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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2015-0829

2. Registrant Information.

Registrant Reference Number: 1501592

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.

13-NOV-14

5. Location of incident.

Country: UNITED STATES

Prov / State: SOUTH CAROLINA

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.       PMRA Submission No.       EPA Registration No. 4822-229

Product Name: Raid Flea Killer Plus Fogger

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration 1.67 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 1 %
    • PYRETHRINS
      • Guarantee/concentration .5 %

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?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify Reptile

3. Breed

Other - Turtle

4. Number of animals affected

1

5. Sex

Female

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

>1 mo <=2 mos / > 1 mois < = 2 mois

11. List all symptoms

System

  • 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?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

11/13/2014 Caller used product in their home a couple of months ago, and placed their turtles in another room with a towel under the door. One turtle has since died, and the other became ill. Caller took the second turtle to a veterinarian, but caller declined to run diagnostics to determine the cause of the turtles illness. 11/21/2014 Attempted cal back to the original caller for follow up information. A family member gave an alternate phone number for the original caller. 11/24/2014 Attempted call back to the original caller. A message was left requesting follow up information.


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. Based on the known toxicological profile of the active ingredients used in this pesticide, when this product is used in the manner described in this incident, such significant adverse effects as reported are not expected and lack biological plausibility. The apparent insidious and delayed onset of the protracted illness reported is not consistent with pyrethroid toxicity even had significant exposure occurred. There are several potential illnesses that may lead to a fatal outcome in a turtle. Without a comprehensive diagnostic testing or an evaluation including necropsy performed by a veterinarian, statements regarding the cause of the illness reported in these turtles is purely speculative.

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Other / Autre

specify Reptile

3. Breed

Other - Turtle

4. Number of animals affected

1

5. Sex

Male

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 - Malaise

12. How long did the symptoms last?

Unknown / Inconnu

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?

Unknown

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Other / Autre

specify Defined point of exposure not evident or witnessed. Exposure based on speculation.

17. Provide any additional details about the incident

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

11/13/2014 Caller used product in their home a couple of months ago, and placed their turtles in another room with a towel under the door. One turtle has since died, and the other became ill. Caller took the second turtle to a veterinarian, but caller declined to run diagnostics to determine the cause of the turtles illness. 11/21/2014 Attempted cal back to the original caller for follow up information. A family member gave an alternate phone number for the original caller. 11/24/2014 Attempted call back to the original caller. A message was left requesting follow up information.


To be determined by Registrant

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

Minor

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. Based on the known toxicological profile of the active ingredients used in this pesticide, when this product is used in the manner described in this incident, such significant adverse effects as reported are not expected and lack biological plausibility. The apparent insidious and delayed onset of the protracted illness reported is not consistent with pyrethroid toxicity even had significant exposure occurred. There are several potential illnesses that may lead to a fatal outcome in a turtle. Without a comprehensive diagnostic testing or an evaluation including necropsy performed by a veterinarian, statements regarding the cause of the illness reported in these turtles is purely speculative.