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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-4066

2. Registrant Information.

Registrant Reference Number: 629877

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.

09-MAY-10

5. Location of incident.

Country: UNITED STATES

Prov / State: WEST VIRGINIA

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.       PMRA Submission No.       EPA Registration No. 4822-271

Product Name: Raid Wasp and Hornet Killer - 17.5 oz

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration .2 %
    • TETRAMETHRIN
      • Guarantee/concentration .2 %

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

Pit Bull Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.50

7. Weight (provide a range if necessary )

40.00

lbs

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

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Vomiting
  • General
    • Symptom - Death
    • Symptom - Lethargy
    • Symptom - Grass ingestion

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

May 9, 2010 The product was applied to four wasp nests on the ceiling in the porch two days ago. The dog was not on the porch during application; Caller has been watching a dog that belongs to a family member for the past week and knows nothing about the dog's past medical history. Since the product was used the dog was seen eating grass in the yard and vomiting afterwards. Dog had also been very lethargic and will not eat. The dog has not had any witnessed exposure to the product nor would exposure be expected since the wasp nests were on the ceiling of the front porch where the dog cannot reach. The caller was told to take the dog to the veterinary ER immediately. Follow-up on May 23, 2010 The dog died on May 10, 2010. The dog was not taken to a veterinarian for treatment as previously recommended. This dog has since been buried in the reporter's backyard.


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 the delayed development of the complications reported in this case is inconceivable and lacks and biological plausibility. Secondly, the product use history would appear to indicate that this dog could not have experienced significant exposure to this pesticide since it was sprayed on wasps nest located in the ceiling of a front porch. Even had casual or incidental contact with this diluted product occurred, such serious illness as reported in this dog is unexpected. Even if true pyrethroid toxicity were to occur in these case is would manifest with acute neurological complications, primarily in the form of tremors and ataxia which was not reported in this incident. Finally, this animal was never properly evaluated and treated by a DVM nor was a necropsy performed to determine a possible cause of death.