Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-3445

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-48401116

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.

30-MAY-17

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

30-MAY-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)

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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 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 61282-51

Product Name: PROZAP ZINC PHOSPHIDE RODENT OAT BAIT

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

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

Cow / Vache

3. Breed

Unknown

4. Number of animals affected

8

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 - 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

1-48401116 - The reporter, an animal owner, indicated his cows may have been exposed to two rodenticides both containing the active ingredient zinc phosphide. During the evening before the day of initial contact with the registrant, the reporter indicated eight of his cows of unknown age, weight, breed and gender had broken into a shed where the product was kept and ate an unknown amount of the product. All of the cows were dead at the time of the call. The reporter was informed that ingestion of even small amount of the product can be deadly. No additional follow up was done. No additional information is available.

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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

Cow / Vache

3. Breed

Unknown

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

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

• Nervous and Muscular Systems
  • Symptom - Recumbent

• 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

1-48401116 - The reporter, an animal owner, indicated his cows may have been exposed to two rodenticides both containing the active ingredient zinc phosphide. During the evening before the day of initial contact with the registrant, the reporter indicated four of his cows of unknown age, weight, breed and gender had broken into a shed where the product was kept and ate an unknown amount of the product. All of the cows were recumbent at the time of the call. The reporter was informed that ingestion of even small amount of the product can be deadly, and immediate veterinary attention was needed. On follow-up call one day after the day of initial contact, the reporter indicated all four cows had died. He was unable to get a veterinarian to come out to his farm. No additional information is available.

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To be determined by Registrant

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

Death

19. Provide supplemental information here