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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2010-3938

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: Prosar 1-20668109

Nom du titulaire (nom légal complet, aucune abbréviation): HACCO, Inc.

Adresse: 110 Hopkins Drive

Ville: Randolph

État: Wisconsin

Pays: USA

Code postal /Zip: 53956

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez l'humain

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

06-NOV-09

5. Lieu de l'incident.

Pays: UNITED STATES

État: OREGON

6. Date de la première observation de l'incident.

Inconnu

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 61282-49

Nom du produit: Prozap Zinc Phosphide Pellets

  • Matière active
    • ZINC PHOSPHIDE
      • Garantie/concentration 2 %

7. b) Type de formulation.

Appât

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

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

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

The product was applied to an unknown site outside the home 1 week prior to the report.

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire II : Incident chez l'humain (Obligation d'utiliser un formulaire séparé pour chaque personne affectée)

1. Source de la déclaration.

Personne affectée

2. Renseignement démographique sur la personne affectée

Sexe: Homme

Âge: >64 yrs / > 64 ans

3. Énumérez tous les symptômes, au moyen des choix suivants.

Système

  • Système cardiovasculaire
    • Symptôme - Bradycardie
  • Systèmes nerveux et musculaire
    • Symptôme - Engourdissement

4. Quelle a été la durée des symptômes?

Unknown / Inconnu

5. La personne affectée a-t-elle reçu des soins médicaux? Donner les détails à la question 13.

Oui

6. a) Est-ce que la personne a été hospitalisée?

Inconnu

6. b) Pendant combien de temps?

7. Scénario d'exposition

Non professionnel

8. Comment l'exposition s'est-elle produite? (cocher tout ce qui s'applique)

Application

9.Si l'exposition s'est produite lors du traitement ou au moment du retour dans la zone traitée, de l'équipement de protection individuelle était-il porté? (cocher tout ce qui s'applique)

Inconnu

10. Voie(s) d'exposition.

Peau

11.Durée de l'exposition?

Unknown / Inconnu

12.Temps écoulé entre l'exposition et l'apparition des symptômes.

Unknown / Inconnu

13.Donner tout détail additionnel au sujet de l'incident (p.ex. description des symptômes tels que la fréquence et la gravité, type de soins médicaux, résultats des tests médicaux, quantité de pesticide à laquelle la personne a été exposée, etc.)

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. No further information was obtained.

À être déterminé par le titulaire

14. Classification selon la gravité.

Modérée

15. Donner des renseignements additionnels ici.

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Other / Autre

préciser Goat

3. Race

Unknown Breed

4. Nombre d'animaux touchés

2

5. Sexe:

Inconnu

6. Âge (fournir un ordre de grandeur si nécessaire)

Inconnu

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Orale

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

  • General
    • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Accidental ingestion/Ingestion accident.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. No further information was obtained.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Dog / Chien

3. Race

Great Pyrenees

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

8

7. Poids (fournir un ordre de grandeur si nécessaire)

90

lbs

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

>8 hrs <=24 hrs / > 8 h < = 24 h

11. Énumérer tous les symptômes

Système

  • Système gastro-intestinal
    • Symptôme - Anorexie
    • Symptôme - Vomit

12. Quelle a été la durée des symptômes?

Unknown / Inconnu

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Oui

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Fully Recovered / Complètement rétabli

16. De quelle manière l'animal a-t-il été exposé?

Other / Autre

préciser Unknown if exposure occurred-possible secondary ingestion of pesticide via eating poisoned goats

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-20668109: A reporter (goat and dog owner) called on 11/06/2009 to report the possible exposure of her 2 goats and 1 dog to a pesticide containing the active ingredient Zinc Phosphide. According to the reporter, the product was applied 1 week prior to the report. Two goats (1st Subform III) ingested an unknown amount of product at an unknown time and died. The reporter's dog (2nd Subform III) may have ingested some of the deceased goat carcasses 24 hours prior. The dog did not want to eat the morning of the report and had vomited 2-3 times. The reporter was advised that the product is a rapidly-acting, commonly-lethal toxicant without an antidote. Prognosis depends upon successful decontamination and aggressive treatment. The reporter was advised to give the dog some antacids and take the dog immediately to the veterinarian for treatment. The reporter was advised that the fumes from vomit may be toxic and was advised to roll the car windows down on the way to the veterinarian. The reporter called back from the veterinary office and the attending veterinarian came on the line to get treatment advice. The veterinarian was advised that phosphide salts and phosphine gas cause severe gastrointestinal inflammation, abdominal distension, pulmonary congestion and edema, and cardiovascular insufficiency. CNS effects such as seizures may also be seen. Renal and hepatic damage are possible between 2 and 14 days following exposure. The veterinarian was advised that antacids may be administered, and doses were discussed. An injection of cimetidine or famotidine should be given prior to inducing emesis in a well-ventilated space or outdoors. The vomit should be collected with gloves, bagged, and thrown away. It should not be rinsed down the drain with water as that will liberate more phosphine gas. The dog should be off food and water for 6-8 hours. Activated charcoal and antacid mixtures may be administered, but the benefits must be weighed against the risks of increasing stomach acid and increasing toxicity. Gastric lavage with 5% sodium bicarbonate may be considered. The dog should then be managed symptomatically and supportively. Liver and kidney values should be evaluated within 48-72 hours and again in 5-7 days. On follow up on 11/09/2009, the initial reporter's husband stated that the dog received antacids, the vomiting resolved, and her appetite returned on 11/06/2009. It is unclear what other treatments were done by the veterinarian. The husband (1st Subform II) also reported that he had spread the product and developed bradycardia and numbness on his left side an unknown time following product exposure. He had been seen by a physician. An MRI had been performed, and the results were unknown. The reporter was advised to continue following up with his physician since the signs described are not expected with the exposure he had. No further information was obtained.


À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Modérée

19. Donner des renseignements additionnels ici