Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-7986
2. Registrant Information.
Registrant Reference Number: 214878
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.
22-JUL-07
5. Location of incident.
Country: UNITED STATES
Prov / State: ARKANSAS
6. Date incident was first observed.
22-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. 4822-399
Product Name: OFF! Deep Woods Insect Repellent Pump Spray 6 oz.4822-399
- Active Ingredient(s)
- DEET (N,N-DIETHYL-M-TOLUAMIDE) PLUS RELATED ACTIVE TOLUAMIDES (ORTHO + PARA ISOMERS)
- Guarantee/concentration 25 %
7. b) Type of formulation.
Liquid
Tablet
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 )
0.22
7. Weight (provide a range if necessary )
5.00
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle weakness
- Symptom - Difficulty getting up
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
Died
16. How was the animal exposed?
Other / Autre
specify Accidentally fell into a bowl of product.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
7/22/2007Product was poured into a bowl, and kitten accidentally fell into the bowl 20 minutes ago. Kitten is wheezing, cannot stand, and tongue is sticking out. 7/24/2007Call back for follow up. Cat died prior to DVM evaluation, and was not evaluated prior to or after death.
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. Difficult to ascertain the pathology associated with this cat's unexpected death given that owners chose not to seek prompt medical attention for their cat. Typically, brief skin exposures to DEET containing insect repellents in small animals would not result in such immediate and profound complications.