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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2498

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: NEW BRUNSWICK

6. Date incident was first observed.

05-JUN-12

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. 25738      PMRA Submission No.       EPA Registration No.

Product Name: Premise 1000 Flea Spray

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .078 %
    • PERMETHRIN
      • Guarantee/concentration .8 %

PMRA Registration No. 21744      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Flea and Tick Spray for dogs and cats

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • PIPERONYL BUTOXIDE
    • PYRETHRINS

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: applied to household furniture/premises

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

1 - 2/3 of a 227g can applied to household furniture/premises (ex.couch) (spray can - aerosol) 2 - spray bottle, 236ml is about 1/2 empty - not sure if used all at once or repeat treatments (2 cats in household). (pump-type spray bottle).

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Short Hair

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

Respiratory

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Hiding
    • Symptom - Abnormal behaviour
    • Specify - acting strange
  • Nervous and Muscular Systems
    • Symptom - Shaking
    • Symptom - Muscle tremors
  • Gastrointestinal System
    • Symptom - Salivating excessively

12. How long did the symptoms last?

>24 hrs <=3 days / >24 h <=3 jours

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

Fully Recovered / Complètement rétabli

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

Exclusively indoor cat. Owner applied spray in am. Cat began hiding, acting strange, shaking, tremors, salivating. Persisted all day, seen on after hours emergency. By the time seen, symptoms were abating and no treatment was required. Very mild compared to usual reactions we see in cats with these products. The owner believes that cat was licking the couch after it was sprayed with product #1 above. I believe she used to topical pet product before without any problems. The 2nd cat in the house exhibited no sign. (but was not licking the furniture!)


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here