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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4862

2. Registrant Information.

Registrant Reference Number: 1-34552944

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-AUG-13

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

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)

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 61282-48

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: 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).

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

Female

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

20

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

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Parasitism
    • Specify - Live worms in stool
    • Symptom - Lethargy

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 Potential access to dead rats that had been poisoned with this product

17. Provide any additional details about the incident

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

1-34552944 - The reporter, a pet owner, indicated that his puppies may have been exposed to a rodenticide containing the active ingredient diphacinone. The reporter indicated that he saw his 3 month old, 20 pound, male mixed breed dog (Subform III #2) licking a dead rat on the day of initial contact with the registrant and at the time of initial contact his dog was not interested in eating his dinner. The reporter was advised that inappetance may be caused by a number of different diseases and relay toxicity is unlikely to result in significant ingestions of the active ingredient. The reporter indicated that there were numerous dead rats that the dog might have had access to. The reporter also indicated that his 3 month old, 20 pound, female, mixed breed puppy (Subform III #1) had been vomiting one day prior to initial contact and passed some worms in her stool. He gave that puppy a horse dewormer but it passed away the following morning. Per the reporter none of the puppies had been vaccinated nor had they ever been seen by a veterinarian. The reporter was advised that unvaccinated puppies are prone to numerous diseases including parvovirus which can present with the reported symptoms and immediate veterinary care was recommended for his male puppy. The reporter was further advised that the veterinarian could run a blood test to ensure the dog had not been exposed to significant amounts of this product but the described symptoms are not consistent with exposure to this active ingredient. On follow-up call, two days later, the reporter indicated that his male puppy had been vomiting and had diarrhea and at the time of the follow-up call the puppy was not moving and the reporter thought he might be dead. The reporter also indicated that there was now a third puppy that was suffering from vomiting and diarrhea. Immediate veterinary care was recommended for the third puppy but the reporter indicated that veterinary care was not an option due to financial constraints. 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

Dog / Chien

3. Breed

MIxed Breed

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

20

lbs

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 - Lethargy
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
    • Symptom - Anorexia
  • 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 Observed licking a dead rat that was poisoned with this product

17. Provide any additional details about the incident

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

1-34552944 - The reporter, a pet owner, indicated that his puppies may have been exposed to a rodenticide containing the active ingredient diphacinone. The reporter indicated that he saw his 3 month old, 20 pound, male mixed breed dog (Subform III #2) licking a dead rat on the day of initial contact with the registrant and at the time of initial contact his dog was not interested in eating his dinner. The reporter was advised that inappetance may be caused by a number of different diseases and relay toxicity is unlikely to result in significant ingestions of the active ingredient. The reporter indicated that there were numerous dead rats that the dog might have had access to. The reporter also indicated that his 3 month old, 20 pound, female, mixed breed puppy (Subform III #1) had been vomiting one day prior to initial contact and passed some worms in her stool. He gave that puppy a horse dewormer but it passed away the following morning. Per the reporter none of the puppies had been vaccinated nor had they ever been seen by a veterinarian. The reporter was advised that unvaccinated puppies are prone to numerous diseases including parvovirus which can present with the reported symptoms and immediate veterinary care was recommended for his male puppy. The reporter was further advised that the veterinarian could run a blood test to ensure the dog had not been exposed to significant amounts of this product but the described symptoms are not consistent with exposure to this active ingredient. On follow-up call, two days later, the reporter indicated that his male puppy had been vomiting and had diarrhea and at the time of the follow-up call the puppy was not moving and the reporter thought he might be dead. The reporter also indicated that there was now a third puppy that was suffering from vomiting and diarrhea. Immediate veterinary care was recommended for the third puppy but the reporter indicated that veterinary care was not an option due to financial constraints. 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