Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-4751
2. Registrant Information.
Registrant Reference Number: 276919
Registrant Name (Full Legal Name no abbreviations): Sergeant's Pet Care Products, Inc.,/DBA PetLogic. LLC
Address: 2625 S. 158th Plaza
City: Omaha
Prov / State: NE
Country: United States
Postal Code: 68130-1770
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
07-JAN-08
5. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
6. Date incident was first observed.
05-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 69932-3-2517
Product Name: Sergeant's Gold Squeeze-On for Cats and Kittens over 5 lbs.
- Active Ingredient(s)
- ETOFENPROX
- Guarantee/concentration 55 %
- PYRIPROXYFEN
- Guarantee/concentration 2.2 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
.7
Units: mL
10. Site pesticide was applied to (select all that apply).
Site: Animal / Usage sur un animal domestique
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
Sometime over the past one to two weeks prior to January 7, 2008, one .7 ml tube was applied to the back of the neck and base of tail. Product should only be applied as a spot behind cat's head.
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
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
4
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Blood
- Symptom - Anemia
- Symptom - Blood urea nitrogen increased
- Specify - BUN Increase, Other LFT abnormality
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
24
Hour(s) / Heure(s)
15. Outcome of the incident
Died
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
Owners applied product to back of neck and base of tail. They saw the cat groom the product but do not recall any GI sxs at the time of ingestion. 1-2 weeks later the cat developed the symptoms. The owners could not afford a transfusion and the cat died naturally over the weekend.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here