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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3878
2. Registrant Information.
Registrant Reference Number: Prosar 1-19481469
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Argentia Road, 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.
11-AUG-095. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
11-AUG-09Product 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)
- Active Ingredient(s)
- BORAX
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).
Three sprays of product were applied to the trash inside a garbage can on 08/10/2009.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
Mixed breed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.25
7. Weight (provide a range if necessary )
5
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Diarrhea
- Symptom - Vomiting
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?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-19481469: A reporter (dog owner) called on 08/11/2009 to report the exposure of her 2 dogs to an insecticide containing the active ingredient Borax. According to the reporter, 3 sprays of the product were applied to the trash inside of a garbage can on 08/10/2009. The dogs ate garbage from the trash can sometime after product application. One hour prior to the report, Dog #1 (1st Subform III) developed diarrhea and multiple episodes of vomiting. Dog #2 (2nd Subform III) vomited once, 1 hour prior to the report. The reporter was advised that the product may result in minor gastrointestinal upset if ingested. The reporter was also advised that eating garbage can result in GI signs as well. A recommendation was made to take the dogs (especially Dog #1) to the veterinarian for evaluation of their signs. Multiple attempts at follow up were 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
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Australian Cattle Dog
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1.58
7. Weight (provide a range if necessary )
50
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Vomiting
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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-19481469: A reporter (dog owner) called on 08/11/2009 to report the exposure of her 2 dogs to an insecticide containing the active ingredient Borax. According to the reporter, 3 sprays of the product were applied to the trash inside of a garbage can on 08/10/2009. The dogs ate garbage from the trash can sometime after product application. One hour prior to the report, Dog #1 (1st Subform III) developed diarrhea and multiple episodes of vomiting. Dog #2 (2nd Subform III) vomited once, 1 hour prior to the report. The reporter was advised that the product may result in minor gastrointestinal upset if ingested. The reporter was also advised that eating garbage can result in GI signs as well. A recommendation was made to take the dogs (especially Dog #1) to the veterinarian for evaluation of their signs. Multiple attempts at follow up were unsuccessful. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
