Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-0341

2. Registrant Information.

Registrant Reference Number: 2010-US-12054

Registrant Name (Full Legal Name no abbreviations): Intervet Canada Corp.

Address: 16750 Trancanada Highway

City: Kirkland

Prov / State: Quebec

Country: Canada

Postal Code: H9H 4M7

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

27-DEC-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

23-DEC-10

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. 773-73

Product Name: Proticall

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration 65 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Units: mL

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).

1 ml was applied topically to the shoulder blade area to 1 dog on 22 December 2010. On 23 December 2010, dog experienced vocalization, lethargy, pale mucous membranes, abdominal pain, rectal haemorrhage and death within 24 hours of administration. The dog was not presented to the veterinarian for treatment. Dog was found dead on 25 December 2010.

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

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

mixed breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

11.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • General
    • Symptom - Lethargy
    • Symptom - Vocalizing
    • Symptom - Pale mucous membrane colour
  • Gastrointestinal System
    • Symptom - Stomach pain
    • Symptom - Bloody diarrhea
  • General
    • 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?

Treatment / Traitement

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

A dog that experienced vocalization, lethargy, pale mucous membrane, abdominal pain, rectal haemorrhage and death within 24 hours of administration of Proticall on 22 Dec 2010. The dog was administered 1 ml Proticall on 22 Dec 2010. On 23 Dec 2010 the owner discovered the dog was vocalizing and lethargic, with pale gums, abdominal pain and rectal haemorrhage. The dog was not presented to the vet for treatment or diagnostics. The owner elected to treat the dog with Aspirin and honey on 24 Dec 2010. The dog was found dead on 25 Dec 2010.


To be determined by Registrant

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

Death

19. Provide supplemental information here