Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2011-0604

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR Case # 1-24920511

Nom du titulaire (nom légal complet, aucune abbréviation): The Scotts Company LLC

Adresse: 14111 Scottslawn Road

Ville: Marysville

État: Ohio

Pays: USA

Code postal /Zip: 43041

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

09-DEC-10

5. Lieu de l'incident.

Pays: UNITED STATES

État: MICHIGAN

6. Date de la première observation de l'incident.

Inconnu

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 239-2682

Nom du produit: Weed-B-Gon Max

• Matière active
  • 2,4-D (PRESENT AS AMINE SALTS : DIMETHYLAMINE SALT, DIETHANOLAMINE SALT, OR OTHER AMINE SALTS)
    • Garantie/concentration .12 %
  • DICAMBA (PRESENT AS ACID, AMINE SALT, ESTER, OR SODIUM SALT)
    • Garantie/concentration .05 %
  • MECOPROP-P (PRESENT AS AMINE SALT)
    • Garantie/concentration .22 %

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7. b) Type de formulation.

Liquide

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Non

9. Dose d'application.

10. Site d'application (choisir tout ce qui s'applique).

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

Domestic Shorthair

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

14

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• General
  • Symptôme - Mort
  • Symptôme - Cancer
  • Specify - Cancer near kidneys found on necropsy

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Inconnu

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Other / Autre

préciser The reporter claimed a man in her neighborhood was routinely breaking into her house to poison her cats. No witnessed exposure.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24920511: The reporter, a pet owner, called on 12/7/10 to report she suspected a man in her neighborhood of intentionally poisoning her cats with a lawn and garden product containing the active ingredients 2,4-D, Dicamba, and Mecoprop. The reporter indicated the man had been repeatedly breaking into her house, and was either: a) force feeding the product to the cats, or b) applying the product to or mixing the product in with a supplement which she gives to the cats. The reporter¿s story changed from one scenario to the other during the course of the call. None of the alleged acts of poisoning had been witnessed by the reporter. According to the reporter, her first cat (1st subform III) passed away in 11/2009; a necropsy was done and cancer was found near the cat¿s kidneys. The reporter¿s second cat (2nd subform III) developed lumps in 01/2010, which were then diagnosed by a veterinarian as cancer in 02/2010. He died in 09/2010. Her third cat (3rd subform III) has been diagnosed with cancer (unspecified timeframe) in her foot and lung. Lastly, the reporter¿s fourth cat (4th subform III) recently gagged and vomited after receiving his supplement, and she could smell the product on his breath after he had vomited. The reporter inquired about any tests that could be run to try and detect the active ingredients, and which laboratories she might contact to run such tests. She also inquired whether or not the product would stay in organs and cause cancer. It was discussed that there was no information at hand regarding either any specific tests which could be run, or the specific half-life of the active ingredients in the body. A recommendation was made that when the reporter discussed her concerns with the police, she should confer with them regarding testing the cat¿s supplements for any signs of tampering. The reporter was told that one of the active ingredients, Dicamba, is a class D carcinogen.

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À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

No witnessed exposure

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

Persian

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

12

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Peau
  • Symptôme - Lésion dermale
  • Specify - Lumps

• General
  • Symptôme - Cancer
  • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Oui

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Other / Autre

préciser The reporter claimed a man in her neighborhood was routinely breaking into her house to poison her cats. No witnessed exposure.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24920511: The reporter, a pet owner, called on 12/7/10 to report she suspected a man in her neighborhood of intentionally poisoning her cats with a lawn and garden product containing the active ingredients 2,4-D, Dicamba, and Mecoprop. The reporter indicated the man had been repeatedly breaking into her house, and was either: a) force feeding the product to the cats, or b) applying the product to or mixing the product in with a supplement which she gives to the cats. The reporter¿s story changed from one scenario to the other during the course of the call. None of the alleged acts of poisoning had been witnessed by the reporter. According to the reporter, her first cat (1st subform III) passed away in 11/2009; a necropsy was done and cancer was found near the cat¿s kidneys. The reporter¿s second cat (2nd subform III) developed lumps in 01/2010, which were then diagnosed by a veterinarian as cancer in 02/2010. He died in 09/2010. Her third cat (3rd subform III) has been diagnosed with cancer (unspecified timeframe) in her foot and lung. Lastly, the reporter¿s fourth cat (4th subform III) recently gagged and vomited after receiving his supplement, and she could smell the product on his breath after he had vomited. The reporter inquired about any tests that could be run to try and detect the active ingredients, and which laboratories she might contact to run such tests. She also inquired whether or not the product would stay in organs and cause cancer. It was discussed that there was no information at hand regarding either any specific tests which could be run, or the specific half-life of the active ingredients in the body. A recommendation was made that when the reporter discussed her concerns with the police, she should confer with them regarding testing the cat¿s supplements for any signs of tampering. The reporter was told that one of the active ingredients, Dicamba, is a class D carcinogen.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

