Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-5526
2. Registrant Information.
Registrant Reference Number: 2008CP038
Registrant Name (Full Legal Name no abbreviations): Bayer Inc
Address: 77 Belfield rd
City: Toronto
Prov / State: ON
Country: Canada
Postal Code: M9W 1G6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
24-OCT-08
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
24-OCT-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. 25128
PMRA Submission No.
EPA Registration No.
Product Name: advantage 9
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
.8
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).
1 tube of advantage 18 was applied to the dorsal midline, between the shoulder blades
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
domestic short hair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
4.6
kg
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
- Respiratory System
- Symptom - Mouth breathing
- Gastrointestinal System
- Symptom - Mouth Irritation
- Specify - 2 ulcers on left side of tongue
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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?
2
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
mouth breathing, not eating or drinking; sublingual inflammation with the presence of 2 ulcers located on the left side of his tongue; bloodwork and chest and abdominal Xrays are normal; treated with IV fluids,sucralfate,famotidine,metoclopramide,meloxicam
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
oral mucosal irritation from the benzyl alcohol in advantage; the product was applied between the shoulder blades and there is evidence of licking within the area of application; the cat licked a large amount of advantage