Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-1708

2. Registrant Information.

Registrant Reference Number: 6036558

Registrant Name (Full Legal Name no abbreviations): Premier Tech Ltd.

Address: 1 avenue Premier,

City: Riviere-du-Loup,

Prov / State: Quebec

Country: Canada

Postal Code: G5R 6C1

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

Domestic Animal

4. Date registrant was first informed of the incident.

01-MAR-19

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

21-FEB-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. 29427      PMRA Submission No.       EPA Registration No.

Product Name: Wilson Predator Rat & Mouse Killer

• Active Ingredient(s)
  • CELLULOSE (FROM POWDERED CORN COBS)

---

7. b) Type of formulation.

Application Information

8. Product was applied?

Unknown

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

Dog / Chien

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

18.3

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

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

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?

Other / Autre

specify Treated by vet with an antidote for an active that was not present in the bait that the animal was exposed.

17. Provide any additional details about the incident

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

2/21/19;12:15pm: Caller stated that on Jan 21st her dog ingested this product outside of a neighbors house. The dog was treated at the vet for warfarin ingestion, and sent home with vit. K. The dog passed away 25 days later at home. The pet owner wants us to send a msds. PCP provided 29427 100% cellulose , pet owner does not agree with what the pc msds has on it. 2/21/19; 12:24pm. Caller called back stating that her dog was being watched by a neighbor. She indicates that he had left a Wilson Predator Rat & Mouse Killer product in an area where the dog could access it and ingested between a third and a half of the 60 gram bag. Caller states that the dog was taken to a vet nearby where it was given fluids and K1 subcutaneously. Dog was released with vitamin K and instructions to give to the dog. Caller states that her dog's condition continued to deteriorate, the dog had been taken to the vet multiple times, but eventually died over the past weekend. Caller states her neighbor provided a PCP act number 29427 - which is cellulose. Her vet did a blood test on the dog with results for difethialone. Caller concerned that packaging does not contain information on product ingredients. She indicates that the box her neighbor had supplied for the product contains no PCP no or active ingredient information. Caller is requesting SDS be sent for the difethialone product to. 2/22/2019; case was transfered over to ASPCA to monitor out. Owner was called to continue the case review, however the call was bumped to internal DVM who spoke with the animal owner. Since the pet was taking vitamin K the DVM didn't feel that the signs were related. Vitamin K is a specific antidote and at appropriate dose is expected to prevent a coagulopathy. The caller wanted to know what happened to the dog, unfortunately an answer was not able to be provided for that question. Necropsy is pending. Outcome unknown

---

To be determined by Registrant

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

Death

19. Provide supplemental information here

Based on the initial information provided, it would appear that the vet treated the animal incorrectly by administering vitamin K as an antidote for an active that was not involved in the incident. Vitamin K has been reported to have the same effect on animals as a rodenticide poisoning. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified.