Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-3160
2. Registrant Information.
Registrant Reference Number: ProPharma Group case #: 1-52793960
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.
13-JUN-18
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
13-JUN-18
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. 30557
PMRA Submission No.
EPA Registration No.
Product Name: ORTHO HOME DEFENSE MAX, HORNET & WASP ELIMINATOR SPRAY
- Active Ingredient(s)
- D-PHENOTHRIN
- TETRAMETHRIN
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. - 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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
12
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
- Gastrointestinal System
- Symptom - Bloody diarrhea
- Symptom - Vomiting
- Nervous and Muscular Systems
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
Unknown/Inconnu
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
1-52793960 - The reporter, a pet owner, indicates an exposure to a pesticide containing the active ingredients tetramethrin and D-phenothrin. One day before the day of initial contact with the registrant, the reporter indicated he sprayed a tree with the product and later his 12-year-old, male, domestic shorthair cat of unknown weight might have slept under the tree. On the day of initial contact, the cat developed vomiting, bloody diarrhea, ataxia, and anorexia. The reporter was advised to get immediate veterinary evaluation of the cat as these symptoms are not consistent with the described exposure. On follow-up call one day later, the reporter indicated he had brought the cat to a veterinarian where the cat was treated, but he still was not eating much. The reporter was advised to follow-up with his veterinarian. No additional information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here