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.
24-AUG-10
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
11-JUN-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. 24175
PMRA Submission No.
EPA Registration No.
Product Name: DRAGNET FT EMULSIFIABLE CONCENTRATE INSECTICIDE
7. b) Type of formulation.
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
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?
Unknown
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
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Vocalizing
- Respiratory System
- Symptom - Other
- Specify - respiratory arrest
- Nervous and Muscular Systems
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
No
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