Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-4945
2. Registrant Information.
Registrant Reference Number: USA-BAYERBAH-2017-US0043831
Registrant Name (Full Legal Name no abbreviations): Bayer inc
Address: 2920 Matheson Blvd
City: Mississaugua
Prov / State: ON
Country: Canada
Postal Code: L4W 5R6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
17-JUL-17
5. Location of incident.
Country: UNITED STATES
Prov / State: WASHINGTON
6. Date incident was first observed.
11-JUL-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. 11556-155
Product Name: Seresto Cat
- Active Ingredient(s)
- FLUMETHRIN
- IMIDACLOPRID
- Guarantee/concentration 10 %
7. b) Type of formulation.
Other (specify)
Collar
Application Information
8. Product was applied?
Yes
9. Application Rate.
1
Other Units: collar
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).
1 Collar 1 Days 1 Dose
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
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
4.082
kg
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 mo <= 6 mos / > 1 mois < = 6 mois
10. Time between exposure and onset of symptoms
>2 mos <=6 mos / > 2 mois < = 6 mois
11. List all symptoms
System
- General
- Symptom - Death
- Symptom - Other
- Specify - Behavioural disorder NOS
- Symptom - Other
- Specify - Uncoded sign
12. How long did the symptoms last?
>2 mos and <=6mos />2 mois et <=6mois
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
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 11-Jul-2017, the cat was let outdoors and did not return home (behavior disorder NOS).
On 14-Jul-2017, the cat was found outdoors, stuck on a fence, dead.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
A-Probable: Reported behavioural sign is unspecific and may have numerous causes. Time to onset is long. Furthermore cat was trapped by the collar to a fence and thus could not return home. Reported death is not anticipated with appropriate product use. When being trapped by the collar, the collar is expected to widen or even break. Unclear if the collar was applied too loose. In the exceptionally rare event that a pet is trapped on other object without the possibility to exert its normal amount of force (e.g. in the exceptional case the pet does not stand on appropriate surface (e.g. slippery surface) or is hanging from an object), the pet may not develop enough force to open the closure mechanism to widen the collar. Overall, a product involvement is considered probable.