Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-5247
2. Registrant Information.
Registrant Reference Number: Prosar 1-16734395
Registrant Name (Full Legal Name no abbreviations): The Scotts Company, LLC
Address: 14111 Scottslawn Rd
City: Marysville
Prov / State: Ohio
Country: USA
Postal Code: 43041
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
11-OCT-08
5. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
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. 1021-1749-239
Product Name: Ant-B-Gon Dust
- Active Ingredient(s)
- PERMETHRIN
- Guarantee/concentration .25 %
7. b) Type of formulation.
Dust
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).
The product was applied "around the home" (unclear if indoors or outside) on a couple of occasions during the summer months. Product exposure was not witnessed.
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
Miniature Schnauzer
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
0.25
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
- Gastrointestinal System
- Symptom - Rectal hemorrhage
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 Product exposure was not witnessed. It is unknown whether the dog had any exposure to the product.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16734395: A reporter called on 10/11/2008 to report the possible exposure of a dog to an insecticide containing the active ingredient Permethrin. According to the reporter, the product had been applied "around the home" (unclear whether product was applied indoors or outside) on a couple of occasions during the summer. Product ingestion or other exposure was not witnessed. At the time of the report the dog had rectal bleeding (onset of signs unknown). The reporter was advised that the sign described is not an expected result of product exposure. A recommendation was made to have the dog evaluated immediately by a veterinarian to rule out other more likely causes for the rectal bleeding. On follow up, the reporter stated that the dog died on 10/12/2008. The reporter had not taken the dog to a veterinarian but had spoken with one who thought the dog likely had parvo. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here