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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-4444
2. Registrant Information.
Registrant Reference Number: Prosar 1-19796144
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.
07-SEP-095. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
07-SEP-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 Ant Trap (Borax)
- Active Ingredient(s)
- BORAX
7. b) Type of formulation.
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
Labrador Retriever
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.5
7. Weight (provide a range if necessary )
55
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
- Symptom - Diarrhea
- General
- Symptom - Lethargy
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
1-19796144: A reporter (dog owner) called on 09/07/2009 to report the possible exposure of her dog to an ant bait containing the active ingredient Borax. According to the reporter, the dog was found with the product in his mouth about 7 hours prior to the report. There was no damage to the trap and any ingestion of bait would have been very minimal based on intact trap/packaging. The reporter left 2 hours prior to the report and came home to find that the dog had vomited, had diarrhea, and was lethargic. There was some grass noted in the vomit. The reporter was advised that the signs described are not consistent with the possible minimal bait ingestion. The reporter was also advised that a much larger amount of product would need to be ingested to result in the gastrointestinal signs described. A recommendation was made to have the dog evaluated by a veterinarian should the signs persist. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
