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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3603

2. Registrant Information.

Registrant Reference Number: 100416-000010

Registrant Name (Full Legal Name no abbreviations): Sergeant's Pet Care 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.

16-APR-10

5. Location of incident.

Country: CANADA

Prov / State: NEWFOUNDLAND

6. Date incident was first observed.

09-APR-10

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. 28610      PMRA Submission No.       EPA Registration No.

Product Name: Sergeant's Pretect Squeeze-on for Cats

  • Active Ingredient(s)
    • PYRIPROXYFEN

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: tube

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

Site: Animal / Usage sur un animal domestique

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

Owner says she applied one tube of the product as directed on the packaging.

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

domestic shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.7

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Trembling
  • Eye
    • Symptom - Other
    • Specify - anisocoria

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.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

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 says she applied one tube of the product according as directed on the packaging at approximately 6pm. The cat began to seizure later that evening. Owner went to the vet at 1:30 am at which point the cat was alert and somewhat responsive but was tremoring severely all over. Valium was administered rectally than intravenously. Methecarbamol was given intravenously to alleviate tremoring. Both treatments were given several times throughout the night and the following day. Intravenous lactated ringers solution was given to compensate for dehydration and to help counteract toxin. The cat was discharged on the second day in the morning since his symptoms had subsided and only anisocoria remained.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here