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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-0932

2. Registrant Information.

Registrant Reference Number: 090130523

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.

23-NOV-09

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

6. Date incident was first observed.

18-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. 2724-485

Product Name: Zodiac Oatmeal Conditioning Shampoo for Dogs and Puppies

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .1 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 1.5 %
    • PYRETHRINS
      • Guarantee/concentration .15 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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).

On November 15, 2009 the owner bathed the dog with the product.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Rat Terrier

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>3 days <=1 wk / >3 jours <=1 sem

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • Eye
    • Symptom - Irritated eye
  • Skin
    • Symptom - Erythema
  • Respiratory System
    • Symptom - Respiratory failure
  • 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?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

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

On November 18, 2009 the owner took the dog to the veterinarian. The veterinarian gave the dog diphenhydramine and sent the dog home. On November 21, 2009 the dog went into respiratory failure, and the owner took him to the veterinary clinic, where the veterinarian put the dog on fluids and on oxygen therapy. On November 22, 2009 the veterinary clinic staff bathed the dog with baby shampoo and gave the dog albuterol, dexamethasone, atropine, and furosemide. On November 23, 2009 the veterinarian contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated a serious toxicity days after the exposure would not be expected.


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 December 2, 2009 an APSS assistant contacted the veterinary clinic to follow up the case. The veterinarian stated the dog was given supportive care and subcutaneous fluids on November 23, 2009 after the APSS consultation. He also stated that the dog died on November 28, 2009. A necropsy was performed at the clinic which showed the body for the most part looked normal, the heart looked good, but the airways were full of red foamy liquid. The veterinarian stated the dog had pulmonary edema, and he sent out some of the red foamy liquid to a laboratory for testing.