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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-3707
2. Registrant Information.
Registrant Reference Number: PROSAR case #: 1-41178145
Registrant Name (Full Legal Name no abbreviations): Scotts Canada Ltd.
Address: 2000 Argentia Road, Plaza 2, Suite 300
City: Mississauga
Prov / State: Ontario
Country: Canada
Postal Code: L5N1V8
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
07-JUL-155. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
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. Unknown
Product Name: Ortho Home Defense Max Perimeter/Indoor Insect Control
- Active Ingredient(s)
- PERMETHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Unknown
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Schipperke
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
17
lbs
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 - Lethargy
- Nervous and Muscular Systems
- Symptom - Depression
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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-41178145 - The reporter, a veterinarian, indicated that a dog may have been exposed to an insecticide containing the active ingredient permethrin. The reporter did not have the product container and was unable to provide a registration number or a bar code number for the product. The reporter could only provide a partial name of Ortho Home defense Max Insect Killer for Indoor and Outdoor. The reporter indicated that she had just received a call from a pet owner who stated that within the last 30 minutes their 4-year-old, 17 pound Schipperke dog had become lethargic and depressed. The pet owner was concerned that the dog may have ingested some of the registrant product but they did not provide information on when the exposure may have occurred. The reporter was advised that small ingestions of this product may cause transient gastro-intestinal irritation. The reporter was further advised that there are numerous possible causes for the described symptoms and additional diagnostics were recommended to help determine an underlying cause and appropriate treatment. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
