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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-2497

2. Registrant Information.

Registrant Reference Number: Prosar case 1-15946410

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 1735 Market Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19103

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

Domestic Animal

4. Date registrant was first informed of the incident.

27-MAR-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

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. 279-3141

Product Name: Astro Insecticide

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration 36.8 %

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: Unknown / Inconnu

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

Product has been used over the last 5 years by a Pest Control Operator and all re-entry procedures were honored.

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

English Setter

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Cancer
    • Specify - Lymphoma
    • Symptom - Death

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown route(s) of exposure

17. Provide any additional details about the incident

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

1-15946410: The reporter, a dog breeder, called on 3/27/08 to report that 2 of his dogs had developed lymphoma and died. A product containing Permethrin had been used over the past 5 years by a Pest Control Operator and the reporter was wondering if use of the product and the deaths of his dogs could be related. According to the reporter, all re-entry procedures for the product were honored. The toxicity and safety profile of the product were discussed with the reporter.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

English Setter

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

6

7. Weight (provide a range if necessary )

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Death
    • Symptom - Cancer
    • Specify - Lymphoma

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Unknown route(s) of exposure

17. Provide any additional details about the incident

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

1-15946410: The reporter, a dog breeder, called on 3/27/08 to report that 2 of his dogs had developed lymphoma and died. A product containing Permethrin had been used over the past 5 years by a Pest Control Operator and the reporter was wondering if use of the product and the deaths of his dogs could be related. According to the reporter, all re-entry procedures for the product were honored. The toxicity and safety profile of the product were discussed with the reporter.


To be determined by Registrant

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

Death

19. Provide supplemental information here