![](media/image1.wmf){width="1.3736111111111111in"
height="1.1972222222222222in"}

**UNITED STATES ENVIRONMENTAL PROTECTION AGENCY**

**WASHINGTON, D.C. 20460**

**OFFICE OF PREVENTION, PESTICIDES AND TOXIC SUBSTANCES**

January 9, 2006

MEMORANDUM

SUBJECT: Updated Review of Rodenticide Incident Reports Primarily
Concerning Children, DP Barcode D332563, Chemical#112701, 112001,
128967, 086002, 067707, 067701, 088601, 802901,112802

FROM: Monica Hawkins, M.P.H., Environmental Health Scientist

Chemistry and Exposure Branch

Health Effects Division (7509P)

Hans D. Allender, Ph.D., Statistician

Chemistry and Exposure Branch

Health Effects Division (7509P)

THRU: David J. Miller, Chief

Chemistry and Exposure Branch

Health Effects Division (7509P)

TO: Laura Parsons, Team Leader

Special Review and Re-registration Division (7508P)

Kelly Sherman, Team Leader

Special Review and Re-registration Division (7508P)

**[RODENTICIDE REVIEW]{.underline}**

This review addresses the incidents of a group of the following nine
rodenticides:

1- Brodifacoum (PC Code 112701),

2- Bromadiolone (PC Code 112001),

3- Difethialone (PC Code 128967),

4- Warfarin (PC Code 086002),

5- Chlorophacinone (PC Code 067707),

6- Diphacinone (PC Code 067701),

7- Zinc Phosphide (PC Code 088601),

8- Cholecalciferol (PC Code 802901), and

9- Bromethalin (PC Code 112802).

The purpose of this review is to update poisoning incident data received
since completion of 1999 incident review by Dr. Blondell[^1]. The Poison
Control Center (PCC) data includes rodenticides that are not currently
under evaluation by EPA. A summary of the various rodenticides in each
analysis time period is given in Attachment 1.

The report is divided in two sections: (i) cases reported in the
Incident Data System from 1999 to the present; and (ii) cases reported
in the Poison Control Center Database from 1999 to 2003. For this later
database, SRRD indicated that cases involving young children (6 years
old or less) were the primary interest and the database search was
limited to cases meeting this criterion.

1.  **[Incident Data System]{.underline}**

1\) OPP Incident Data System (IDS) - reports of incidents from various
sources, including registrants, other federal and state health and
environmental agencies and individual consumers, submitted to OPP since
1992. Reports submitted to the Incident Data System represent anecdotal
reports or allegations only, unless otherwise stated. Typically no
conclusions can be drawn implicating the pesticide as a cause of any of
the reported health effects. Nevertheless, sometimes with enough cases
and/or documentation risk mitigation measures may be suggested.

According to the Incident Data System, it appears that the majority of
cases in children occurred from exposure to Brodifacoum (30 cases out of
43 or 68%) and the most common symptoms reported were diarrhea,
vomiting, and skin rash. Specifics relating to these incidents are
detailed and fully described in Attachment 2, where they are identified
by Incident Number and sorted by rodenticide name.

**2. Number range CHAPTER[Poison Control Center Data - 1999 through 2003
for a combination of 9-Rodenticides]{.underline}**

This section discusses results from the Poison Control Center's Toxic
Exposure Surveillance System (TESS) from the years 1999 through 2003 and
reflects only data collected for children six years of age or less.
Cases involving exposures to multiple products and cases with unrelated
medical outcome are excluded. The tables included in this section
transmit acute pesticide poisoning incidence resulting from exposure to
the following [9 rodenticides:]{.underline}

1- Brodifacoum (PC Code 112701),

2- Bromadiolone (PC Code 112001),

3- Difethialone (PC Code 128967),

4- Warfarin (PC Code 086002),

5- Chlorophacinone (PC Code 067707),

6- Diphacinone (PC Code 067701),

7- Zinc Phosphide (PC Code 088601),

8- Cholecalciferol (PC Code 802901), and

9- Bromethalin (PC Code 112802)

Table 1 below compares the frequency of poisoning incidents among all 9
rodenticides in the EPA group with the composite of [all]{.underline}
pesticides for which the PCC received an incident report. The frequency
of events is reported by health effect severity category (all symptoms,
moderate, and major) and by level of health care received. This ratio
provides a simple measure of the relative frequency of reported health
effects by severity category. Knowledge of the ratios of symptoms for a
class of chemical (or a single chemical) provides a relative measure of
the public health impact of the acute pesticide events. In addition, a
Likelihood Ratio test shows whether the compounds under study are
significantly different from the average of all other pesticides. An
(**s**) indicates the proportions are significantly different.

