Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3938

2. Registrant Information.

Registrant Reference Number: Prosar 1-20668109

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.

Human

Domestic Animal

4. Date registrant was first informed of the incident.

06-NOV-09

5. Location of incident.

Country: UNITED STATES

Prov / State: OREGON

6. Date incident was first observed.

Unknown

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. 61282-49

Product Name: Prozap Zinc Phosphide Pellets

• Active Ingredient(s)
  • ZINC PHOSPHIDE
    • Guarantee/concentration 2 %

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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 to an unknown site outside the home 1 week prior to the report.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Male

Age: >64 yrs / > 64 ans

3. List all symptoms, using the selections below.

System

• Cardiovascular System
  • Symptom - Bradycardia

• Nervous and Muscular Systems
  • Symptom - Numbness

4. How long did the symptoms last?

Unknown / Inconnu

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

Yes

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Application

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. No further information was obtained.

To be determined by Registrant

14. Severity classification.

Moderate

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify Goat

3. Breed

Unknown Breed

4. Number of animals affected

2

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

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 - 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

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. 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

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Great Pyrenees

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

90

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

12. How long did the symptoms last?

Unknown / Inconnu

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify Unknown if exposure occurred-possible secondary ingestion of pesticide via eating poisoned goats

17. Provide any additional details about the incident

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

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. 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

Moderate

19. Provide supplemental information here