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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-6007

2. Registrant Information.

Registrant Reference Number: 070060690

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.

15-JUN-07

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

14-JUN-07

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. 2724496

Product Name: Extinguish Plus

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .25 %
    • HYDRAMETHYLNON
      • Guarantee/concentration .365 %

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Yes

9. Application Rate.

14

Other Units: Tablespoons

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On June 14, 2007 at 9:10 am CDT, the owner applied the said product per label around the perimeter of the owner's house in attempts to rid the lawn of fire ants. The owners 1.5 year old, 70 pound, male, Labrador Retriever had access to the lawn and could have grazed on or ingested up to 14 tablespoons of the agent.

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

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

1.5

7. Weight (provide a range if necessary )

70

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

>8 hrs <= 24 hrs / >8 h <= 24 h

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
    • Symptom - Diarrhea
  • General
    • Symptom - Weakness
  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Seizure
  • General
    • Symptom - Lethargy
    • Symptom - Death

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

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

Not recovered / Non rétabli

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On June 14, 2007 at 7:00 pm, CDT, 7 hours after the owner applied the said product around the perimeter of the house, the owner noted that the animal was experiencing vomiting and diarrhea. On June 15, 2007 at 7:00 am, CDT, 22 hours after the owner applied the said product around the perimeter of the house, the owner noted that the animal was exhibiting lethargy, weakness, ataxia and seizures. On June 15, 2007 at 8:05 am, CDT, 23 hours after the owner applied the said product, the owner noted that the animal had died. The APSS staff member stated that, because of the products wide margin of safety, she would not expect these signs from this minimal exposure and also noted that the signs the dogs were displaying had a doubtful likelihood of being correlated with the exposure. The APSS staff member recommended the owner have a necropsy performed but the owner was unsure if that was something she wanted to pursue.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

The owner took the dog to the vet for bloodwork that revealed renal failure. APSS stated product had doubtful likelihood of causing the clinical situation.