For a more detailed explanation of Table 1 see Attachment 3.

**Table 1**. **Relative Frequency of Acute Poisoning Incidents by
Symptom Severity: Non-Occupational Cases Involving Children Six Years of
Age or Less.**

+-------------------+-------+-------+-------+-------+-------+-------+
|                   | **Sev |       |       | **To  | **H   |       |
|                   | erity |       |       | tal** | ealth |       |
|                   | of    |       |       |       | c     |       |
|                   | outc  |       |       | *     | are** |       |
|                   | ome** |       |       | *expo |       |       |
|                   |       |       |       | sed** | **    |       |
|                   | **(ou |       |       |       | provi |       |
|                   | tcome |       |       |       | ded** |       |
|                   | det   |       |       |       |       |       |
|                   | ermin |       |       |       |       |       |
|                   | ed)** |       |       |       |       |       |
+===================+=======+=======+=======+=======+=======+=======+
| **Denominator     | **25, |       |       | **68, | **18, |       |
| numbers**         | 549** |       |       | 005** | 084** |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| **Measures**      | **SYM | **MOD | **MAJ | **HCF | *     | **ICU |
|                   | ^1^** | ^2^** | ^3^** | ^4^** | *HOSP | ^6^** |
|                   |       |       |       |       | ^5^** |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| **Numerator       | 578   | 83    | 9     | 1     | 302   | 219   |
| numbers**         |       |       |       | 8,084 |       |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| **9 Rodenticides  | 2.26% | 0.32% | 0.03% | 2     | 1.67% | 1.21% |
| percents**        |       |       |       | 6.59% |       |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| **All Pesticides  | **21. | **1.  | **0.  | **15. | **4.  | **1.  |
| percents**        | 72%** | 42%** | 12%** | 68%** | 34%** | 75%** |
+-------------------+-------+-------+-------+-------+-------+-------+
| **Ratio of 9      | *     | *     | **0   | *     | *     | **0   |
| Rodenticides**    | *0.10 | *0.23 | .25** | *1.69 | *0.38 | .69** |
|                   | (S)** | (S)** |       | (S)** | (S)** |       |
| **/All            |       |       | **P = |       |       | **P   |
| pesticides**      | **P   | **P = | 0.9   | **P = | **P = | =0    |
|                   | =0    | 0     | 4\*** | 0     | 0     | .51** |
|                   | .00** | .00** |       | .00** | .00** |       |
+-------------------+-------+-------+-------+-------+-------+-------+

\*Proportions and sample size too small for a valid significance test.

1\) percent with ANY symptom in relation to the total of cases followed,

2\) percent with moderate symptoms in relation to the total of cases
followed,

3\) percent with major or fatal outcome in relation to the total of
cases followed,

4\) percent of case seen in a Health Care Facility (HCF) in relation to
total exposures

5\) percent of cases seen in a Hospital in relation to cases seen in a
HCF

6\) percent of cases taken to an Intensive Care Unit (ICU) in relation
to cases seen in a HCF.

**[Analysis of Results]{.underline}**

The ratio of children seen at a HCF is higher than the proportion seen
among all pesticides exposure -- approximately 27% v. 16%. This may be
due to increased concern for children's safety; difficulty in
determining exposure in children (cannot communicate exposure
experience) and therefore require additional testing; knowledge or fear
concerning rodenticides; or other unknown factors. Importantly, the
proportion of children admitted to hospital or ICU is less than or equal
to that seen among the ALL pesticide composite. This suggests that while
visits to HCF is high, effects seen are treatable and do not require
hospitalization. However for severity of outcome, (SYM, MOD, and MAJ)
rodenticide incidents are significantly lower compared to all
pesticides.

