Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-1236
2. Registrant Information.
Registrant Reference Number: Rocky Mountain PC Case#: 6029167
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.
30-JAN-19
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
16-JAN-19
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. 24175
PMRA Submission No.
EPA Registration No.
Product Name:
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. - 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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.16
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
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
- Gastrointestinal System
- Symptom - Drooling
- Symptom - Vomiting
- Symptom - Anorexia
- Nervous and Muscular Systems
- Symptom - Depression
- Symptom - Trembling
- Symptom - Muscle tremors
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
1
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
Caller states that she had her apartment sprayed with Dragnet FT Emulsifiable Concentrate in her kitchen
and bathroom under and around the sinks. Caller states that about 36 hours after the treatment she had brought home a new
kitten. She indicates that the first place she had taken her kitten was into the bathroom, where the cat had rubbed itself on the
sink/cabinet. The following day the cat had developed some symptoms drooling, vomiting, loss of appetite, lethargy, and tremors.
Cat was take to a vet, treated and observed for 24 hours.
Caller indicates that the cat is now fine.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here