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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0929

2. Registrant Information.

Registrant Reference Number: 090126064

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.

11-NOV-09

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

6. Date incident was first observed.

08-NOV-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. 2724-774-270

Product Name: Bio Spot Home Protection Inverted Carpet Spray

  • Active Ingredient(s)
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration 1 %
    • PERMETHRIN
      • Guarantee/concentration .2 %
    • PYRIPROXYFEN

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 November 4, 2009 the owner soaked a futon with the product while the cat was at the veterinary clinic for routine surgery.

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 Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.33

7. Weight (provide a range if necessary )

4

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Nervous and Muscular Systems
    • Symptom - Ataxia
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

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

On November 7, 2009 the cat came home from the veterinary clinic and laid on the futon. On November 8 the owners took him to the veterinarian who gave him subcutaneous fluids, anzemet, and meloxicam. On November 9, the owners noticed the cat's signs were worsening, so they syringe fed him. On November 10, 2009 the owners contacted the veterinary clinic who told them to bring him in, but he died on the way to the clinic. On November 11, 2009 the APSS veterinarian stated with this exposure to the product, it would be unlikely to see signs as long as the product had dried before the pet was allowed onto the treated surface. She also stated that if he had contact with the surface before it dried and licked it, we could see a taste reaction. She further stated that if the alcohol in the product was still present, we could see ataxia or depression, but it is very unlikely, as the alcohol tends to evaporate rapidly. The APSS veterinarian recommended a necropsy.


To be determined by Registrant

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

Death

19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation. On November 17, 2009 an APSS technician contacted the veterinary clinic to follow up on the necropsy. The veterinary clinic stated that a necropsy was unavailable as the cat's body had already been picked up for cremation.