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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-3100

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.

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

15-JUN-17

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. 30433      PMRA Submission No.       EPA Registration No.

Product Name: 2% LIQUID STRYCHNINE CONCENTRATE

  • Active Ingredient(s)
    • STRYCHNINE

7. b) Type of formulation.

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

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The site treated was approximately 40 acres of cereal crop. 1 kg of oats mixed with 250ml of 2% Liquid stychnine concentrate. The recommended application rate is 5-15 g of strychnine treated gaine deep in the burrow hole. Dog owner believes dog left his property and went into producer's field where strychnine had been put out to kill gophers. Dog ate a gopher. It is unknown how many, vet did not send stomach contents away for analysis. Dog did survive.

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

German Sheppard

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

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 - Discomfort
    • Specify - uncomfortable
  • Gastrointestinal System
    • Symptom - Other
    • Specify - stomach partially rotated
    • Symptom - Other
    • Specify - gas buildup

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

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?

Accidental ingestion/Ingestion accident.

specify Dog owner believes dog left his property and went into producer's field where strychnine had been put out to kill gophers. Dog ate a gopher. It is unknown how many, vet did not send stomach contents away for analysis. Dog did survive.

17. Provide any additional details about the incident

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

Dog owner noticed his dog feeling uncomfortable. He took to the vet on night of June 15, 2016. A physical exam and radiograph were completed. Gopher bones were spotted in intestines. Suspect mild dose poisoning. The local vet stated the timeline did not fit for poisoning. Dog exhibited symptoms of gas build up, the stomach was particularly rotated not flipped and full of gas. Dog owner came to Municipal (name) Administration Building on the morning of June 16,2017 stating he believed his dog was at the vet sick due to he believed strychnine exposure from eating a gopher. MD By-law officer went to site. Julie Sisson Pesticide Compliance Officer from Health Canada was contacted and she made a site visit by late that afternoon.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here