Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-0210
2. Registrant Information.
Registrant Reference Number: 090108551
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.
27-SEP-09
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
26-SEP-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. 21573
PMRA Submission No.
EPA Registration No.
Product Name: Precor EC Emulsifiable Concentrate
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. - 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 September 26, 2009 the owner applied 2 products inside the home.
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Shih Tzu
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.83
7. Weight (provide a range if necessary )
6.9
kg
8. Route(s) of exposure
Skin
Oral
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
- Gastrointestinal System
- Symptom - Vomiting
- Symptom - Drooling
- Skin
- Symptom - Pruritus
- Specify - Rubbing face
12. How long did the symptoms last?
Unknown / Inconnu
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
Unknown/Inconnu
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
On September 27, 2009 an emergency veterinarian contacted the Animal Product Safety Service (APSS). The APSS veterinarian recommended that the pet be monitored for GI signs and to protect the GI tract, along with giving fluid therapy. She also recommended symptomatic and supportive care and a diagnostic evaluation. In addition, she recommended that the emergency vet call back with questions.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
Signs were expected to be mild and self-limiting.