Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-5186
2. Registrant Information.
Registrant Reference Number: 090125554
Registrant Name (Full Legal Name no abbreviations): Wellmark International
Address: 100 Stone Road West, Suite 111
City: Guelph
Prov / State: Ontario
Country: Canada
Postal Code: N1G5L3
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
10-NOV-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
06-NOV-09
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. 26496
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Spot On Flea Control for Cats and Kittens
PMRA Registration No. 28199
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Powerband Plus Dual Action Flea and Tick Collar
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: Animal / Usage sur un animal domestique
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
On November 4, 2009, the pet owner applied the spot on product and placed the collar on the cat.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
10
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>3 days <=1 wk / >3 jours <=1 sem
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Seizure
- Skin
- Symptom - Pale mucous membrane colour
- Respiratory System
- Symptom - Mouth breathing
- Nervous and Muscular Systems
- Symptom - Stiffness
- Specify - Muscle Stiffness
- Symptom - Disorientation
- General
- Symptom - Jaundice
- Specify - Icterus
- Respiratory System
- Symptom - Pleural effusion
- Specify - Pleural Effusion
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
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
Euthanised / Euthanasie
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
On November 10, the APSS technician stated that seizures would not be expected and recommended the owner take the cat to the veterinarian for an evaluation. She suggested the veterinarian call back with questions. On November 12, an APSS veterinarian contacted the attending veterinary clinic to discuss hair testing. At that time, the veterinary staff informed the APSS that the cat had become disoriented, developed icterus and pleural effusion on November 11. The cat was euthanized that day.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
The APSS veterinarian stated that the substances were considered to have a doubtful likelihood of causing the clinical situation. Necropsy results are pending.