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Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-2887

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.

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

12-MAY-13

Product 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. 26713 PMRA Submission No. EPA Registration No.

Product Name: SERGEANT'S PRETECT SQUEEZE-ON FLEA & TICK CONTROL FOR DOGS UP TO 15KG

Active Ingredient(s)
- PERMETHRIN
- PYRIPROXYFEN

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

.75

Units: mL

10. Site pesticide was applied to (select all that apply).

Site: Animal / Usage sur un animal domestique

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

1/2 of 1.5ml squeezed between the shoulder blades of my 8 pound dogs. (spot on treatment). Inside my home in the kitchen.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

mixed breed

4. Number of animals affected

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

Nervous and Muscular Systems
- Symptom - Muscle tremors

Gastrointestinal System
- Symptom - Foaming at mouth
- Specify - frothing at the mouth
- Symptom - Vomiting

Respiratory System
- Symptom - Panting

12. How long did the symptoms last?

<=30 min / <=30 min

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Day(s) / Jour(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

specify Rosie, started panting immediately after licking the dog

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Mixed breed, Rosie, started panting immediately after licking the dog. Then started having tremors, frothing at the mouth, and finally vomiting. Rosie required 3 days at the vet on a fast IV flush with valium to help the tremors. The other 3 cats, 2 tabbies werer unbalanced for a day and the Norwegian forest had severe inflammation behind the neck. All were seen by the vet. Cat were not treated but licked dogs or walked in an area that dogs rolled in, then washed temselves, ingesting the poison.I think the public should be advised NEVER to use over the counter products. Only a vet should prescribe and discuss treatment. Even though I am very experienced dealing with many animals - even following close instructions can lead to tragedy. I think this product should be banned to prevent more unfortunate accidents.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Not Applicable

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

tabby

4. Number of animals affected

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

General
- Symptom - Loss of balance
- Specify - unbalanced

12. How long did the symptoms last?

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

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

The other 3 cats, 2 tabbies were unbalanced for a day and the Norwegian forest had severe inflammation behind the neck. All were seen by the vet. Cats were not treated but licked dogs or walked in an area that dogs rolled in, then washed themselves, ingesting the poison. I think the public should be advised NEVER to use over the counter products. Only a vet should prescribe and discuss treatment. Even though I am very experienced dealing with many animals - even following close instructions can lead to tragedy. I think this product should be banned to prevent more unfortunate accidents.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Not Applicable

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Norwegian forest

4. Number of animals affected

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

General
- Symptom - Other
- Specify - severe inflammation behind the neck

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

The Norwegian forest had severe inflammation behind the neck. All were seen by the vet. I think the public should be advised NEVER to use over the counter products. Only a vet should prescribe and discuss treatment. Even though I am very experienced dealing with many animals - even following close instructions can lead to tragedy. I think this product should be banned to prevent more unfortunate accidents.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Not Applicable

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Chihuahua

4. Number of animals affected

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

General
- Symptom - Lethargy
- Symptom - Adipsia
- Symptom - Other
- Specify - nose is hot
- Symptom - Other
- Specify - nose is dry

Nervous and Muscular Systems
- Symptom - Muscle twitching
- Specify - one would lift his rear leg and it would twitch uncontrollably

General
- Symptom - Abnormal behaviour
- Specify - just slept

Gastrointestinal System
- Symptom - Anorexia

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Dogs were lethargic for 2 days. Did not eat. Would not drink. Just slept. Noses dry and hot. One would lift his rear leg and it would twitch uncontrollably. Neuroogical symptom. There were better in 48 hours. saw vet - they were alright vital signs ok. I think the public should be advised NEVER to use over the counter products. Only a vet should prescribe and discuss treatment. Even though I am very experienced dealing with many animals - even following close instructions can lead to tragedy. I think this product should be banned to prevent more unfortunate accidents.

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Not Applicable