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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2691

2. Registrant Information.

Registrant Reference Number: Prosar case 1-16026521

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.

16-APR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

16-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. 61282-46

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?

Yes

9. Application Rate.

Unknown

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

Site: Unknown / Inconnu

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

The reporter stated the product was placed out on 4/9/08 and the dog had had access to those areas ever since.

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

Unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

40

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 - Vocalizing
    • Symptom - Hypothermia
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
  • Nervous and Muscular Systems
    • Symptom - Depression
  • General
    • Symptom - Pale mucous membrane colour
    • Specify - White gums
    • 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, presumed ingestion

17. Provide any additional details about the incident

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

1-16026521: The reporter called on 4/16/08 to report his 4 month old female puppy may have been exposed to rodenticide containing the active ingredient Diphacinone. The product was placed out on 4/9/08 and the puppy had had access to the areas where the product was applied ever since. On 4/16/08 the puppy had become anorexic, depressed, lethargic, and was vocalizing. She was taken to a veterinarian, where an examination revealed her to be hypothermic (94 F) with white mucous membranes. Hospitalization and blood work was recommended, which the owner refused due to financial constraints. The reporter called hoping there was something he could do at home. He was advised that hospitalization and aggressive emergency treatment are critical, as there was nothing worthwhile he could do at home. The reporter then disconnected. Several attempts were made at follow-up; on 4/21/08 contact was established and the reporter revealed that the puppy had died at home on 4/17/08.


To be determined by Registrant

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

Death

19. Provide supplemental information here