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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-5251

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: ONTARIO

6. Date incident was first observed.

01-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.       PMRA Submission No.       EPA Registration No.

Product Name: Fiesta

  • Active Ingredient(s)
    • IRON (PRESENT AS FEHEDTA)

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).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The following was reported: We live where Fiesta is applied to properties surrounding ours. It is applied with hoses and sprayed. There are issues with droplets carried by wind as it is generally always windy here. Both dogs exhibit identical symptoms of iron toxicity. The first dog, (name), eventually succumbed to illness at the age of 5 years. The second dog, (name), is only 3 and is exhibiting the same health decline. There are 3 other small dogs within the same area of application, and all of these dogs exhibit the same toxic overload symptoms.

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

Dog / Chien

3. Breed

unknown

4. Number of animals affected

5. Sex

Female

6. Age (provide a range if necessary )

5

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 - Death
    • Symptom - Loss of balance
  • Nervous and Muscular Systems
    • Symptom - Abnormal gait
  • General
    • Symptom - Abnormal behaviour
    • Specify - personality changes
    • Symptom - Hiding
  • Respiratory System
    • Symptom - Panting
    • Symptom - Coughing
  • General
    • Symptom - Bad breath
  • Skin
    • Symptom - Other
    • Specify - foul smelling body
  • General
    • Symptom - Other
    • Specify - exercise intolerance
  • Gastrointestinal System
    • Symptom - Melena
    • Symptom - Vomiting
    • Symptom - Other
    • Specify - gastritis
  • Skin
    • Symptom - Lesion

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?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify unknown

17. Provide any additional details about the incident

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

The following was reported: Both dogs exhibit identical symptoms of iron toxicity. The first dog, (name), eventually succumbed to illness at the age of 5 years.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

unknown

4. Number of animals affected

5. Sex

Female

6. Age (provide a range if necessary )

3

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

  • Skin
    • Symptom - Lesion
    • Specify - lesions that leak fluid
  • Gastrointestinal System
    • Symptom - Other
    • Specify - gastritis
    • Symptom - Melena
  • General
    • Symptom - Abnormal behaviour
    • Specify - personality changes
  • Nervous and Muscular Systems
    • Symptom - Abnormal gait
  • Respiratory System
    • Symptom - Coughing
  • Gastrointestinal System
    • Symptom - Bad breath
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Hiding
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Loss of balance
  • Skin
    • Symptom - Other
    • Specify - foul smelling body
  • General
    • Symptom - Other
    • Specify - exercise intolerance
  • Skin
    • Symptom - Itchy skin
    • Specify - itchy skin and feet
  • Gastrointestinal System
    • Symptom - Other
    • Specify - bowel movement issues
    • Symptom - Other
    • Specify - bowel blockage
    • Symptom - Nausea
  • General
    • Symptom - Lethargy
    • Symptom - Weakness

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?

Unknown

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Other / Autre

specify unknown

17. Provide any additional details about the incident

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

The following was reported: The second dog, (name), is only 3 and is exhibiting the same health decline. The surviving dog, (name), cannot walk far or fast without excessive panting and exhaustion. Again, she is only 3 years old. She suffers from external lesions that leak fluid on her back, itchy skin and feet, bowel movement issues, gastritis, bowel blockage, nausea and vomiting, lethargy, weakness and balance issues. We will be continuing with toxicology reports fall and again in the spring to see how the numbers change over the winter.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Dog / Chien

3. Breed

unknown

4. Number of animals affected

3

5. Sex

Unknown

6. Age (provide a range if necessary )

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

  • Skin
    • Symptom - Lesion
  • Gastrointestinal System
    • Symptom - Other
    • Specify - gastritis
    • Symptom - Vomiting
    • Symptom - Melena
  • General
    • Symptom - Other
    • Specify - exercise intolerance
  • Respiratory System
    • Symptom - Coughing
  • General
    • Symptom - Bad breath
  • Skin
    • Symptom - Other
    • Specify - foul smelling body
  • Respiratory System
    • Symptom - Panting
  • General
    • Symptom - Hiding
    • Symptom - Abnormal behaviour
    • Specify - personality changes
    • Symptom - Loss of balance
  • Nervous and Muscular Systems
    • Symptom - Abnormal gait

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?

Unknown

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Other / Autre

specify unknown

17. Provide any additional details about the incident

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

The following was reported: There are 3 other small dogs within the same area of application, and all of these dogs exhibit the same toxic overload symptoms.


To be determined by Registrant

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

Not Applicable

19. Provide supplemental information here