Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-6333
2. Registrant Information.
Registrant Reference Number: 2017CK069
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.
22-JUN-17
5. Location of incident.
Country: CANADA
Prov / State: ALBERTA
6. Date incident was first observed.
21-JUN-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. 29779
PMRA Submission No.
EPA Registration No.
Product Name: k9 advantix II extra large dog
- Active Ingredient(s)
- IMIDACLOPRID
- PERMETHRIN
- PYRIPROXYFEN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
4
Units: mL
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 june 20th at 4.30pm, a dog in the same household was treated wtih 1 tube of k9 advantix II XL. The cat and the dog were separated for at least 12 hours after treatment. there was no known contact between the dog and the cat at any point (they do not like each other) or between the cat and the discarded product packaging.
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
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
dsh
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
12
7. Weight (provide a range if necessary )
3.7
kg
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
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
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
Unknown
15. Outcome of the incident
Unknown/Inconnu
16. How was the animal exposed?
Other / Autre
specify contact is unknown and exposure considered unlikely
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
A 12yr fs dsh 3.7kg cat seizured in the late evening of June 21st after returning to the pet owners home from being unsupervised out doors for an unknown length of time.. The cat had no previous history of seizures. the cat was hospitalized at a veterinary clinic and stabilized with multiple unknown medications.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
The attending veterinarian did not believe the k9 Advantix II to be responsible for the cats clinical signs due to the lack of exposure to the product