Veterinary Pesticide Incident Reporting Portal

Overview:

Welcome to NPIC's Veterinary Incident Reporting portal.

This system is only for use by veterinarians or their staff to report adverse effects of an animal's exposure to pesticides.

The purpose of this system is to gather information from qualified medical professionals. Use of this system by others is strongly discouraged and may result in the termination of this service.

Information from this portal may be directly sent in its entirety to the U.S. Environmental Protection Agency. Data from this portal may be used to inform decision-making in the federal regulation of pesticides. Please note that the information submitted through this portal will not be used for targeted enforcement. If you wish to speak with someone about a potential investigation, please contact your state's lead agency for pesticide enforcement.

An overview of required and optional information needed to submit a report is available here.

If you are not a veterinarian, but would like to report an adverse effect of a pesticide to your pet, please call NPIC at 1-800-858-7378 and we will take your report over the phone.

Click the button below if you are a veterinarian and would like to submit a report:

Contact Information

You must provide contact information for the veterinarian responsible for the animal's treatment. The information submitted through this portal will not be sold to anyone. It may be shared with the U.S. Environmental Protection Agency for review, including the contact information provided on this page.

Name:
Title:	Veterinarian Technician Other (please specify below)
Clinic/Company Name:
Street Address 1:
Street Address 2:	(optional)
City:
State:
Zip Code:
Phone Number:
E-mail address:

(Fill in required fields to continue)

Pesticide Product Information

Please provide the EPA Registration Number if possible. The Registration Number is located on the pesticide product labeling. This number is extremely important for reviewers to accurately record and assess an incident.

If you do not know the EPA Registration Number, click the "I don't know the number" button and you can provide the pesticide product name and the active ingredient(s) instead. Many products have similar names. Providing the name and the active ingredient will allow reviewers of this report to better assess the incident.

If you do not know the Product Name or Active Ingredient(s), type "unknown".

Pesticide Registration Number: Or:
Product Name:
Active Ingredient:	AI %
Active Ingredient 2:	AI % (optional)
Active Ingredient 3:	AI % (optional)
Active Ingredient 4:	AI % (optional)
Active Ingredient 5:	AI % (optional)
Active Ingredient 6:	AI % (optional)
Active Ingredient 7:	AI % (optional)
Active Ingredient 8:	AI % (optional)
Active Ingredient 9:	AI % (optional)
Active Ingredient 10:	AI % (optional)
Type of Pesticide:	(optional)
Formulation:	(optional)

(Fill in required fields to continue)

Additional Information (optional):

Additional Information (Optional)

Optional: Please enter any additional information about this exposure as you need.

You may also use this page to provide feedback or general comments to us about this reporting system.

Please enter any additional information about this report (optional):

(optional)

Review Summary

Contact Information

Name:
Title:
Clinic/Company:
Street Address 1:
Street Address 2:
City:
State:
Zip Code
Phone:
E-mail address:

Product Information

EPA Registration Number:
Product Name:
Active Ingredient:
Active Ingredient 2:
Active Ingredient 3:
Active Ingredient 4:
Active Ingredient 5:	%
Active Ingredient 6:	%
Active Ingredient 7:	%
Active Ingredient 8:	%
Active Ingredient 9:	%
Active Ingredient 10:	%
Formulation:
Type of Pesticide:

Animal Information

Species:
Breed:
Sex
Age:
Weight:
Date of examination:
State where exposure occurred:
Route(s) of Exposure:
Additional Details of Exposure:
Date of exposure:
Toxicity/signs:
Additional Details Of Toxicity:
Onset of Symptoms:
Outcome:
Additional Details Of Outcome:

Additional Information (optional)

Additional information:

Species:	Other:
Breed:	(optional)
Sex:	male female neutered male neutered female (optional)
Age:	days months years (optional)
Weight:	lbs kg (optional)
Date of exposure (month/day/year):	(optional)
Date of examination (month/day/year):	(optional)
In what U.S. state/territory did the exposure occur?
Route(s) of Exposure: (may pick more than one -- hold the [ctrl] or [command] key while clicking)
Additional Details of Exposure:	(optional)
Toxicity/signs: (may pick more than one -- hold the [ctrl] or [command] key while clicking)
Additional Details Of Toxicity:	(optional)
Onset of Symptoms:	minutes hours days (optional)
Outcome:
Additional Details Of Outcome:	(optional)