Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2022-0976

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.

Human

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.

02-FEB-22

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. 33076      PMRA Submission No.       EPA Registration No.

Product Name: PROZAP 10% ZINC PHOSPHIDE TRACKING POWDER

• Active Ingredient(s)
  • ZINC PHOSPHIDE

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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).

On October 5 2021, X came to my apt for a mouse sighting. They used large amounts of this product in open spaces in my home (in kitchen cupboards!). At the time, I did not know that this product is federally regulated, and it states clearly on the label that it is not for residential use. Prior to adopting my cat, I cleaned this product myself out of every corner of my small apartment not knowing it was poison. I was not made aware that it needed to be disposed of in any special way, or cleaned wearing gloves and a respirator. I thought I had cleaned it all up, but I didn't see where the X employee had put it in my bathroom. Under the cabinet beneath my bathroom sink, there is a baseboard covering the gap between the floor and the bottom of the cabinet. This baseboard was not properly secured, and excessive amounts were found underneath the cabinet.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform II: Human Incident Report (A separate form for each person affected)

1. Source of Report.

Data Subject

2. Demographic information of data subject

Sex: Female

Age: >19 <=64 yrs / >19 <=64 ans

3. List all symptoms, using the selections below.

System

• Nervous and Muscular Systems
  • Symptom - Dizziness

• Gastrointestinal System
  • Symptom - Nausea

• Nervous and Muscular Systems
  • Symptom - Headache

4. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

6. a) Was the person hospitalized?

Unknown

6. b) For how long?

7. Exposure scenario

Non-occupational

8. How did exposure occur? (Select all that apply)

Contact with treated area

What was the activity? CLEANING PRODUCT FROM APARTMENT

Other

9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)

Unknown

10. Route(s) of exposure.

Skin

Respiratory

11. What was the length of exposure?

Unknown / Inconnu

12. Time between exposure and onset of symptoms.

Unknown / Inconnu

13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)

Prior to adopting my cat, I cleaned this product myself out of every corner of my small apartment not knowing it was poison. I was not made aware that it needed to be disposed of in any special way, or cleaned wearing gloves and a respirator. I was not aware that this poison causes a release of phosphine gas into the air, so I did not open any windows. Out of fear of my cat eating more of the grey powder, I tried to clean most of the powder myself. I began to feel dizzy, nauseous and had a headache (still not knowing this was rat poison). I called ASPCA poison control, and they informed me to call human poison control as well as I had been exposed to phosphine gas.

To be determined by Registrant

14. Severity classification.

15. Provide supplemental information here.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

UNKNOWN

4. Number of animals affected

1

5. Sex

Unknown

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

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Lethargy
  • Symptom - Subdued
  • Specify - Depressed

• Gastrointestinal System
  • Symptom - Loss of appetite

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

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

On Feb 22, 2022 my cat pulled the baseboard off and ate the poison. In the middle of the night, I woke up to my cat being sick on my bed, and on the floor and numerous other spots around my home. I called the emergency vet and they told me to contact X to find out what was used in my home. I brought my cat to the vet.

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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