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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-8878

2. Registrant Information.

Registrant Reference Number: 070081193

Registrant Name (Full Legal Name no abbreviations): Wellmark International

Address: 100 Stone Rd 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.

02-AUG-07

5. Location of incident.

Country: UNITED STATES

Prov / State: MINNESOTA

6. Date incident was first observed.

01-AUG-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. 2724274

Product Name: Starbar Golden Malrin Fly Bait2724274

  • Active Ingredient(s)
    • (Z)-9-TRICOSENE
      • Guarantee/concentration .049 %
    • METHOMYL
      • Guarantee/concentration 1.1 %

7. b) Type of formulation.

Granular

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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).

Product put out by neighbour on their property. Amount unknown.

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

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

50

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • General
    • Symptom - Weakness
  • Nervous and Muscular Systems
    • Symptom - Recumbent
  • Respiratory System
    • Symptom - Dyspnea
  • Nervous and Muscular Systems
    • Symptom - Rigidity
  • Gastrointestinal System
    • Symptom - Drooling
    • Symptom - Other
    • Specify - Injected Mucous Membranes
  • Cardiovascular System
    • Symptom - Cardiac arrest
  • General
    • 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.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

5

Hour(s) / Heure(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

The emergency veterinarian placed the dog on IV fluids, did a chemistry profile, an electrolyte panel, a CBC, an Ethylene glycol test, coagulation profile, and a drug test. The emergency veterinarian also took radiographs and placed the dog on oxygen therapy prior to contacting the Animal Product Safety Service (APSS) veterinarian. The APSS veterinarian recommended that the emergency veterinarian support the dog's respiratory function, and give the dog Atropine if the dog becomes bradycardic or dyspneic. The APSS veterinarian also recommended that the emergency vet call the center back with any questions. The emergency veterinarian informed the APSS staff member that on August 2, 2007 the dog passed away.


To be determined by Registrant

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

Death

19. Provide supplemental information here

Off label use - label states product not to be placed in areas accessible to children, animals or pets. Possible accidental ingestion of pesticide on neighbour's property. APSS stated since dog roams, concerned about botulism, polyradiculoneuritis, tick paralysis or other etiologies. A necropsy was not performed on the animal. APSS stated product considered to have doubtful likelihood of causing the clinical situation.