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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-0779

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-55225199

Registrant Name (Full Legal Name no abbreviations): Neogen Corporation

Address: 620 Lesher Place

City: Lansing

Prov / State: Michigan

Country: USA

Postal Code: 48912

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

12-JAN-19

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

12-JAN-19

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. 61282-48

Product Name: RAMIK GREEN BAIT PACK KILLS RATS & MICE FISH FLAVORED WEATHER-RESISE

  • Active Ingredient(s)
    • DIPHACINONE (PRESENT IN FREE FORM OR AS SODIUM SALT)
      • Guarantee/concentration .005 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - In Home / Rés. - à l'int. maison

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

Dog / Chien

3. Breed

Mixed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

10

lbs

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
  • Gastrointestinal System
    • Symptom - Bloody vomit

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

1-55225199 - The reporter indicates an exposure to a pesticide containing the active ingredient diphacinone (present in free form or as a sodium salt). On the day of initial contact with the registrant, the reporter indicated her neighbor's 3-year-old, 10-pound, female, mixed-breed dog was vomiting blood. The reporter indicated that she had placed the product under her mobile home an unknown amount of time before the day of initial contact, and that the neighbor's dog had free range in the neighborhood. The reporter was advised to tell her neighbor to seek immediate veterinary care for the dog as the symptom could be related to product ingestion. On follow-up call two days later, the reporter indicated the dog had died before the neighbor could get her to the vet. No additional information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here