Table 2 provides additional detail by year and Figure 1 shows this same
information in a graphical form. No trend is apparent for the 5
year-span for the 9-rodenticides group for the total exposure. There is
no apparent trend in the cases that were symptomatic through the years;
the numbers show a steady average of about 115 symptomatic cases per
year.

**Table 2. Number of Rodenticides Cases by Year**

+------+---------+-------+------+------+-------+------+------+------+
| **Ye | *       | **    | *    | **C  | **To  | **H  | **Ho | **I  |
| ar** | *Sympto | Moder | *Maj | ases | tal** | CF** | spit | CU** |
|      | matic** | ate** | or** | Fo   |       |      | al** |      |
|      |         |       |      | llow | **E   | *    |      | *    |
|      | **      | **Ca  | *    | ed** | xposu | *Cas | *    | *Cas |
|      | Cases** | ses** | *Cas |      | res** | es** | *Cas | es** |
|      |         |       | es** |      |       |      | es** |      |
+------+---------+-------+------+------+-------+------+------+------+
| 1999 | 117     | 14    | 4    | 5845 | 13647 | 3939 | 62   | 53   |
+------+---------+-------+------+------+-------+------+------+------+
| 2000 | 129     | 21    | 3    | 5206 | 13650 | 3643 | 59   | 44   |
+------+---------+-------+------+------+-------+------+------+------+
| 2001 | 96      | 19    | 2    | 4845 | 13642 | 3624 | 63   | 43   |
+------+---------+-------+------+------+-------+------+------+------+
| 2002 | 124     | 11    | 0    | 4997 | 13842 | 3551 | 59   | 42   |
+------+---------+-------+------+------+-------+------+------+------+
| 2003 | 112     | 18    | 0    | 4656 | 13224 | 3327 | 59   | 37   |
+------+---------+-------+------+------+-------+------+------+------+
| T    | 578     | 83    | 9    | 2    | 68005 | 1    | 302  | 219  |
| otal |         |       |      | 5549 |       | 8084 |      |      |
+------+---------+-------+------+------+-------+------+------+------+

No apparent trend is noted on the 5 year-span for the 9-rodenticides
group for the total exposure. However, there is a reduction of cases
followed in relation to annual total exposure. This is, in 1999, 5,845
cases out of 13,367 (42.8%) were followed; at the other extreme, in 2003
only 4,656 cases out of 13,224 (35.2%) were followed. There is no
apparent trend in the cases that were symptomatic through the years; the
numbers show a steady average of about 115 symptomatic cases per year.

**Figure 1. Total Cases and Symptomatic Cases by Year.**

![](media/image2.wmf){width="6.03125in" height="4.333333333333333in"}

The relative contribution of each individual rodenticide to the total
number of persons exposed to rodenticides over the 5 year period of
interest is presented in Figure 2. This figure indicates that
Brodifacoum contributes almost 80% of the total exposure cases of the
group; the combination of Bromadiolone, Difethialone, and Diphacinone
produce about 16% of the exposures. In contrast, Chlorophacinone, Zinc
Phosphide, and Cholecalciferol make a combined contribution of less than
1%. The percentages are taken against the total exposure for the
five-year period of 68,005.

**Figure 2. Individual Contribution of Each Rodenticide to the
9-rodenticides Group.**

![](media/image3.wmf){width="6.21875in" height="4.958333333333333in"}

A similar proportion is observed in relation to the number of cases that
were symptomatic, as shown in Figure 3. The percentages are calculated
against the total of 578 symptomatic cases. Brodifacoum contributes more
than 72% of the total of symptoms, which may be a function of market
share. Chlorophacinone, Zinc Phosphide, and Cholecalciferol make a
combined contribution of less than 2.5%.