No witnessed exposure

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

Domestic Longhair

4. Nombre d'animaux touchés

1

5. Sexe:

Femme

6. Âge (fournir un ordre de grandeur si nécessaire)

Inconnu

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• General
  • Symptôme - Cancer

12. Quelle a été la durée des symptômes?

Anticip. permanent/Permanence anticipée

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Inconnu

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Unknown/Inconnu

16. De quelle manière l'animal a-t-il été exposé?

Other / Autre

préciser The reporter claimed a man in her neighborhood was routinely breaking into her house to poison her cats. No witnessed exposure.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24920511: The reporter, a pet owner, called on 12/7/10 to report she suspected a man in her neighborhood of intentionally poisoning her cats with a lawn and garden product containing the active ingredients 2,4-D, Dicamba, and Mecoprop. The reporter indicated the man had been repeatedly breaking into her house, and was either: a) force feeding the product to the cats, or b) applying the product to or mixing the product in with a supplement which she gives to the cats. The reporter¿s story changed from one scenario to the other during the course of the call. None of the alleged acts of poisoning had been witnessed by the reporter. According to the reporter, her first cat (1st subform III) passed away in 11/2009; a necropsy was done and cancer was found near the cat¿s kidneys. The reporter¿s second cat (2nd subform III) developed lumps in 01/2010, which were then diagnosed by a veterinarian as cancer in 02/2010. He died in 09/2010. Her third cat (3rd subform III) has been diagnosed with cancer (unspecified timeframe) in her foot and lung. Lastly, the reporter¿s fourth cat (4th subform III) recently gagged and vomited after receiving his supplement, and she could smell the product on his breath after he had vomited. The reporter inquired about any tests that could be run to try and detect the active ingredients, and which laboratories she might contact to run such tests. She also inquired whether or not the product would stay in organs and cause cancer. It was discussed that there was no information at hand regarding either any specific tests which could be run, or the specific half-life of the active ingredients in the body. A recommendation was made that when the reporter discussed her concerns with the police, she should confer with them regarding testing the cat¿s supplements for any signs of tampering. The reporter was told that one of the active ingredients, Dicamba, is a class D carcinogen.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Majeure

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

Persian

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

Inconnu

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Système gastro-intestinal
  • Symptôme - Avoir des haut-le-coeur
  • Symptôme - Vomit
  • Symptôme -
  • Specify - Owner smelled the product on the cat's breath after the cat vomited

12. Quelle a été la durée des symptômes?

Unknown / Inconnu

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Inconnu

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Inconnu

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Unknown/Inconnu

16. De quelle manière l'animal a-t-il été exposé?

Other / Autre

préciser The reporter claimed a man in her neighborhood was routinely breaking into her house to poison her cats. No witnessed exposure.

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-24920511: The reporter, a pet owner, called on 12/7/10 to report she suspected a man in her neighborhood of intentionally poisoning her cats with a lawn and garden product containing the active ingredients 2,4-D, Dicamba, and Mecoprop. The reporter indicated the man had been repeatedly breaking into her house, and was either: a) force feeding the product to the cats, or b) applying the product to or mixing the product in with a supplement which she gives to the cats. The reporter¿s story changed from one scenario to the other during the course of the call. None of the alleged acts of poisoning had been witnessed by the reporter. According to the reporter, her first cat (1st subform III) passed away in 11/2009; a necropsy was done and cancer was found near the cat¿s kidneys. The reporter¿s second cat (2nd subform III) developed lumps in 01/2010, which were then diagnosed by a veterinarian as cancer in 02/2010. He died in 09/2010. Her third cat (3rd subform III) has been diagnosed with cancer (unspecified timeframe) in her foot and lung. Lastly, the reporter¿s fourth cat (4th subform III) recently gagged and vomited after receiving his supplement, and she could smell the product on his breath after he had vomited. The reporter inquired about any tests that could be run to try and detect the active ingredients, and which laboratories she might contact to run such tests. She also inquired whether or not the product would stay in organs and cause cancer. It was discussed that there was no information at hand regarding either any specific tests which could be run, or the specific half-life of the active ingredients in the body. A recommendation was made that when the reporter discussed her concerns with the police, she should confer with them regarding testing the cat¿s supplements for any signs of tampering. The reporter was told that one of the active ingredients, Dicamba, is a class D carcinogen.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Modérée

19. Donner des renseignements additionnels ici