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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3093
2. Registrant Information.
Registrant Reference Number: 807334
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.
21-JUN-115. Location of incident.
Country: CANADA
Prov / State: ONTARIO
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. 18449 PMRA Submission No. EPA Registration No.
Product Name: Raid Liquid Ant Killer - Canada
- Active Ingredient(s)
- BORAX
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
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?
YesSubform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
DSH
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
18
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
- Gastrointestinal System
- Symptom - Vomiting
- General
- Symptom - Death
- Symptom - Lethargy
- Respiratory System
- Symptom - Shortness of breath
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 Exposure is merely speculative. No known or witnessed exposure to treated surfaces occurred.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Consumer reports that she has three adult cats, two which recently had birthed a litter of cats. The third adult cat was elderly. She states the Raid Liquid Ant Killer was applied to a windowsill in the home about 3-4 weeks ago. The cats and kittens had free access to the area around this windowsill but there were never seen in the windowsill. About 2 weeks ago, one litter of 4 kittens started showing labored breathing and lethargy and eventually died. The second litter of 5 kittens that was just 2 weeks old displayed the same symptoms and eventually died as well. The elderly cat started developing vomiting, was unable to hold down water and eventually died, as well. None of these animals were evaluated by a veterinarian. All cats had ready access to the outdoors and none had preventive vaccine care.
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. The product use history is vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact with a treated surface occurred, such serious illness resulting in fatality would be unexpected and biologically implausible. These animals were never properly evaluated and treated by a DVM and had not received proper preventative veterinary care (vaccines) prior to this incident. Finally, necropsies were not performed to determine a possible cause of death.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
DSH
4. Number of animals affected
5
5. Sex
Unknown
6. Age (provide a range if necessary )
0.04
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 - Death
- Symptom - Lethargy
- Respiratory System
- Symptom - Shortness of breath
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 Exposure is merely speculative. No known or witnessed exposure to treated surfaces occurred.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Consumer reports that she has three adult cats, two which recently had birthed a litter of cats. The third adult cat was elderly. She states the Raid Liquid Ant Killer was applied to a windowsill in the home about 3-4 weeks ago. The cats and kittens had free access to the area around this windowsill but there were never seen in the windowsill. About 2 weeks ago, one litter of 4 kittens started showing labored breathing and lethargy and eventually died. The second litter of 5 kittens that was just 2 weeks old displayed the same symptoms and eventually died as well. The elderly cat started developing vomiting, was unable to hold down water and eventually died, as well. None of these animals were evaluated by a veterinarian. All cats had ready access to the outdoors and none had preventive vaccine care.
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. The product use history is vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact with a treated surface occurred, such serious illness resulting in fatality would be unexpected and biologically implausible. These animals were never properly evaluated and treated by a DVM and had not received proper preventative veterinary care (vaccines) prior to this incident. Finally, necropsies were not performed to determine a possible cause of death.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
DSH
4. Number of animals affected
4
5. Sex
Unknown
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 - Death
- Symptom - Lethargy
- Respiratory System
- Symptom - Shortness of breath
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 Exposure is merely speculative. No known or witnessed exposure to treated surfaces occurred.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
Consumer reports that she has three adult cats, two which recently had birthed a litter of cats. The third adult cat was elderly. She states the Raid Liquid Ant Killer was applied to a windowsill in the home about 3-4 weeks ago. The cats and kittens had free access to the area around this windowsill but there were never seen in the windowsill. About 2 weeks ago, one litter of 4 kittens started showing labored breathing and lethargy and eventually died. The second litter of 5 kittens that was just 2 weeks old displayed the same symptoms and eventually died as well. The elderly cat started developing vomiting, was unable to hold down water and eventually died, as well. None of these animals were evaluated by a veterinarian. All cats had ready access to the outdoors and none had preventive vaccine care.
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. The product use history is vague and lacks any description of a known or defined point of direct exposure to this product. Even had casual or incidental contact with a treated surface occurred, such serious illness resulting in fatality would be unexpected and biologically implausible. These animals were never properly evaluated and treated by a DVM and had not received proper preventative veterinary care (vaccines) prior to this incident. Finally, necropsies were not performed to determine a possible cause of death.