**Figure 3. Symptomatic Cases of Rodenticides from the 9-rodenticides
Group.**

![](media/image4.wmf){width="6.40625in" height="5.25in"}

Figure 4 shows a relatively flat pattern with no decrease of exposures.
There is an increase of 2,024 exposures or 22%. (from 9,128 in 1999 to
11,152 in 2003). This is equivalent to an annual average increase of
exposures to Brodifacoum of 4.4%. Symptomatic cases remain relatively
small proportion of total exposure.

**Figure 4. Annual Distribution of Brodifacoum for Cases with Exposure
and Symptoms.**

![](media/image5.wmf){width="6.458333333333333in"
height="4.333333333333333in"}

**Summary**

According to PCC data, there are no significant changes in cases per
year or proportions of rodenticides when compared to the previous report
"Updated Review of Rodenticides Incident Reports Primarily Concerning
Children DP Barcode D256673" dated June 3, 1999.

The summary findings for the period 1999 to 2003 for children are as
follow:

-   The combination of 9-rodenticides is statistically well below the
    composite of all pesticides in the production of symptoms, in the
    production of moderate symptoms and (although not statistically
    significant) in the production of major symptoms.

-   The ratio of children seen in a Health Care Facility as a result of
    a potential exposure to the 9-rodenticides group is almost 70%
    higher than the composite of all pesticides, and statistically
    significant.

-   The ratio of children seen in a hospital is statistically
    significant and lower than the composite; the fraction sent to ICU,
    although also lower, shows no statistical difference to the
    composite.

-   Only 37% of exposure cases are followed.

-   There is an annual reduction of cases followed of about 7% in the
    five-year span.

-   About 1.18% of cases followed and 0.44% of the total children
    exposed warrant a visit to a Hospital.

-   No apparent annual trend is noticed in the 5 year-span for the
    9-rodenticides group.

-   Brodifacoum contributes almost 80% of the total exposure cases of
    the group; this may be due to market share.

-   Brodifacoum contributes more than 72% of the total of symptoms
    produce by the 9-rodenticides group.

**[Recommendations]{.underline}**

Given the total number of rodenticide exposures for children under 6
years of age, risk mitigation measures to reduce exposure to this
rodenticide should be considered. This could include public education
and outreach, product substitution and/or use of bait stations.

> **Attachment 1.**
>
> **Summary of the Various Rodenticides Groups in Each Analysis Time
> Period**

-   \*Internet source; should check how PCC defines "superwarfarin"

-   \*\* Includes 9 subject of Comprehensive Ecological Risk Assessment

-   \*\*\*Separate RED for Zinc Phosphide

**Attachment 2.**

**Cases from the Incident Data System**

**[Brodifacoum reports]{.underline}**

Incident#11098-10

A pesticide incident occurred in 2000, when a girl, who is less than six
years old, reported stomach pain and frequent urination. The girl's
mother found some of the products pellets under their couch cushions and
in one of her child's room. The mother stated that she was certain that
her daughter did not ingest any of the pellets. No further information
on the disposition of the case was reported.

Incident#12587-11

A pesticide incident occurred in 2002, when a fifteen month old girl
reported spots that spread across her face. The girl's grandmother
reported that her granddaughter ingested two or three of the product's
pellets. No further information on the disposition of the case was
reported.

Incident#13052-12

A pesticide incident occurred in 2002, when a fifteen month old girl
grabbed the product's pellets out of the cupboard. The girl's mother
took five or six pellets out of her mouth and was not sure if she
swallowed any of them. The girl was taken to the emergency room and was
diagnosed with a parasite. No further information on the disposition of
the case was reported.

Incident#13338-15

A pesticide incident occurred in 2002, when a four year old girl
reported fever, throat irritation, and drowsiness after she was found
playing with the product. She was treated by a physician and the results
for her mono and strep test were negative. No further information on the
disposition of the case was reported.

Incident#13639-11

A pesticide incident occurred in 2002, when a two year old boy walked
into a room in his house carrying the product. The boy reported
blisters. He was taken to the emergency room and hooked up to a cardiac
monitor for several hours. No changes in the rhythm were detected. No
further information on the disposition of the case was reported.

Incident#14934-13

A pesticide incident occurred in 2004, when a one year old boy reported
vomiting and diarrhea after the product's container was found ripped up
behind the television and in a closet in his house. The boy's father
vacuumed the floor and was not sure if his son ingested the product or
not. No further information on the disposition of the case was reported.

