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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-7427
2. Registrant Information.
Registrant Reference Number: SJB
Registrant Name (Full Legal Name no abbreviations): Spectrum Brands IP Inc.
Address: P.O. Box 21001
City: Brantford
Prov / State: ON
Country: Canada
Postal Code: N3R 7W9
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
12-SEP-075. Location of incident.
Country: CANADA
Prov / State: UNKNOWN
6. Date incident was first observed.
02-AUG-07Product 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. 28352 PMRA Submission No. EPA Registration No.
Product Name: WILSON PREDATOR RAT & MOUSE KILLER BLOKS WITH DIFETHELIONE "KILLS IN
- Active Ingredient(s)
- DIFETHIALONE
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. - Out Home / Rés - à l'ext.maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The pet owner indicated that 5 cubes of rodenticide were put under the deck 2 weeks ago and indicated that this area is unaccessible to the dogs. The Owner's of the pets went on vacation and the dog's stayed in a boarding kennel. Owner's have been home for 24hrs and 1 dog is now sick while the other one is doing fine.To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Great Dane
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
125
lbs
8. Route(s) of exposure
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
- Gastrointestinal System
- Symptom - Bloody diarrhea
- Symptom - Vomiting
- Symptom - Rectal hemorrhage
- Liver
- Symptom - Hepatic failure
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?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Pet owner's put 5 cubes under the deck 2 weeks ago. Unaccessible to the dogs. Owner's went on vacation and dog's stayed in the boarding kennel. Owner's have been home for 24hrs and one dog is now sick and the other is doing fine. Dog just suddenly became unresponsive. Only blinking eyes. Owner's splashed him with water and dog got up. He first developed vomiting which was was brown then became, bright red blood. He had black diarrhea, then developed into bright red blood. Blood leaking from anus. Dog is at the vet. Vet has given Vit K and IV fluids and antibiotics. Vet has run blood work and believes the dog's liver is in failure. Pancreas levels are bad and liver enzymes can't register on the machine. Several vets over the course of a few days follow up with the dog owner's personal vet and have confirmed that the dog has fully recovered.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
