VPIS Retrospective Case Report

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1. Date and time of incident (Required.)

Please tell us when it happened (if known, or give an approximate date and time if unknown)

Date

Time

AM/PM

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2. Location of incident (Required.)

Home and surroundings

Farm

Public space, park, woodland

Veterinary surgery

Stables

Unknown

Other (please specify)

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3. Postcode or town (Required.)

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4. Species involved (Required.)

Dog

Cat

Rabbit

Equine

Other (please specify)

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5. Breed (Required.)

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6. Animal reference (e.g. your reference number)

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7. Body weight (kg) (Required.)

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8. Age of animal (Required.)

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9. Sex of animal (Required.)

Female entire

Female spayed

Female unknown

Female pregnant

Female lactating

Male entire

Male neutered

Male unknown

Unknown

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10. What was the animal exposed to? (Required.)

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11. Route of exposure (Required.)

Oral

Skin

Eye

Ear

Inhalation

Intravenous

Subcutaneous

Intramuscular

Other (please specify)

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12. Amount, if known (please include units e.g. mg, ml, tablets, etc) (Required.)

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13. Time from exposure to presentation (Required.)

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14. What clinical signs did the animal develop? (Required.)

None, remained asymptomatic

Other (please specify)

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15. What treatments were given and what investigations were performed? (Required.)

None required

Emetic (apomorphine)

Emetic (other, please specify below)

Activated charcoal, single dose

Activated charcoal, repeated doses

IV fluids

Renal function tests

Liver enzymes

ECG

X-ray

Other (please specify)

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16. Outcome of case (Required.)

Full recovery (add time to recovery in box below)

Died (add time to death in box below)

Euthanised (add time to euthanasia in box below)

Euthanised, not related (add details of diagnosis in box below)

Remained asymptomatic

Died – not related

Not known – did not present

Not known

Further details

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17. Any further comments on the case?

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18. Contact for further information, if required (optional).
Thank you for taking the time to complete the questionnaire. We are very grateful for your help.

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* 1. Date and time of incident (Required.)

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* 2. Location of incident (Required.)

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* 3. Postcode or town (Required.)

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* 4. Species involved (Required.)

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* 5. Breed (Required.)

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* 6. Animal reference (e.g. your reference number)

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* 7. Body weight (kg) (Required.)

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* 8. Age of animal (Required.)

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* 9. Sex of animal (Required.)

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* 10. What was the animal exposed to? (Required.)

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* 11. Route of exposure (Required.)

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* 12. Amount, if known (please include units e.g. mg, ml, tablets, etc) (Required.)

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* 13. Time from exposure to presentation (Required.)

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* 14. What clinical signs did the animal develop? (Required.)

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* 15. What treatments were given and what investigations were performed? (Required.)

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* 16. Outcome of case (Required.)

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* 17. Any further comments on the case?

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* 18. Contact for further information, if required (optional). Thank you for taking the time to complete the questionnaire. We are very grateful for your help.

1. Date and time of incident (Required.)

2. Location of incident (Required.)

3. Postcode or town (Required.)

4. Species involved (Required.)

5. Breed (Required.)

6. Animal reference (e.g. your reference number)

7. Body weight (kg) (Required.)

8. Age of animal (Required.)

9. Sex of animal (Required.)

10. What was the animal exposed to? (Required.)

11. Route of exposure (Required.)

12. Amount, if known (please include units e.g. mg, ml, tablets, etc) (Required.)

13. Time from exposure to presentation (Required.)

14. What clinical signs did the animal develop? (Required.)

15. What treatments were given and what investigations were performed? (Required.)

16. Outcome of case (Required.)

17. Any further comments on the case?

18. Contact for further information, if required (optional).
Thank you for taking the time to complete the questionnaire. We are very grateful for your help.