Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5340

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-27750293

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.

20-OCT-11

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

6. Date incident was first observed.

18-OCT-11

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. 61282-49

Product Name: Prozap Zinc Phosphide Pellets

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

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: Agricultural-Outdoor/Agricole-extérieur

Préciser le type: poultry (chicken)

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

Bird - Poultry / Oiseau - Volaille

3. Breed

chicken (nonspecific)

4. Number of animals affected

4

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Seizure
  • 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

1-27750293- The reporter, an animal owner, indicated her animals had been exposed to a pesticide containing the active ingredient zinc phosphide. The animal owner indicated her spouse had placed the product in a gopher hole to target that species. She believed the gophers had pushed the pesticide out of their hole and her chickens that had access to the area had ingested the product. The reporter indicated her husband baited for the rodents four days prior to her initial contact. She reported four animals (Subform III, #1) developed ataxia seizures and died three days after application. No ingestion was observed. She reported one remaining animal (Subform III, #2) developed ataxia but was responding favorably to nursing care she had provided. She reported the animal had laid an egg the morning of her initial contact that was visibly not normal. She asked how long the withdrawal period was associated with food animals destine for human consumption was following accidental ingestion. It was recommended the caller contact her area USDA, board of animal heath, or extension office to see if they had such data. She was advised not to consume the animal or eggs until she could be provided an appropriate withdrawal interval. No further information is available.


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

Bird - Poultry / Oiseau - Volaille

3. Breed

Chicken (nonspecific)

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

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

  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • Reproductive System
    • Symptom - Other
    • Specify - anormal egg

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

1-27750293- The reporter, an animal owner, indicated her animals had been exposed to a pesticide containing the active ingredient zinc phosphide. The animal owner indicated her spouse had placed the product in a gopher hole to target that species. She believed the gophers had pushed the pesticide out of their hole and her chickens that had access to the area had ingested the product. The reporter indicated her husband baited for the rodents four days prior to her initial contact. She reported four animals (Subform III, #1) developed ataxia seizures and died three days after application. No ingestion was observed. She reported one remaining animal (Subform III, #2) developed ataxia but was responding favorably to nursing care she had provided. She reported the animal had laid an egg the morning of her initial contact that was visibly not normal. She asked how long the withdrawal period was associated with food animals destine for human consumption was following accidental ingestion. It was recommended the caller contact her area USDA, board of animal heath, or extension office to see if they had such data. She was advised not to consume the animal or eggs until she could be provided an appropriate withdrawal interval. No further information is available.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here