Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3146
2. Registrant Information.
Registrant Reference Number: 090727-000018
Registrant Name (Full Legal Name no abbreviations): Sergeant's Pet Products Inc.
Address: 2625 South 158th Plaza
City: Omaha
Prov / State: NE
Country: USA
Postal Code: 68130-1770
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
27-JUL-09
5. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
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. 28280
PMRA Submission No.
EPA Registration No.
Product Name: Sergeant's Pretect Squeeze-on for Dogs
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).
Owner applied one tube at the back of the dog's neck. Owner says that she followed directions on box.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Labrador
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.75
7. Weight (provide a range if necessary )
70
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Loss of appetite
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
Fully Recovered / Complètement rétabli
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
Owner treated dog when she saw that he had fleas. Two days after the first dose, dog started scratching himself, vomiting and refusing to eat. Owner called vet who said that it might be an allergic reaction. Owner gave dog a bath and the itching was relieved. Dog is now better.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here