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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0186

2. Registrant Information.

Registrant Reference Number: 090097614

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.

29-AUG-09

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

29-AUG-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. 15176      PMRA Submission No.       EPA Registration No.

Product Name: Agricultural Starbar Premium Fly Bait with Muscamone

  • Active Ingredient(s)
    • (Z)-9-TRICOSENE
    • METHOMYL

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: 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 August 29, 2009 the dog ingested the product that had been placed in the neighbor's yard.

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

Dog / Chien

3. Breed

Miniature Schnauzer

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

9.3

kg

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors
  • Gastrointestinal System
    • Symptom - Nausea
    • Symptom - Drooling

12. How long did the symptoms last?

>2 hrs <=8 hrs / > 2 h < = 8 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?

24

Hour(s) / Heure(s)

15. Outcome of the incident

Fully Recovered / Complètement rétabli

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 pet owner contacted the Animal Product Safety Service (APSS) on August 29, 2009 after witnessing her dog ingest the substance from her neighbor's yard. The APSS veterinarian recommended that the pet owner take the dog to the veterinarian immediately and have the veterinarian call for information. The emergency veterinarian contacted the APSS that same day. The APSS veterinarian recommended that the emergency veterinarian not induce vomiting due to the rapid onset of signs, give activated charcoal if the dog is stable, monitor for central nervous system (CNS) signs, monitor for SLUDDE, provide fluid therapy, give atropine, give methocarbamol for tremors, and give diazepam for seizures, provide symptomatic care, and call back with questions.


To be determined by Registrant

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

Moderate

19. Provide supplemental information here

On September 4, 2009 an APSS technician received an update from the emergency clinic via fax. The emergency vet monitored for SLUDDE and CNS signs, provided fluid therapy, gave methocarbamol for tremors, provided symptomatic care, performed a chemistry panel and complete blood count (CBC), and monitored the dog's electrolytes. The dog made a full recovery on the evening of August 29, 2009. The product was not used according to label directions: Not to be used where pets are likely to be present.