Incident#14983-5

A pesticide incident occurred in 2004, when a five year old boy, who
denies ingesting the product, was hospitalized for a week for possible
ingestion of the product. His father works in a restaurant that uses the
product. One day, the boy's father left him alone while he was at work
and the boy could have eaten the product. The boy was released to foster
care until the situation is resolved. No further information on the
disposition of the case was reported.

Incident#15104-15

A pesticide incident occurred in 2004, when a two year old boy reported
diarrhea, vomiting, and a fever. The boy's mother placed a few of the
traps in her home. She checked the traps and noticed that ¾ of one of
them was missing. The boy said that he ate some of the product. No
further information on the disposition of the case was reported.

Incident#15180-5

A pesticide incident occurred in 2004, when a three year old boy, who
has a history of nose bleeds, went behind a sofa to ingest the product.
The boy was treated at a health care facility by a physician for a
prolonged prothrombin time. No further information on the disposition of
the case was reported.

Incident#15417-3

A pesticide incident occurred in 2004, when a twenty-two month old girl
may have ingested the product that was placed behind a coach and in
several other open areas. The girl's grandmother was not absolutely
certain that she ingested the product during the previous few days.
There was no evidence of the product in her mouth. The girl reported
diarrhea for two days and was treated by a physician. No further
information on the disposition of the case was reported.

Incident#15529-2

A pesticide incident occurred in 2004, when a nineteen month old girl
reported hives and welts. The girl's mother is not absolutely certain
that she ingested the product. There was no evidence of the product in
her mouth but she may have been able to rinse her mouth out with the
contents in her sippy cup. The girl's mother stated that she would take
her daughter to the doctor. No further information on the disposition of
the case was reported.

Incident#15610-2

A pesticide incident occurred in 2004, when two children licked the
product. Both children were asymptomatic. A three year old boy reported
a rash that was due to exposure to something else. No further
information on the disposition of the case was reported.

Incident#15619-2

A pesticide incident occurred in 2004, when a one year old girl ingested
less than 10 pellets of the product that were detectable in her teeth
and on her tongue. The mother reported that her daughter's stool was
hard and contained blood and the color of the pellets was in it. No
further information on the disposition of the case was reported.

Incident#15732-4

A pesticide incident occurred in 2004, when a two year old girl reported
a rash on her stomach after being at a cabin earlier in the day. Several
boxes of the product were placed in the cabin. No further information on
the disposition of the case was reported.

Incident#15783-10

A pesticide incident occurred in 2004, when a two year old boy reported
vomiting, diarrhea, tremor, and hitting himself on the head. The boy may
have picked up his pacifier off the floor. No further information on the
disposition of the case was reported.

Incident#15865-1

A pesticide incident occurred in 2004, when a two year old boy may have
ingested as much as one half of the product. Half of the product was
missing but the pellets were not detectable in his teeth or mouth. The
boy reported hives and welts all over his entire body. No further
information on the disposition of the case was reported.

Incident#16032-3

A pesticide incident occurred in 2005, when a two year old boy was found
with a box of the product but very little was missing. The boy reported
melena. No further information on the disposition of the case was
reported.

Incident#16032-6

A pesticide incident occurred in 2005, when a nine month old boy
ingested an unknown amount of the product. The boy reported a rash. No
further information on the disposition of the case was reported.

Incident#16136-15

A pesticide incident occurred in 2005, when a one year old boy ate one
pellet of the product. The boy found it under his aunt's refrigerator
and ate it before she could remove it from his hands or mouth. The boy
reported a fever and a throat infection and was treated by a physician.
No further information on the disposition of the case was reported.

Incident#16583-5

A pesticide incident occurred in 2005, when a six year old girl reported
vomiting, edema, and a rash. The girl's parent was unsure if she
ingested the entire box of the product or not but the girl denied eating
the product. The girl was treated by a physician. No further information
on the disposition of the case was reported.

