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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5869

2. Registrant Information.

Registrant Reference Number: 665318

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.

20-JUL-10

5. Location of incident.

Country: UNITED STATES

Prov / State: PENNSYLVANIA

6. Date incident was first observed.

18-JUL-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.       PMRA Submission No.       EPA Registration No. 4822-529

Product Name: Raid Ant Baits III USA (non-specific))

  • Active Ingredient(s)
    • ABAMECTIN
      • Guarantee/concentration .01 %

PMRA Registration No.       PMRA Submission No.       EPA Registration No. Unknown

Product Name: Hartz Wormer

  • Active Ingredient(s)

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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

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

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

Dog / Chien

3. Breed

Mixed Breed

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 )

25.00

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Bloody stool
    • Symptom - Bloody vomit
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • General
    • Symptom - Death

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

7/20/2010 Caller reports that his dog chewed on a bait station 2 days ago. The bait station was still intact and only had teeth marks on it. No plastic was missing. The dog has vomited approximately 20 times in the last 2 days. Caller brought the dog to a veterinarian, but declined therapy due to the cost. Caller did not notice any plastic missing from the bait at the time of exposure. 7/24/2010 Callback to the original caller for follow up. The caller reports that the dog was also given a de-wormer the same day as the exposure to the product as the owner found a live worm in the dog's emesis. The dog continued to vomit through the night. Caller tried to give the dog Gatorade and Pedailyte through a syringe since the dog would no longer eat or drink on its own. The dog also developed hematemesis and bloody diarrhea. The dog died the following day.


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. Exposure history appears to indicate that even though the bait station had been chewed on, it was still intact such that majority of the bait pesticide still remained within the bait station housing. It would appear from the history given that this dog suffered from an intestinal parasitic infestation as evidenced by the worm found in its emesis and the fact that the dog was also recently treated with a dewormer. Finally, this animal was never properly evaluated and treated by a DVM nor was a necropsy performed.