Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-5928

2. Registrant Information.

Registrant Reference Number: Prosar 1-16718567

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.

07-OCT-08

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

07-OCT-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 61282-23

Product Name: Ramik Green Mini Bait Pack

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

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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 product was applied outside on 10/07/2008.

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

Mixed Breed

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Blood
  • Symptom - Bleeding

• 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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-16718567: A reporter called on 10/07/2008 to report the exposure of three dogs to an anticoagulant rodenticide containing the active ingredient Diphacinone. According to the reporter, the product was spread outside earlier on the day of the report where he thought the dogs would not have access to it. Twenty minutes prior to the report, the reporter saw the older dog eat 6-7 pellets, and the two puppies ingested an unknown amount. The reporter was advised of the toxic doses for each dog given the reported weights. The caller was also advised that based on the potential for toxicity, all three dogs need to be evaluated by a veterinarian and treated with the antidote, Vitamin K1, for 3-4 weeks. The toxic profile was discussed including time frame to onset of signs, clinical signs, and potential for death without treatment. Induction of emesis was discussed including the procedure and the need to follow up with a veterinarian for treatment regardless of whether the dogs vomit product or not. A recommendation was made to have the treating veterinarian check a prothrombin time 48 hours after completion of the Vitamin K1 therapy to ensure treatment is complete. After several unsuccessful attempts at follow up, the reporter was reached on 10/10/2008. The reporter stated that the older dog had been seen by the veterinarian and given an unknown injection. Neither puppy had been evaluated by a veterinarian as the reporter stated that they are skittish and he was unable to catch them. The reporter was advised that the dogs needed to be evaluated immediately by a veterinarian given the potential for toxicity. On follow up on 10/13/2008, the reporter stated that the adult dog was evaluated by a veterinarian (unknown date) and started on Vitamin K1 for 2 weeks. This dog was asymptomatic. Neither puppy was seen by the veterinarian and neither puppy had been given Vitamin K1. One puppy was asymptomatic at the time of the follow up. The second puppy developed severe hemorrhage (unknown date) and died on 10/12/2008. No further information was obtained.

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To be determined by Registrant

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

Death

19. Provide supplemental information here