Incident#16807-4

A pesticide incident occurred in 2005, when a two year old boy's mother
found three pellets in his mouth. The boy reported blood on his behind
and was treated by a physician at an emergency room. No further
information on the disposition of the case was reported.

Incident#16944-6

A pesticide incident occurred in 2005, when a two year old girl played
with the product and almost ¾ of it is present. The girl reported
hematuria. No further information on the disposition of the case was
reported.

Incident#16988-2

A pesticide incident occurred in 2005, when a fifteen month old boy
found a container of the product in the kitchen with his mother present.
His mother did not see the product in his mouth or in his hands. The boy
reported not having a good appetite for three days and ataxia. No
further information on the disposition of the case was reported.

Incident#17044-5

A pesticide incident occurred in 2005, when a two year old boy reported
a small amount of blood in his stool. The boy's mother placed the
product in her home. The box appeared undisturbed but she was concerned
about poisoning. No further information on the disposition of the case
was reported.

Incident#17230-7

A pesticide incident occurred in 2006, when a two year old girl may have
ingested some of the product. The girl reported vomiting and was taken
to the emergency room by her grandparent. No further information on the
disposition of the case was reported.

Incident#17265-2

A pesticide incident occurred in 2006, when an eight year old boy
reported difficulty breathing and lethargy. His parents placed three
packets of the product out and one of the three remaining packets was
left in the box. The boy's teacher sent a note home and stated that the
boy fell asleep three times in her class. No further information on the
disposition of the case was reported.

Incident#17464-15

A pesticide incident occurred in 2006, when a boy, who is less than six
years old, was taken to the emergency room by his grandparent after
possibly ingesting the product. The boy reported edema and blood was
dripping from his nose and ears. No further information on the
disposition of the case was reported.

Incident#17510-4

A pesticide incident occurred in 2006, when a two year old girl was
found with an open product. The product was not detected in her mouth or
on her hands. A small amount was missing from the product. The girl's
mother gave her something to drink. The girl passed black stool and
blood was found around her anal area. No further information on the
disposition of the case was reported.

Incident#17221-1

A pesticide incident occurred in 2006, when a two year old girl was
found by her uncle with the product in her hands and the product was
wet. The girl reported melena and was being taken to the hospital. No
further information on the disposition of the case was reported.

Incident#17226-14

A pesticide incident occurred in 2006, when a nine year old boy's father
had an empty pail from the product that he was storing bolts in. There
is some residue in the pails. The boy's father wasn't sure if his son
touched the bolts and the product was absorbed through the skin or not.
The boy reported diarrhea for three to four days. No further information
on the disposition of the case was reported.

**[Bromadiolone reports]{.underline}**

Incident#12563-1

A pesticide incident occurred in 2000, when a two year old girl reported
vomiting. The product was discovered open and under the bathroom sink by
her parent. The girl may have ingested the product. No further
information on the disposition of the case was reported.

Incident#12690-1

A pesticide incident occurred in 2002, when a sixteen month old girl
reported hematuria and was treated by a physician. The girl may have
ingested the product but her symptoms may be due to living in an
extremely unsanitary home. No further information on the disposition of
the case was reported.

Incident#13542-1

A pesticide incident occurred in 2002, when a fifteen month old girl
reported vomiting that contained blood, discolored stool, and diarrhea.
The girl was treated by a physician at an emergency room. No further
information on the disposition of the case was reported.

Incident#15242-1

A pesticide incident occurred in 2004, when a five year old boy reported
a prolonged prothrombin time and was treated by a physician. The boy was
playing with the product at a neighbor's house. Some of the pellets were
found in his mouth. No further information on the disposition of the
case was reported.

Incident#15508-2

A pesticide incident occurred in 2004, when a two year old boy reported
discolored stool (bright green like the product) and a fever. His mother
placed two one-ounce blocks of the product in her home that disappeared.
No further information on the disposition of the case was reported.

Incident#15644-1

A pesticide incident occurred in 2004, when a twenty month old boy
reported a fever and chills. The boy's mother caught him and his dog
playing with one bait block. The dog ate about ¼ of the 28 gram block
and the boy may have been chewing on it. The boy was treated by a
physician and diagnosed with a viral illness. No further information on
the disposition of the case was reported.

