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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-6391

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.

05-NOV-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.

Product Name: Jaguar 50

  • Active Ingredient(s)
    • BRODIFACOUM

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

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

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The following was reported: We were unaware that someone had placed Jaguar 50 by Motomco rodenticide on our property without our knowledge.

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

Male

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

  • Respiratory System
    • Symptom - Coughing
    • Symptom - Difficulty Breathing
    • Specify - windpipe was almost completely closed
  • General
    • Symptom - Hemorrhage
    • Specify - massive internal bleeding
  • Nervous and Muscular Systems
    • Symptom - Lameness
    • Specify - could not put any pressure on his front paw
  • 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?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify exposure was not witnessed

17. Provide any additional details about the incident

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

The following was reported: Coughing started around November 9, 2019 and we thought it was kennel cough so when it got worse over the next couple days we decided to take him in. He was making an awful noise while breathing anytime he moved around. He could not put any pressure on his front paw the evening before we took him in. When we took him to the vet on November 12th his windpipe was almost completely closed up and he had massive internal bleeding. We left him at the vet clinic overnight with a tube down his throat to keep his airway open and on oxygen. They also administered multiple doses of K1 but it was too late. The vet said it was either major trauma (hit by a vehicle) or rodenticide. He passed in the early hours of November 13th. We do have a blood sample that we may decided to have tested.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here