Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-2124

2. Registrant Information.

Registrant Reference Number: 2010316

Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

23-MAR-17

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

Unknown

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)

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PMRA Registration No. 27185      PMRA Submission No.       EPA Registration No.

Product Name: (discontinued) Raid EarthBlends Ant & Earwig Dust 225g - Canada

• Active Ingredient(s)
  • SILICON DIOXIDE (PRESENT AS 100% DIATOMACEOUS EARTH) - FRESH WATER FOSSILS

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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

Site: Res. - In Home / Rés. - à l'int. maison

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

7.00

lbs

8. Route(s) of exposure

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

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

Unknown / Inconnu

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?

1

Day(s) / Jour(s)

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

3/23/2017 Caller has used the product for years, and applies it under his stove. One cat is at the veterinarian currently because she began to get sick 3 or 4 days ago. The cat is lethargic and anorexic. The veterinarian has treated with intravenous fluids and are running blood tests. Another of caller's cats died 3 to 4 weeks ago after becoming sick. Caller had a third cat that died last year. Both cats that died had the same clinical signs of lethargy and anorexia. None of the cats had any witnessed exposure. 3/25/2017 Call back to the original caller for follow up information. The cat was kept at the clinic overnight on intravenous fluids and brought home yesterday. She is improving, but symptoms have not resolved. The veterinarian stated that the product was not related, and symptoms were due to a flea/tick bite that causes red blood cells to be attacked. Caller declined a blood transfusion for the cat, and was sent home with an unknown medication.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here

Any relationship between the use of this product and the delayed development of the complications reported in this case is inconceivable and lacks biological plausibility. Secondly, the product use history is extremely vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact occurred, such serious illness as reported in this cat is unexpected. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

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

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death
  • Symptom - Lethargy

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

3/23/2017 Caller has used the product for years, and applies it under his stove. One cat is at the veterinarian currently because she began to get sick 3 or 4 days ago. The cat is lethargic and anorexic. The veterinarian has treated with intravenous fluids and are running blood tests. Another of caller's cats died 3 to 4 weeks ago after becoming sick. Caller had a third cat that died last year. Both cats that died had the same clinical signs of lethargy and anorexia. None of the cats had any witnessed exposure. 3/25/2017 Call back to the original caller for follow up information. The cat was kept at the clinic overnight on intravenous fluids and brought home yesterday. She is improving, but symptoms have not resolved. The veterinarian stated that the product was not related, and symptoms were due to a flea/tick bite that causes red blood cells to be attacked. Caller declined a blood transfusion for the cat, and was sent home with an unknown medication.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

Any relationship between the use of this product and the delayed development of the complications reported in this case is inconceivable and lacks biological plausibility. Secondly, the product use history is extremely vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact occurred, such serious illness as reported in this cat is unexpected. Finally, this animal was never properly evaluated and treated by a DVM nor was a necropsy performed to determine a possible cause of death. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

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

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Death
  • Symptom - Lethargy

12. How long did the symptoms last?

Persisted until death

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

No

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

3/23/2017 Caller has used the product for years, and applies it under his stove. One cat is at the veterinarian currently because she began to get sick 3 or 4 days ago. The cat is lethargic and anorexic. The veterinarian has treated with intravenous fluids and are running blood tests. Another of caller's cats died 3 to 4 weeks ago after becoming sick. Caller had a third cat that died last year. Both cats that died had the same clinical signs of lethargy and anorexia. None of the cats had any witnessed exposure. 3/25/2017 Call back to the original caller for follow up information. The cat was kept at the clinic overnight on intravenous fluids and brought home yesterday. She is improving, but symptoms have not resolved. The veterinarian stated that the product was not related, and symptoms were due to a flea/tick bite that causes red blood cells to be attacked. Caller declined a blood transfusion for the cat, and was sent home with an unknown medication.

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To be determined by Registrant

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

Death

19. Provide supplemental information here

Any relationship between the use of this product and the delayed development of the complications reported in this case is inconceivable and lacks biological plausibility. Secondly, the product use history is extremely vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact occurred, such serious illness as reported in this cat is unexpected. Finally, this animal was never properly evaluated and treated by a DVM nor was a necropsy performed to determine a possible cause of death. The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews.