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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1460

2. Registrant Information.

Registrant Reference Number: 110008917

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.

21-JAN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

6. Date incident was first observed.

21-JAN-11

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. 2724-274

Product Name: Starbar Golden Malrin Fly Bait 1% Methomyl

  • Active Ingredient(s)
    • (Z)-9-TRICOSENE
      • Guarantee/concentration .049 %
    • METHOMYL
      • Guarantee/concentration 1 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

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

Animal's Owner

2. Type of animal affected

Other / Autre

specify Monkey

3. Breed

White fronted Capuchin

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

8.0

7. Weight (provide a range if necessary )

12.0

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Recumbent
  • Gastrointestinal System
    • Symptom - Drooling
  • 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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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

On January 21, 2011 the owner noticed the monkey was symptomatic. The owner then contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian recommended the owner take the monkey to the veterinarian and to have the veterinarian call for information. That same day, the owner took the monkey to an emergency veterinarian, who then contacted the APSS to discuss the case. The APSS veterinarian recommended monitoring for SLUDDE and central nervous system signs, monitoring cardiovascular function, and for respiratory signs, recommended fluid therapy, Atropine, endotracheal intubation, Diazepam, providing symptomatic care, gastric lavage, recommended not inducing emesis and managing any vomiting, referring the monkey to an emergency clinic, and calling back with questions.


To be determined by Registrant

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

Death

19. Provide supplemental information here

On January 25, 2011 an APSS technician contacted the owner to follow up on the case. The owner stated that on an unknown date at an unknown time, the veterinarian provided the monkey with a physical examination, monitored for SLUDDE and central nervous system signs, monitored cardiovascular function, and for respiratory signs, and provided Atropine. The veterinarian did not provide fluid therapy or call back with questions. The owner also stated the monkey died on January 22, 2011. A necropsy was not available. This product was not used according to label directions: do not use in areas where animals or children have access to.