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: 2008-3220

2. Registrant Information.

Registrant Reference Number: 327631

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.

04-JUN-08

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

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. 4822-469

Product Name: OFF! Mosquito Lamp Refill

  • Active Ingredient(s)
    • D-CIS, TRANS ALLETHRIN
      • Guarantee/concentration 21.97 %

7. b) Type of formulation.

Other (specify)

Compressed aggregate

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic shorthair

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

0.13

7. Weight (provide a range if necessary )

1

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • General
    • Symptom - Death
    • Symptom - Lethargy

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 Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

6/4/2008 Caller reports that she had used product in her carport on 6/2/2008. She also states that she has three feral kittens and a mother that have been staying in her carport. The kittens have not had any known direct exposure to product. Caller states that one kitten became weak and died last night and another died this morning. The third kitten is weak. The kittens were never evaluated by a veterinarian as the caller could not afford veterinary care. The mother has been fine. 6/6/2008 Callback to original caller for follow up. Caller states that the third kitten died that evening. The kitten was not seen by a veterinarian.


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. Product not intended to be used in an enclosed area and in the immediate vicinity of pets. Even with such improper use, animal exposure to airborne material would not be expected to product insidious illness leading to death. These kittens were never evaluation by a veterinarian to determine possible cause of illness. There are several potential causes for severe illness in feral kittens that have had no preventative medical care such as vaccines, deworming, and flea eradication.