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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2090

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.       PMRA Submission No.       EPA Registration No.

Product Name: Powerspot SM

  • 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: Animal / Usage sur un animal domestique

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

On 26 May I use it on my dog.

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

Dog / Chien

3. 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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms


  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Muscle spasm
  • Respiratory System
    • Symptom - Panting

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


16. How was the animal exposed?

Treatment / Traitement

17. Provide any additional details about the incident

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

I would like to report a toxic pesticide incident. On 25 May 2012, I purchased Powerspot SM for dogs (flea and tick medication containing permethrin) from (Company name) in (City), Ontario. This is manufactured by a US company. On May 26, I use it on my dog. He had seizures, muscle spasms and panting. It almost killed him. Unfortunately this happened at night on a weekend so I was unable to find a vet that would take him. Last year, the same thing happened with a similar product sold by Hartz which caused me the same problems and this product was subsequently taken off the shelves totally by (name). Unfortunately and unknowingly I did not realize that the product I bought also contained permethrin. I did some research and discovered that the "EPA has a report of over 44,000 reported incidents of animals being pets having reactions to chemical flea products. Of course, this is a low number because most people don't report incidents to the EPA. The chemical flea medications are actually poisonous. The chemicals in them are neuro toxins, and as this word implies, they are toxic to nerve cells. They damage &/or kill nerve cells. That is why a common reaction is seizures and involuntary body movements." I would ask you to please have this product removed from the Canadian marketplace so that no further animals have to suffer this misery. I wrote to the Manufacturer and to date have had no response.

To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here