Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4759

2. Registrant Information.

Registrant Reference Number: 316752

Registrant Name (Full Legal Name no abbreviations): Sergeant's Pet Care Products, Inc. /DBA PetLogic, LLC

Address: 2625 South 158th Plaza

City: Omaha

Prov / State: NE

Country: United States

Postal Code: 68130

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

Domestic Animal

4. Date registrant was first informed of the incident.

07-MAY-08

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 69332-3-2517

Product Name: Sergeant's Gold Flea and Tick Squeeze-On for Cats and Kittens

• Active Ingredient(s)
  • ETOFENPROX
    • Guarantee/concentration 55 %
  • PYRIPROXYFEN
    • Guarantee/concentration 2.2 %

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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).

Product was applied to the cat. Details of application unknown.

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

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

11.40

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

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• Skin
  • Symptom - Hair loss

• General
  • Symptom - Lethargy

• Skin
  • Symptom - Lesion

• General
  • Symptom - Death

12. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

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

Cat developed hair loss and ulceration in area of application within 3 days. Cat was taken to Vet and then released. Then cat was admitted overnight at DVM after developing lethargy. Owner unsure of treatments performed. Stated that two blood tests were performed but were inconclusive. The next day the cat died. Cause of death was not determined by DVM.

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To be determined by Registrant

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

Death

19. Provide supplemental information here