Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2580
2. Registrant Information.
Registrant Reference Number: 090043361
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.
22-APR-09
5. Location of incident.
Country: UNITED STATES
Prov / State: IOWA
6. Date incident was first observed.
22-APR-09
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. 2724-490
Product Name: Vet Kem Siphotrol Plus II Premise Spray
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .085 %
- D-PHENOTHRIN
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration 2 %
- PERMETHRIN
- Guarantee/concentration .35 %
7. b) Type of formulation.
Other (specify)
Aerosol
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
10. Site pesticide was applied to (select all that apply).
Site: Res. - In Home / Rés. - à l'int. maison
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
On April 22, 2009, the owner sprayed the product in a room while the cat was present.
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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair Cat
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
5
lbs
8. Route(s) of exposure
Respiratory
9. What was the length of exposure?
>2 hrs <=8 hrs / >2 h <=8 h
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- General
- Symptom - Vocalizing
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
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
The APSS staff member, per the APSS veterinarian, recommended that the owner move the pet into fresh air. If the pet did not improve within 5-10 minutes of being in the fresh air, the APSS staff member recommended that the owner take the pet to the veterinarian and have the veterinarian call back. Later on April 22, the owner called back to report that the pet had died. The APSS veterinarian recommended a necropsy, but the owner declined.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
According to APSS it is unlikely the cat's death is related to product exposure and one possibility for the cat's demise is an underlying heart condition.