Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-4972

2. Registrant Information.

Registrant Reference Number: 506095

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.

22-JUL-09

5. Location of incident.

Country: UNITED STATES

Prov / State: RHODE ISLAND

6. Date incident was first observed.

17-JUL-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 4822-283

Product Name: Raid House and Garden Bug Killer Formula 7- 11 oz

• Active Ingredient(s)
  • D-PHENOTHRIN
    • Guarantee/concentration .096 %
  • D-TRANS-ALLETHRIN
    • Guarantee/concentration .239 %

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7. b) Type of formulation.

Liquid

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).

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

7/22/2009 Product was sprayed in the caller's apartment by the landlord. Caller's cat vomited for 10 minutes, and then was asymptomatic for the rest of the day. The cat died suddenly the next day. The cat had no witnessed exposure to the product. The caller refused to have a necropsy performed on the cat.

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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. Any relationship between the use of this product and development of fatality 24 hours later is inconceivable and lacks biological plausibility. The product use history is extremely vague and lacks any description of a known or defined point of direct exposure to this product. Had the cat ingested material that had been sprayed with this insecticide or walked across the treated surface and subsequently licked its paws, the concentration of the active ingredients in this product would not be expected to lead to fatal illness. While toxicity from these particular active ingredients may cause toxicity in felines, the percent of active ingredient needs to exceed at least 100 times this concentration for systemic issues to occur. Finally, medical evaluation by a licensed veterinarian in order to determine the cause of the illness was never sought.