Health Canada
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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-4841
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.
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.
Product Name:
- Active Ingredient(s)
- STRYCHNINE
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Unknown / Inconnu
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
Other
2. Type of animal affected
Other / Autre
3. Breed
Dog
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
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
- General
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
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
Died
16. How was the animal exposed?
Other / Autre
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
On March 13, 2010, a dog was poisoned on Mrs.(name) property and died. The lab report confirmed that strychnine was the cause. County officials and RCMP investigated the incident to determine the source of strychnine. RCMP Cst (name), SRD Cst.(first and last name) and County Ag.(name), (First and last name), checked for sources of strychnine and interviewed the neighbours. (First and last name), County of (name), advised that one producer, Mr.(first and last name), did participate in the two percent LSC program in the previous year. Mr.(name)owns the land surrounding Mrs.(last name)property and purchased three cases to treat three quarters of land. This was not an unreasonable amount of product for that much land. No other sources of strychnine were uncovered in this area. The lab report from Mrs.(name)vet indicates that five per cent LSC was used. Also, venison meat was indicated in the stomach contents. The suspect in this case was not Mr.(name) but the neighbour, who is a former trapper. This neighbour has never purchased two per cent LSC from program.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Not Applicable
