Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-3066

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Country: 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: BRITISH COLUMBIA

6. Date incident was first observed.

27-MAY-20

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.

Product Name: Compound 1080

• Active Ingredient(s)
  • SODIUM MONOFLUOROACETATE

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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).

Site: Unknown / Inconnu

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

The following was reported: Two dogs from different owners were walking in the same area and both showed up in our clinic on emergency, dead on arrival. Both dogs exhibited signs of Compound 1080 ingestion (see above). We have seen deaths from Compound 1080 before so we had a feeling it was exactly this. Necropsy and toxicology confirmed this. The pathologist suspects due to the low ppb, that this was a secondary poisoning (the dogs ate some of a carcass that originally died from compound 1080 ingestion).

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Unknown

4. Number of animals affected

2

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

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Fecal incontinence

• General
  • Symptom - Abnormal behaviour
  • Specify - acting frantic

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify suspected accidental secondary poisoning

17. Provide any additional details about the incident

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

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To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here

The following was reported: Both dogs walked in the same area. 4-6 hours later, both dogs were acting frantic, seizuring, deficating, and then dying. Both brought dead on arrival to (Name) Veterinary Clinic on emergency after hours call.