Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2023-6751

2. Registrant Information.

Registrant Reference Number: 3716909

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.

14-SEP-23

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

11-SEP-23

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. 32317      PMRA Submission No.       EPA Registration No.

Product Name: RAID Max Double Control Ant Baits 2 (with adhesive), 4g [Canada]

• Active Ingredient(s)
  • ABAMECTIN

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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

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

6.00

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
  • Symptom - Nausea
  • Symptom - Vomiting
  • Symptom - Weight loss

• General
  • Symptom - Dehydration

• Renal System
  • Symptom - Renal failure
  • Symptom - Other
  • Specify - Kidneys smaller than normal

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Ataxia
  • Symptom - Recumbent
  • Specify - Down animal, unable to rise

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?

15. Outcome of the incident

Euthanised / Euthanasie

16. How was the animal exposed?

Other / Autre

specify No known exposure occurred.

17. Provide any additional details about the incident

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

9/14/2023 On approx. 11SEPT2023, caller's cat began to experience lethargy, anorexia, nausea, vomiting and ataxia. Caller states that he uses RAID Max Double Control Ant Baits 2 in his cottage they are currently staying in, no ingestion or exposure was witnessed but caller would like to know if this product could cause these symptoms. Cat is currently being evaluated by a veterinarian. 9/18/2023 Follow up with owner: The owner brought the cat to the veterinarian the same day as speaking with us (14Sept2023). At the time the cat was brought in it was also down and unable to rise, dehydrated, and had unplanned weight loss. The veterinarian diagnosed [Name] with kidney failure and stated that he had small kidneys. The veterinarian noted that the cat had probably been sick for quite some time, and just was not showing symptoms. The veterinarian did advise the owner that the product was not at any fault for the symptoms or kidney failure. Due to poor prognosis the owner elected to euthanize.

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To be determined by Registrant

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

Major

19. Provide supplemental information here

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.