Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-4466
2. Registrant Information.
Registrant Reference Number: 080107040
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.
24-SEP-08
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
21-SEP-08
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. 19209
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Flea and Tick Shampoo
- Active Ingredient(s)
- PIPERONYL BUTOXIDE
- PYRETHRINS
7. b) Type of formulation.
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).
The owner used the product on the cat as a form of treatment.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Ragdoll
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2.9
7. Weight (provide a range if necessary )
9
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>30 min <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Eye
- Symptom - Edema
- Specify - Eyelid Edema
- General
- Symptom - Hemorrhage
- Specify - Scleral Hemorrhage
- Eye
- Symptom - Other
- Specify - Increased Intraocular Pressure
- Blood
- Symptom - Blood urea nitrogen decreased
- Specify - Low Blood Urea Nitrogen
- Symptom - Hyperglycemia
- Eye
- Symptom - Discharge eye
- Specify - Oozing serosanguinous liquid from eyes
- Symptom - Pupil dilation
- Specify - Mydriasis
- Blood
- Symptom - Leukocytosis
- Specify - Granulocytosis
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?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Euthanised / Euthanasie
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
Bloodwork and diagnostic tests revealed generalized signs of illness with no clear diagnosis or indication of the cause of the clinical signs. Tests for feline leukemia and feline immuno-deficiency virus were declined by the owner. DRM also recommended referral to a specialist hospital but this was also declined. Even with treatment, the cat continued to become worse and was euthanized.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
The APSS veterinarian doubted that this substance was related to causing the clinical situation. A necropsy of this animal was unavailable, so the cause of the clinical signs could not be determined.