Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-7521
2. Registrant Information.
Registrant Reference Number: 160115448
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.
05-AUG-16
5. Location of incident.
Country: UNITED STATES
Prov / State: NEW YORK
6. Date incident was first observed.
03-AUG-16
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.
EPA Registration No. 2724-813-270
Product Name: Adams Flea and Tick Spot On for Cats and Kittens Over 2.5 but Under 5
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 3.6 %
- ETOFENPROX
- Guarantee/concentration 40 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
1
Other Units: cc
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 August 3, 2016 the owner applied the product onto the cat to treat fleas.
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
Maine Coon Mix
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
12.0
7. Weight (provide a range if necessary )
5.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Nervous and Muscular Systems
- Eye
- Symptom - Glazed eye
- Symptom - Pupil dilation
- Nervous and Muscular Systems
- Symptom - Muscle weakness
- Specify - Hind Limb Weakness
- General
- Symptom - Vocalizing
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
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 August 3, 2016 the owner noticed the cat developed symptoms. On August 4, 2016 the owner found the cat dead. On August 5, 2016 the owner contacted the Animal Product Safety Service (APSS). The APSS assistant gathered minimal case history as the owner was extremely upset with the company and making threats. The owner declined speaking with an APSS veterinarian.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
A necropsy and follow-up was not pursued due to the owner declining to speak with an APSS veterinarian and making threats.