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Sécurité des produits de consommation

Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2013-1136

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: 1004467

Nom du titulaire (nom légal complet, aucune abbréviation): McLaughlin Gormley King Company

Adresse: 8810 Tenth Ave North

Ville: Minneapolis

État: MN

Pays: USA

Code postal /Zip: 55427-4319

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-JUL-12

5. Lieu de l'incident.

Pays: UNITED STATES

État: NEW YORK

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

09-JUL-11

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)

ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 1021-1623-83253

Nom du produit: EctoKyl IGR Total Release Fogger

  • Matière active
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Garantie/concentration .38 %
    • PERMETHRIN
      • Garantie/concentration .4 %
    • PYRETHRINS
      • Garantie/concentration .05 %
    • PYRIPROXYFEN
      • Garantie/concentration .1 %

7. b) Type de formulation.

Liquide

Renseignments sur l'application

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

Oui

9. Dose d'application.

Inconnu

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

Site: Res. - In Home / Rés. - à l'int. maison

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

Please refer to field 13 on Subform II or field 17 of subform III for a detailed description regarding application.

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?

Non

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)

Inconnu

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

8.00

lbs

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

<=15 min / <=15 min

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

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

  • General
    • Symptôme - Mort
    • Symptôme - Lethargie
  • Système gastro-intestinal
    • Symptôme - Anorexie
  • Foie
    • Symptôme - Hépatique

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?

Non

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?

Contact treat.area/Contact surf. traitée

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

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

July 9, 2012 Caller reports that she set off a fogger 1 hr ago, in the basement. She admits that she has a bad problem with fleas in the house and that there may be cats in the basement with the discharging fogger. She just noticed that one of her 30 cats is missing. She wants to know if the cat will be harmed if the cat is exposed to the product. She says that the cat is 'feral' and she cannot handle her. She also reported that 1 year ago, she had another cat that may have been exposed to the same product because after discharging the product, she couldn't locate the cat. With incident from 1 year ago, approximately 1-2 days after she used the product, the cat became lethargic and wouldn't eat. She had taken the cat to her DVM where the cat was placed on IV fluids and medications were given. Upon blood work, they had found that the cat was in either liver or kidney failure (caller couldn't remember which one) and the cat died at the clinic. Follow-up on July 15 Owner reports that she found her missing cat and that it had died of unknown causes. This cat was never evaluated by a DVM.


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

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. It is unclear if these animals had been left in the area where the fogger had been discharged. It appears to be possible that this product had been grossly misused. Had this occurred, the primary symptomotology would consist of respiratory distress. Systemic pyrethroid toxicity was not normally be expected from such a low concentration aerosol product. If pyrethroid toxicity were to occur, it would manifest primarily with neurological symptoms which were not reported in this case. Pyrethrin and pyrethroid toxicity is not typically associated with primary liver or kidney failure.

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)

6

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

8.00

lbs

8. Voie(s) d'exposition:

Inconnu

9. Durée de l'exposition?

<=15 min / <=15 min

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

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

  • General
    • 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.

Non

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

Non

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?

Contact treat.area/Contact surf. traitée

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

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

July 9, 2012 Caller reports that she set off a fogger 1 hr ago, in the basement. She admits that she has a bad problem with fleas in the house and that there may be cats in the basement with the discharging fogger. She just noticed that one of her 30 cats is missing. She wants to know if the cat will be harmed if the cat is exposed to the product. She says that the cat is 'feral' and she cannot handle her. She also reported that 1 year ago, she had another cat that may have been exposed to the same product because after discharging the product, she couldn't locate the cat. With incident from 1 year ago, approximately 1-2 days after she used the product, the cat became lethargic and wouldn't eat. She had taken the cat to her DVM where the cat was placed on IV fluids and medications were given. Upon blood work, they had found that the cat was in either liver or kidney failure (caller couldn't remember which one) and the cat died at the clinic. Follow-up on July 15 Owner reports that she found her missing cat and that it had died of unknown causes. This cat was never evaluated by a DVM.


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

The information contained in this report is based on self-reported statements provided to the registrant during telephone Interview(s). These self-reported descriptions of an incident have not been independently verified to be factually correct or complete descriptions of the incident. For that reason, information contained in this report does not and can not form the basis for a determination of whether the reported clinical effects are causally related to exposure to the product identified in the telephone interviews. It is unclear if these animals had been left in the area where the fogger had been discharged. It appears to be possible that this product had been grossly misused. Had this occurred, the primary symptomotology would consist of respiratory distress. Systemic pyrethroid toxicity was not normally be expected from such a low concentration aerosol product. If pyrethroid toxicity were to occur, it would manifest primarily with neurological symptoms which were not reported in this case. Pyrethrin and pyrethroid toxicity is not typically associated with primary liver or kidney failure.