Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-3964

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.


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.


PMRA Registration No. 24175      PMRA Submission No.       EPA Registration No.


  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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

Site: Res. - In Home / Rés. - à l'int. maison

Préciser le type: Apartment

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

Spray for cockroaches, amount unknown. Apartment sprayed with Dragnet June 11.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Himalayan, pure breed

4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )


8. Route(s) of exposure


9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms


  • General
    • Symptom - Lethargy
    • Symptom - Vocalizing
  • Respiratory System
    • Symptom - Other
    • Specify - respiratory arrest
  • Nervous and Muscular Systems
    • Symptom - Coma

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident

Euthanised / Euthanasie

16. How was the animal exposed?

Other / Autre

specify Licking the areas where poison deposited suspected.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Owner and animal left the apartment for four hours, June 11 at 2:15 p.m. returned at 6:15 p.m. Cat started to display lethargy and strange vocalization right away. Upon consulting with Vet Emergency (and getting a quite apathetic response), owner took cat to balcony and symptoms seemed to soften. They continued. By midnight, they worsened and cat would fall trying to stand up. Taken to Vet Emergency, nobody was able to identify the poison then as it was a Friday night, very late. Poison Control was contacted, they wouldn't know either. Veterinarian diagnosed "stroke" and prescribed blood tests, IV hydration and sedatives. By 3 am the animal started to have respiratory arrests and went into coma. Veterinarian finally recommended and prescribed euthansia as the only solution. Query respiratory ways. Licking the areas where poison deposited suspected. Total time in environment exposed four hours, two hours in balcony.

To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here