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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0597

2. Registrant Information.

Registrant Reference Number: ProPharma Group case#: 1-46493509

Registrant Name (Full Legal Name no abbreviations): FMC Corporation

Address: 2929 Walnut Street

City: Philadelphia

Prov / State: Pennsylvania

Country: USA

Postal Code: 19104

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

Domestic Animal

4. Date registrant was first informed of the incident.

08-DEC-16

5. Location of incident.

Country: UNITED STATES

Prov / State: UTAH

6. Date incident was first observed.

08-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. 279-9552

Product Name: TALSTAR XTRA GRANULAR INSECTICIDE FEATURING VERGE GRANULE TECHNOLOGY

  • Active Ingredient(s)
    • BIFENTHRIN
    • CYPERMETHRIN
      • Guarantee/concentration .05 %

7. b) Type of formulation.

Granular

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

Other

2. Type of animal affected

Dog / Chien

3. Breed

French Bulldog

4. Number of animals affected

1

5. Sex

Unknown

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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • General
    • Symptom - Death
  • Gastrointestinal System
    • Symptom - Diarrhea
    • Symptom - Vomiting
  • Liver
    • Symptom - Hepatic failure

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

1-46493509 - The reporter, a pest control officer, indicated a dog may have been exposed to a pesticide containing the active ingredients bifenthrin and cypermethrin. One month before the day of initial contact with the registrant, the reporter applied the product to the yard of the owner of a French Bulldog of unknown age, weight, and gender. Within 24 hours of application, the dog became ill with vomiting and diarrhea, was taken to a veterinarian, and recovered within three days. No exposure was witnessed. On the day of initial contact, the dogs owner informed the reporter that the dog had died of liver failure, and the veterinarian indicated the pesticide was the cause. The reporter was informed that the initial bout of vomiting and diarrhea would not be unexpected from a small ingestion of the product, but liver damage occurring weeks after the potential initial exposure is unlikely. 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