Health Canada
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Consumer Product Safety
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-2316
2. Registrant Information.
Registrant Reference Number: x
Registrant Name (Full Legal Name no abbreviations): x
Address: x
City: x
Prov / State: x
Country: x
Postal Code: X
3. Select the appropriate subform(s) for the incident.
Environment
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
29-AUG-13Product 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.
Product Name: Avitrol
- Active Ingredient(s)
- 4-AMINOPYRIDINE
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
Site: Pub. Area - Outdoor/Zone publique - ext
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
On August 29, 2013, a newspaper article ran, reporting that stressed or dying pigeons (3, over the previous week) had been found in the vicinity of the xxx Mall and xxx General Hospital - which are approximately 1 km apart. One of the birds, found Sunday, August 25, 2013, had been found in the xxx Mall parking lot, and was taken to a wildlife centre. Poisoning, likely by pesticide (avicide) was suspected.To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Bird - Flocking/Oiseau-Vivant en colonie
2. Common name(s)
pigeon
3. Scientific name(s)
Unknown
4. Number of organisms affected
6
5. Description of site where incident was observed
Fresh water
Terrestrial
Other
Salt Water
6. Check all symptoms that apply
Death
Impairment of health
7. Describe symptoms and outcome (died, recovered, etc.).
Stressed or dying pigeons (3, over the previous week) had been found in the vicinity. Caller also noted that a friend had observed 3 similarly stressed pigeons at the hospital property.
8. a) Was the incident a result of (select all that apply)
Application
8. b) i) How many times has the product been applied this year?
8. b) ii) What was the date of the last application?
9. Did it rain
9. a) During application?
No
9. b) Up to 3 days after application?
No
10. a) Was there a buffer zone?
No
10. b) What type?
Aquatic
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
No
