Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-3362
2. Registrant Information.
Registrant Reference Number: ProPharma Group case#: 1-60022535
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.
04-FEB-20
5. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
04-FEB-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 61282-48
Product Name: RAMIK GREEN BAIT PACK KILLS RATS & MICE FISH FLAVORED WEATHER-RESISTAN
- 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?
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
Pit Bull Terrier
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
60
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- General
- Symptom - Death
- Symptom - Lethargy
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?
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
1-60022535 - The reporter, a pet owner, indicates an exposure to a pesticide containing the active ingredient diphacinone (present in free form or as sodium salt). Five days before the day of initial contact with the registrant, the reporter stated his 1-year-old, 60-pound, female, Pit Bull Terrier dog ate an unknown amount of the product. On the day of initial contact, the dog was lethargic and not eating. The reporter was advised to see immediate veterinary evaluation for the dog as the symptoms could be related to product ingestion. On follow-up call two days later, the reporter stated the dog had died at the veterinarian's office. 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