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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-4358

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

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

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

18-JUN-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. 31368      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac (produit antipuces pour chatons) avec methoprene

  • Active Ingredient(s)
    • (S)-METHOPRENE

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: 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).

The following was reported/ce qui suit a été rapporté: Je vous ecris pour vous signaler l'incident cause par le produit Zodiac spot-on II pour chatons sur notre chat adulte le 18 juin 2019. Notre chat venait tout juste de voir le veterinaire et est en sante; il a eu une reaction nerveuse grave suite a l'application du produit. Nous avons respecte le dosage et en avons mis moins encore (une dose pour chatons) et il n'a pas pu se lecher, puisque nous l'avons surveiller pendant 2-3 heures alors qu'il est alle se cacher sous un meuble apres l'application. La seule application lui a cause de la douleur et des tremblements et tics nerveux. Il semblait desoriente et miaulait beaucoup. Il rasait le sol et semblait avoir peur. Nous avons du le laver et immediatement apres lui avoir donne un shampoing naturel doux, il s'est mis a se sentir mieux. Nous nous sommes ensuite assures qu'il boive beaucoup d'eau pour evacuer tout le poison.

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

Male

6. Age (provide a range if necessary )

Unknown

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

Unknown / Inconnu

11. List all symptoms

System

  • General
    • Symptom - Vocalizing
    • Symptom - Pain
  • Nervous and Muscular Systems
    • Symptom - Disorientation
    • Symptom - Trembling
  • General
    • Symptom - Hiding
    • Symptom - Other
    • Specify - Seemed scared
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - nervous tics
    • Symptom - Abnormal posture
    • Specify - rasait le sol

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

The following was reported/ce qui suit a été rapporté: Ses miaulements indiquaient de la douleur et de la peur. Il etait desoriente et avait des tremblements et tics nerveux et miaulait beaucoup d'une facon inhabituelle. Il rasait le sol.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here