Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-3132

2. Registrant Information.

Registrant Reference Number: 478136

Registrant Name (Full Legal Name no abbreviations): S.C. Johnson and Son, Limited

Address: 1 Webster Street

City: Brantford

Prov / State: ON

Country: Canada

Postal Code: N3T 5R1

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

Domestic Animal

4. Date registrant was first informed of the incident.

27-MAY-09

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

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. 4822-469

Product Name: OFF! Powerpad Lamp Refill

• Active Ingredient(s)
  • D-CIS, TRANS ALLETHRIN
    • Guarantee/concentration 21.97 %

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7. b) Type of formulation.

Other (specify)

Solid lamp strip

Application Information

8. Product was applied?

Unknown

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

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

Great Dane

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 )

60

lbs

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 - Anorexia
  • Symptom - Diarrhea

• General
  • Symptom - Death
  • Symptom - Lethargy

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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

5/27/2009 Caller reports that two of the product refills have gone missing sometime in the past two to 8 hours. She suspects her dog may have eaten them, but she is not sure. The caller's dog has developed lethargy, diarrhea, anorexia. The dog has had no witnessed exposure to the product. 6/9/2009 Callback attempted to original caller. A message was left requesting follow up information. 6/11/2009 Callback to original caller for follow up information. The dog was taken to a veterinarian for an evaluation. The dog was given something for pain control. Caller brought the dog home where the dog died. No cause of death was determined as the owner was not able to afford advanced testing or treatment.

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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

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. The possibility of product exposure appears to be based on speculation as there is no visible evidence that the dog actually ingested the pesticide refills. Secondly, the ingestion of d-cis trans allethrin containing refill strips may be expected to produce primarily stomach irritation resulting in vomiting, however, such a symptom was not reported in this case, thus suggesting that exposure may not have occurred. When considering the body of regulatory data and post-marketing data as well as the weight of scientific peer reviewed evidence on the d-cis tran allethrin used in this product such a causal relationship appears to be scientifically implausible even if the animal had managed to ingest two full strips of the lamp refill. Unfortunately, the pet owner did not seek prompt medical attention nor was she able to afford the necessary diagnostic testing to determine the cause of the illness and identify potentially life saving treatment interventions.