Incident#16204-1

A pesticide incident occurred in 2005, when a two year old boy reported
a fever and hallucination. His father thinks he may have ingested the
product. No further information on the disposition of the case was
reported.

**[Difethialone reports]{.underline}**

Incident#16807-20

Missing Incident.

**[Warfarin reports]{.underline}**

There were no incident reports involving children exposed to warfarin in
the Incident Data System.

**[Chlorophacinone reports]{.underline}**

There were no incident reports involving children exposed to
chlorophacinone in the Incident Data System.

**[Diphacinone reports]{.underline}**

Incident#11808-1

A pesticide incident occurred in 2001, when a nineteen month old girl
was taken to the emergency room after it was not certain whether she
ingested the product or not. The girl's coagulation study was normal so
the attending physician did not administer any type of treatment. No
further information on the disposition of the case was reported.

Incident#16363-1

A pesticide incident occurred in 2005, when a thirteen month old girl
tasted one pellet of the product as witnessed by her father. The girl
reported a rash over her entire body and swollen eyes. No further
information on the disposition of the case was reported.

Incident#17324-1

A pesticide incident occurred in 2006, when a one year old girl ingested
one pellet of the product as witnessed by her mother. The girl reported
vomiting for a few days. No further information on the disposition of
the case was reported.

**[Zinc Phosphide reports]{.underline}**

Incident#17470-1

A pesticide incident occurred in 2006, when a seven year old boy and his
brother swept their shed with the product that spread across the floor.
The boy reported abdominal pain, conjunctivitis, and shortness of
breath. The boy was treated by a physician. No further information on
the disposition of the case was reported.

**[Cholecalciferol reports]{.underline}**

There were no incident reports involving children exposed to
cholecalciferol in the Incident Data System.

**[Bromethalin reports]{.underline}**

Incident#11593-10

A pesticide incident occurred in 2001, when a fourteen month old boy
ingested the product. The boy reported agitation, irritability, and
vomiting and was treated by a physician at an emergency room. No further
information on the disposition of the case was reported.

Incident#13273-1

A pesticide incident occurred in 2002, when an eighteen month old girl's
mother was not watching her daughter while she cleaned her house. Her
mother was not sure if she ingested some of the product that she had
placed behind her couch. She gave her daughter some milk and she vomited
and also reported a fever. The girl was treated by a physician for a
virus. No further information on the disposition of the case was
reported.

**Attachment 3.**

**Table Description**

**Table 1.**

+-------------------+-------+-------+-------+-------+-------+-------+
|                   | Sev   |       |       | Total | H     |       |
|                   | erity |       |       |       | ealth |       |
|                   | of    |       |       | ex    | care  |       |
|                   | ou    |       |       | posed |       |       |
|                   | tcome |       |       |       | pro   |       |
|                   |       |       |       |       | vided |       |
|                   | (ou   |       |       |       |       |       |
|                   | tcome |       |       |       |       |       |
|                   | d     |       |       |       |       |       |
|                   | eterm |       |       |       |       |       |
|                   | ined) |       |       |       |       |       |
+===================+=======+=======+=======+=======+=======+=======+
| Denominator       | **25, |       |       | **68, | **18, |       |
| numbers           | 549** |       |       | 005** | 084** |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| Measures          | **    | **    | **    | **    | **H   | **    |
|                   | SYM** | MOD** | MAJ** | HCF** | OSP** | ICU** |
+-------------------+-------+-------+-------+-------+-------+-------+
| Numerator numbers | 578   | 83    | 9     | 1     | 302   | 219   |
|                   |       |       |       | 8,084 |       |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| 9 Rodenticides    | 2.26% | 0.32% | 0.03% | 2     | 1.67% | 1.21% |
| percents          |       |       |       | 6.59% |       |       |
+-------------------+-------+-------+-------+-------+-------+-------+
| All Pesticides    | **21. | **1.  | **0.  | **15. | **4.  | **1.  |
| percents          | 72%** | 42%** | 12%** | 68%** | 34%** | 75%** |
+-------------------+-------+-------+-------+-------+-------+-------+
| Ratio of 9        | *     | *     | **0   | *     | *     | **0   |
| Rodenticides      | *0.10 | *0.23 | .25** | *1.69 | *0.38 | .69** |
|                   | (S)** | (S)** |       | (S)** | (S)** |       |
| /All pesticides   |       |       | **P = |       |       | **P   |
|                   | **P   | **P = | 0.9   | **P = | **P = | =0    |
|                   | =0    | 0     | 4\*** | 0     | 0     | .51** |
|                   | .00** | .00** |       | .00** | .00** |       |
+-------------------+-------+-------+-------+-------+-------+-------+

