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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-5800

2. Registrant Information.

Registrant Reference Number: 2020-25

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.

09-NOV-20

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

13-SEP-20

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. 2018-6489      EPA Registration No. 499-570

Product Name: Fendona CS Controlled Release Insecticide

  • Active Ingredient(s)
    • ALPHA-CYPERMETHRIN
      • Guarantee/concentration 3 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Unknown

9. Application Rate.

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).

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

Brittany Spaniel

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

12

7. Weight (provide a range if necessary )

36

lbs

8. Route(s) of exposure

Unknown

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 - Other
    • Specify - bumps and scabs
  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
    • Symptom - Anorexia

12. How long did the symptoms last?

Unknown / Inconnu

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

Yes

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?

Other / Autre

specify Unknown

17. Provide any additional details about the incident

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

Animal owner states her dog became extremely ill after being in a yard sprayed with an unknown product for mosquitoes. Her daughter's lawn was sprayed at an unknown time, and is sprayed once per month. It was supposed to be dry on the lawn when the dog swam in the pool and rolled on the lawn on Sept 13th. That night the dog developed vomiting and diarrhea, and the dog refused food and water for three days. He did not see a vet immediately. He was put on rice and chicken broth, kaopectate, and probiotics. On October 18, caller took her dog back to her daughter's house for 5 hours. The dog again was in the pool and rolling on the grass. He also rubbed on the bushes. That night the dog again had extreme diarrhea and vomiting. 2 days later the dog developed scabs/bumps on his head and his back. The animal owner put him on an antibiotic, benadryl, probiotic, and pepto bismol. The dog continued to get worse with more bumps, and the diarrhea continued. The owner took him to the vet on 11/7. The vet was not allowed to do x-rays or lab work. The vet put him on a different antibiotic and apoquel. the owner states that the dog passed away ultimately due to liver failure.


To be determined by Registrant

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

Death

19. Provide supplemental information here