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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2019-5835

2. Registrant Information.

Registrant Reference Number: 2019-39

Registrant Name (Full Legal Name no abbreviations): BASF Canada Inc.

Address: 100 Milverton Drive, 5th Floor

City: Mississauga

Prov / State: Ontario

Country: Canada

Postal Code: L5R 4H1

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

Domestic Animal

4. Date registrant was first informed of the incident.

07-OCT-19

5. Location of incident.

Country: UNITED STATES

Prov / State: OHIO

6. Date incident was first observed.

07-OCT-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. 30664      PMRA Submission No.       EPA Registration No. 499-548

Product Name: PT Phantom 2 Insecticide

  • Active Ingredient(s)
    • CHLORFENAPYR
      • Guarantee/concentration .5 %

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).

A friend brought over the PT Phantom 2 Insecticide to spray for fleas and heavily sprayed the room where the kitten was. The friend took the product from work (a hotel) and said that at the hotel they 'always spray it near pets'.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Short Hair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.6

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Respiratory

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 - Anorexia
    • Symptom - Diarrhea
  • General
    • Symptom - Lethargy
    • Symptom - Drowsiness
    • Symptom - Death
    • Symptom - Adipsia

12. How long did the symptoms last?

Persisted until death

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

Died

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

Became ill and lethargic and started to have watery diarrhea and would not eat or drink.


To be determined by Registrant

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

Death

19. Provide supplemental information here