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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-7984

2. Registrant Information.

Registrant Reference Number: 211469

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-JUL-07

5. Location of incident.

Country: UNITED STATES

Prov / State: COLORADO

6. Date incident was first observed.

11-JUL-07

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.       PMRA Submission No.       EPA Registration No. 4822-513

Product Name: Raid Flying Insect Killer Formula 6 Outdoor Fresh 15 oz4822-513

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration .1 %
    • TETRAMETHRIN
      • Guarantee/concentration .35 %

7. b) Type of formulation.

Liquid

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).

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

Dog / Chien

3. Breed

Great Dane

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

120.00

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Confusion
  • Renal System
    • Symptom - Renal failure

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?

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 Clearly defined point of exposure or direct contact with pesticide or pesticide treated surface is not evident and based on speculation.

17. Provide any additional details about the incident

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

7/14/2007Product applied outside of home on 7/11/2007. Product was also misapplied inside and outside of a dog house. The dog developed lethargy and ataxia on 7/13. Dog was to be taken to vet hospital for medical care. It is unclear exactly how dog was exposed to the pesticide, but presumably, since the product was sprayed inside of a dog house, the dog likely was exposed to pesticide off the floor of the dog house.7/24/2007Follow-up with owner. Dog found to have developed renal failure of unknown etiology. Dog ended up being euthanized at the vet hospital. No necropsy was performed.


To be determined by Registrant

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

Death

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.Even had direct contact with treated surface occurred, profound renal failure such as reported in this case would not be expected based on what is known regarding the toxicological profile of the active ingredients used in this pesticide at application concentrations. Pyrethroid insecticides are not typically associate with renal failure as the primary pathology in cases of true poisoning, especially in the absence of more classical neurological symptoms of pyrethroid toxicity.