The following is a brief description of the table components:

A)  The first row "Denominator numbers" presents all the numbers that
    will serve as denominators in the calculation of the percents, and
    they are:

    a.  In the center column, total amount of individuals exposed to
        group of 9 rodenticides (n = 68,005) Total Exposed.

    b.  In the left, amount of cases followed, (n = 25,546) these cases
        have an outcome determined (Outcome determined)

    c.  At the right of the table, cases that visited a Health Care
        Facility (n = 18084) Health care provided

> B\) The row "Measures" describes the outcomes for the cases: SYM cases
> that were symptomatic; MOD cases that were classified as moderate; MAJ
> cases that were classified as major or fatal; HCF cases of exposure
> that went to a Health Care Facility; HOSP cases that went to a
> hospital; and ICU cases that went to an Intensive Care Unit.
>
> C\) The row "Numerator numbers" are actually the number of cases that
> presented the outcome describe in the Measures row.
>
> D\) The row "9 Rodenticides percents" gives the percentages on each
> measure. These percentages are calculated by dividing the numerator
> number by the denominator number (from each major section of the
> Table 1) and multiplying by 100. For example 578, 83, and 9 are
> divided by 25,549 producing the respective percents 2.26, 0.32, and
> 0.03, for SYM, MOD, and MAJ. In a similar fashion 18,084 is divided by
> 68,005 for the percentage of cases seen in a HCF of 26.59; and for the
> last section of the Table 1, 302 and 219 are divided by 18,084 to find
> the percentages of cases that went to a hospital and ICU.

E)  The row "All Pesticides Percents" are percentages that were
    calculated using all cases available in the PCC database. These
    percentages serve as the baseline for the comparison with the given
    pesticide, or grouping, in this case a group of 9 rodenticides.

F)  The "Ratio of 9 Rodenticides/All pesticides" row is obtained by
    dividing the percentages of the given compound by the "all
    pesticides" percentages, to obtain a dimensionless number or ratio.
    This ratio provides an idea of the relative importance of the given
    compound (in this case a group of nine). For example, a ratio of 1
    (one) indicates that the percentages are the same for the compound
    (or group) under study and the composite of all pesticides; a ratio,
    say of 2 (two) indicates that the chemical under study (in this case
    the average of 9 rodenticides) produces twice the effect; and a
    ratio of 0.5 indicates that the compound has half of the activity of
    the "composite." The advantage of these ratios is that they provide
    a quick overview of the relative importance of the chemical or
    grouping.

G)  Also, the "p" value that results from a Likelihood ratio test is
    entered in the ratio cell and when significant (p \< 0.05) then an
    **(S)** is entered next to the ratio to mark statistical
    significance. A cell marked with **(S)** means that the percentages
    that produce the ratios are "statistically" significant and not due
    to chance. The percentage of the given compound could be higher or
    lower than the percentage produce by the composite as indicated by
    the ratio. For example, a ratio = 1.6 **(S)** means the effect
    produced by the compound is higher that the effect produced by the
    composite and statistically different; a ratio = 0.7 **(S)**
    signifies that the chemical has a lower effect than the composite
    and is statistically different. On the other hand, a ratio = 1.2,
    with no **(S)**, means that the percentage, although higher, is not
    statistically different from the composite.

[^1]: The chemicals of regulatory interest that comprise this
    "Rodenticide Group" have changed over time and differ somewhat
    between the 1999 incident review by J. Blondell and this "updated"
    incident review.