Health Canada
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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2022-5593
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.
Environment
4. Date registrant was first informed of the incident.
5. Location of incident.
Country: CANADA
Prov / State: PRINCE EDWARD ISLAND
6. Date incident was first observed.
01-AUG-22Product 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: AVITROL (UNSPECIFIED FORMULATION)
- Active Ingredient(s)
- 4-AMINOPYRIDINE
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 IV: Environment (includes plants insects and wildlife)
1. Type of organism affected
Bird - Flocking/Oiseau-Vivant en colonie
2. Common name(s)
ROCK PIGEON
3. Scientific name(s)
Unknown
4. Number of organisms affected
1
5. Description of site where incident was observed
Fresh water
Terrestrial
Roadside
Salt Water
6. Check all symptoms that apply
Abnormal behavioural effects
Impairment of health
7. Describe symptoms and outcome (died, recovered, etc.).
A Rock pigeon was found downtown Charlottetown in front of the [Company] [Address] on August 2, 2022. It was shaking, convulsing and moving around on its abdomen. It was picked up and brought to the [Service]. The pigeon was euthanized by T61 while under isoflurane, as per Avian Influenza protocol. Avitrol (4-AMINOPYRIDINE) use is suspected and stomach samples were collected and frozen in the -80 freezer of the [Organization] at the [Organization]. The crop contents of this pigeon were sent for testing to the [University] [Laboratory] in September and results show that it was strongly positive for Avitrol - 4-AMINOPYRIDINE.
8. a) Was the incident a result of (select all that apply)
Unknown
8. b) i) How many times has the product been applied this year?
Unknown
8. b) ii) What was the date of the last application?
Unknown
9. Did it rain
9. a) During application?
Unknown
9. b) Up to 3 days after application?
Unknown
10. a) Was there a buffer zone?
Unknown
10. b) What type?
10. c) What was the size of the buffer zone?
11. a) Were environmental samples collected and analysed?
Yes
