Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-3398
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-33795790
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Argentia Road, Plaza 5, Suite 101
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N2R7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
27-MAY-135. 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. 28376 PMRA Submission No. EPA Registration No.
Product Name: Ecosense Bug B Gon Insecticidal Soap RTU
- Active Ingredient(s)
- POTASSIUM SALTS OF FATTY ACIDS
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. - Out Home / Rés - à l'ext.maison
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
Bichon Frise
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
12
7. Weight (provide a range if necessary )
40
lbs
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Eye
- Symptom - Watery eye
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-33795790 - The reporter, a pet owner, indicated that his dog was exposed to an insecticidal product containing the active ingredient potassium salt of fatty acids. At the time of initial contact with the registrant the reporter indicated that he had sprayed the product on his garden for about one week. Caller indicated that his 12 year old, 40 pound, male, Bichon Frise had eaten some of the treated plants and was now having problems with watery eyes. The reporter was advised that with ingestion mild gastrointestinal upset may occur but watering eyes are not expected after ingestion of the product. The reporter was further advised to seek veterinary care for appropriate diagnosis and treatment. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
