Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-6080
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.
08-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. 31358
PMRA Submission No.
EPA Registration No.
Product Name: home and gardener wasp and hornet killer
- Active Ingredient(s)
- D-PHENOTHRIN
- TETRAMETHRIN
7. b) Type of formulation.
Other (specify)
foam
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).
The following was reported: Landlord used home and gardener wasp and hornet killer in and around wasps entry/exit hole in brick outside of house and on the wasps and deck where wasps had fallen onto the deck. NOTE: It is suspected that the cat had walked over an area of the deck where there was poison residue and of course as cats clean themselves, it not only had skin exposure, but ingested the poison via licking to clean itself. It also may have come in contact with wasps inside the house which may have had the poison on them.
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
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
Oral
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 - Vomiting
- Symptom - Diarrhea
- General
- Symptom - Malaise
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Abnormal posture
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
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
The following was reported: The cat had vomited multiple times and had diarrhea and was very obviously quite sick - it didn't move much - hunched down, not drinking, eating or even sleeping for the remainder of the night. Finally around 4am when water was offered, it managed to drink a significant amount of water. The following day, the cat was moving around more, but still did not want to eat. Now about 3 days later, the cat's appetite (with enticing) is beginning to return. It has been urinating, but not defecating.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Not Applicable
19. Provide supplemental information here