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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2016-3090

2. Registrant Information.

Registrant Reference Number: 1751142

Registrant Name (Full Legal Name no abbreviations): McLaughlin Gormley King Company

Address: 8810 Tenth Ave North

City: Minneapolis

Prov / State: MN

Country: USA

Postal Code: 55427-4319

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

07-JAN-16

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

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. 1021-2684-89459

Product Name: Zodiac flea and tick dip for dogs and cats quick kill alcohol free

  • Active Ingredient(s)
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 3 %
    • PYRETHRINS
      • Guarantee/concentration .3 %

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: 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).

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

Cat / Chat

3. Breed

DSH

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

10.00

lbs

8. Route(s) of exposure

Skin

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 - Unreactive pupil
    • Symptom - Pupil dilation
  • General
    • Symptom - Death
    • Symptom - Pale mucous membrane colour
  • Nervous and Muscular Systems
    • Symptom - Coma
    • Symptom - Difficulty walking
    • Specify - limp

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

5/26/2016 The following report dated 1/7/2016 was forwarded for documentation. The report states that the cat owner had been keeping a close eye on the cat for a couple of days prior to using the product as the cat had been lethargic. While caller was checking the cat over, caller noticed a significant amount of flea dirt on the cat. Caller mixed the product and started the process of dipping the cat. The cat did struggle a bit as she was not keen on getting wet. Within a couple of minutes, the cat went limp. Caller initially thought the cat got tired of resisting. Upon further investigation, caller found that the cat's eyes were dilated and not responding to light stimulus, and her gums were white. Within 10 minutes of starting the dip the cat had died.


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. The signs and symptoms reported in this case are not consistent with the known toxicology of the material involved at the concentrations used in this product. A necropsy would need to be performed on this animal before any objective evaluations regarding cause of death can be made.