Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-0765
2. Registrant Information.
Registrant Reference Number: 180174796
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.
18-OCT-18
5. Location of incident.
Country: UNITED STATES
Prov / State: NORTH CAROLINA
6. Date incident was first observed.
13-OCT-18
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. 2724-792
Product Name: Zodiac Flea And Tick Shampoo For Dogs And Cats Coconut Conditioners
- Active Ingredient(s)
- PIPERONYL BUTOXIDE
- Guarantee/concentration .5 %
- PYRETHRINS
- Guarantee/concentration .05 %
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 2596-139-89459
Product Name: Adams Plus Flea And Tick Collar For Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 1.02 %
- TETRACHLORVINPHOS
- Guarantee/concentration 14.55 %
7. b) Type of formulation.
Liquid
Other (specify)
Collar
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 October 12, 2018, the owner bathed the cat with the shampoo product as prevention. On October 13, 2018, the owner applied the collar to the cat as 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 Unspecified
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
10.0
7. Weight (provide a range if necessary )
15.0
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
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Hiding
- Gastrointestinal System
- Symptom - Salivating excessively
- Symptom - Mouth Irritation
- Specify - Oral Ulcers
12. How long did the symptoms last?
Persisted until death
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
In the afternoon on October 13, 2018, the cat developed lethargy and was hiding. Soon after, the owner bathed the cat with water to try to remove any residual shampoo. On October 18, 2018, the cat developed hypersalivation and oral ulcers (the owner stated it looked like burns in his mouth). A couple of hours later, the owner dropped the cat off at the regular veterinarian. When the owner returned to pick up the cat, the regular veterinarian stated that the cat had passed away that afternoon. Soon after, the owner contacted the Animal Product Safety Service (APSS). The APSS technician recommended the owner call back with questions.
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 substances were not considered to be related to causing the clinical situation. A necropsy was unavailable.