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Consumer Product Safety

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
  • General
    • Symptom - Death

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