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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0356

2. Registrant Information.

Registrant Reference Number: ProPharma Group case #: 1-46113404

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.

01-NOV-16

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

6. Date incident was first observed.

01-NOV-16

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. 279-9534-239

Product Name: ORTHO HOME DEFENSE MAX INSECT KILLER FOR INDOOR & PERIMETER 1

  • Active Ingredient(s)
    • BIFENTHRIN
    • ZETA-CYPERMETHRIN

7. b) Type of formulation.

Liquid

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).

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

American Eskimo

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

10

7. Weight (provide a range if necessary )

25

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

  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Difficulty getting up
    • Symptom - Coma
    • Specify - semi-comatose
    • Symptom - Other
    • Specify - tongue lolling
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-46113404 - The reporter, a veterinarian, indicates a dog was exposed to a pesticide containing the active ingredients zeta-cypermethrin and bifenthrin. The reporter stated the dogs owner applied the product to the interior of their home one day before the day of initial contact with the registrant, and their dog was observed licking some of the wet product. On the day of initial contact, the owner of the dog noticed the 10-year-old, 25-pound, male, American Eskimo dog was unable to get up on his own, but could stand with assistance, is ataxic, semi-comatose, and his tongue is lolling. The dog was presented to the reporter. The reporter was advised that the product has a very low concentration of the active ingredients. Small ingestions of the product may cause minor gastrointestinal upset, but a very large amount of the product would have to be ingested to cause the dogs symptoms. On follow-up call one day later a voice mail message was left requesting an update on the dog. A follow-up call two days after the day of initial contact revealed the dog had died on the day of initial contact. The veterinarian thinks the dog died of heart failure and had nothing to do with the product. No additional information is available.


To be determined by Registrant

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

Death

19. Provide supplemental information here