Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-0600

2. Registrant Information.

Registrant Reference Number: 01022008-28059

Registrant Name (Full Legal Name no abbreviations): Reckitt Benckiser (Canad) Inc.

Address: 1680 Tech Ave

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L4W 5S9

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

Domestic Animal

4. Date registrant was first informed of the incident.

25-JAN-08

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

25-JAN-08

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. 28059      PMRA Submission No.       EPA Registration No.

Product Name: Lysol Brand Continuous Action Toilet Bowl Cleaner

• Active Ingredient(s)
  • 1,3-DICHLORO-5,5-DIMETHYLHYDANTOIN
  • 1,3-DICHLORO-5-ETHYL-5 METHYLHYDANTOIN
  • 1-BROMO-3-CHLORO-5,5-DIMETHYLHYDANTOIN

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

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

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

To be determined by Registrant

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

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Boxer

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

80

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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

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

Owner found dog drinking diluted product from toilet, 2 hours after dog vomited several times and began acting lethargic.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here