Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-0471
2. Registrant Information.
Registrant Reference Number: Prosar 1-17377337
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd
Address: 2000 Argentia Rd, Plaza 5, Suite 101
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N2R7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
24-JAN-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
24-JAN-09
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. 9167
PMRA Submission No.
EPA Registration No.
Product Name: Ant-B-Gon Max Ant Killer Liquid (Ortho)
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - In Home / Rés. - à l'int. maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
The product was applied in the home during the week prior to the report.
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
Unknown breed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.42
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 - Salivating excessively
- Symptom - Bloody diarrhea
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify Unknown if exposure occurred
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-17377337: A reporter called on 01/24/2009 to report the possible exposure of a cat to an insecticide containing the active ingredient Borax. According to the reporter, the product had been applied to the home during the week prior to the report. The only exposure the cat may have had would have been ingestion of ants that had been in the area where the product was applied. The cat started salivating and having bloody diarrhea the morning of the report. The reporter also stated that the cat had been neutered earlier in the week. The reporter was advised that exposure to the product is not expected to cause bloody diarrhea. The reporter was also advised that signs are not expected without direct exposure to the product. A recommendation was made to have the cat evaluated by a veterinarian. An attempt at follow up was unsuccessful. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here