Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3605
2. Registrant Information.
Registrant Reference Number: 100504-000024
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.
04-MAY-10
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
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. 28610
PMRA Submission No.
EPA Registration No.
Product Name: Sergeant's Pretect Squeeze-on for Cats
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 (back of the cat's neck) because the cat had fleas.
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
unknown
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.83
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>15 min <=2 hrs / >15 min <=2 h
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Cardiovascular System
- Symptom - Abnormally fast heart rate
- Respiratory System
- Symptom - Heavy breathing
- Nervous and Muscular Systems
12. How long did the symptoms last?
>30 min <=2 hrs / >30 min <=2 h
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 says she applied one tube of the product as directed on the packaging (on the back of the cat's neck) and that five minutes later the cat had convulsions, was panting and had a fast heartbeat. They gave the cat some milk and washed the treated area with soap and water, after which the cat stopped panting.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here