Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-1459

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-51639449

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.

12-MAR-18

5. Location of incident.

Country: UNITED STATES

Prov / State: IDAHO

6. Date incident was first observed.

12-MAR-18

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. Unknown

Product Name: PROZAP ZINC PHOSPHIDE 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?

Unknown

9. Application Rate.

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

Animal's Owner

2. Type of animal affected

Horse / Cheval

3. Breed

Quarter Horse

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

18

7. Weight (provide a range if necessary )

1000

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Renal System
  • Symptom - Frequent urination

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

1-51639449 - The reporter indicated his horse was exposed to a rodenticide containing the active ingredient zinc phosphide. One day before the day of initial contact with the registrant, the reporter indicated his 18-year-old, 1000-pound, male, Quarter horse ate some of the product. On the day of initial contact with the registrant, the horse was wobbly and looked like he was trying to urinate all the time. The reporter was advised to seek immediate veterinary care for the horse as the product is highly toxic. On follow-up call one day later, the reporter indicated he had called his veterinarian who said there was not much that could be done for the horse. The horse died on the day of initial contact. 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