Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-2692
2. Registrant Information.
Registrant Reference Number: 170035503
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.
06-MAR-17
5. Location of incident.
Country: UNITED STATES
Prov / State: INDIANA
6. Date incident was first observed.
05-MAR-17
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. 2724-803-270
Product Name: Adams Flea and Tick Spray for Dogs and Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .1 %
- ETOFENPROX
- Guarantee/concentration .25 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .75 %
7. b) Type of formulation.
Liquid
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 March 5, 2017 the owner sprayed the cat with the product for the first time for prevention.
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
Cat / Chat
3. Breed
Domestic Longhair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1.0
7. Weight (provide a range if necessary )
9.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Gastrointestinal System
- Symptom - Inappropriate defecation
- Symptom - Vomiting
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 March 5, 2017 the cat started vocalizing as soon as the product was applied. A few minutes later, the owner gave the cat a bath (using Dawn dish soap) to remove the product. The cat became agitated and starting panting and defecating. The owner stated two people were holding the cat down trying to bathe. After the bath, the cat vomited and was still vocalizing. The owner was heading to a clinic when the cat died in the car. The owner notes that the cat died within 45 minutes of application. On March 6, 2017 the owner contacted the Animal Product Safety Service (APSS) to report the death and request reimbursement for the loss of her pet and her medical bills (the cat bit her during the bath). The APSS assistant recommended referral to the manufacturer. The owner declined consultation with an APSS veterinarian. The APSS veterinarian stated that death was not expected.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation. A necropsy was not available as the cat's body had already been buried.