Health Canada
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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-17Product 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
