig / Cochon

3. Breed

Pot-Bellied

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

200

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

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Nervous and Muscular Systems
    • Symptom - Recumbent
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

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. The reporter thought the pig may have ingested product sometime within 2-3 days of the call.

17. Provide any additional details about the incident

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

1-16213267: The reporter called on 5/30/08 to report the possible ingestion of a long acting anti-coagulant rodenticide by her 3 year old, 200 lb pot bellied pig sometime within the previous 2-3 days. The exposure had not been witnessed. The rodenticide contained the active ingredient Diphacinone. According to the reporter, on 5/29 the pig had developed lethargy, anorexia and would not get up. She had contacted her veterinarian, but by the time of the call the pig had not been examined. The reporter inquired about and was given information on the toxic dose for the pig. After receiving this information, she revealed that the amount of product missing was considerably less than this toxic amount. The safety profile of the product was discussed, including signs to monitor for if the pig had ingested a toxic amount of product. PT testing was discussed as a way to rule out exposure to a long acting anti-coagulant rodenticide. A recommendation was also made to have the pig evaluated by a veterinarian. A follow-up call on 6/3 revealed the pig had passed away without being seen by a veterinarian.


To be determined by Registrant

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

Death

19. Provide supplemental information here