Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-0833

2. Registrant Information.

Registrant Reference Number: 259874

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.

12-NOV-07

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

Unknown

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.

Product Name: Raid Double Control Small Roach Baits 12 ct

  • Active Ingredient(s)
    • ABAMECTIN
      • Guarantee/concentration .05 %

7. b) Type of formulation.

Bait

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

Other / Autre

specify Exotic

3. Breed

Rabbit

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

2

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • General
    • Symptom - Death
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Paralysis

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Unknown

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify No exposure is evident or was witnessed. Owner admits that she is merely speculating that pet may have been exposed.

17. Provide any additional details about the incident

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

11/12/2007 1:26:04 PMCaller concerned that rabbit might have licked the product this morning. She relates her maid found the animal lethargic and not moving. Caller is wondering if this is product related. She is not sure the rabbit even got into the product. No one saw the rabbit near the bait station, however, the rabbit is allowed to roam around the room where the bait is sitting out. Owner was instructed to bring the rabbit to a DVM ASAP.11/27/2007 4:18:35 PMFollow-up with owner. She did take the rabbit to the vet. They now suspected that the rabbit may have chewed on an electrical chord in the home. There was rear paralysis per DVM. The rabbit died that night. No necropsy.


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.There is no evidence to suggest that this rabbit ever had contact with the bait station. Even had the rabbit licked the outside of the hard plastic housing surrounding the still intact bait inside, there would be negligible to no exposure to abamectin. Even had the rabbit ingested the entire contents of this bait station, the potential dose of abamectin this rabbit could have received from a single bait station is well below any dose of this compound that could potentially lead to significant illness. Finally, an independent veterinary evaluation has determined another unrelated cause for this rabbit's illness.