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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2204

2. Registrant Information.

Registrant Reference Number: 110004591

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-JAN-11

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

05-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. 2724-490

Product Name: Precor 2000 Plus Premise Spray

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .085 %
    • D-PHENOTHRIN
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration 2 %
    • PERMETHRIN
      • Guarantee/concentration .35 %
    • PIPERONYL BUTOXIDE
      • Guarantee/concentration 1.4 %

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 January 5, 2011, the pest control organization (PCO) sprayed the product in the pet owner's home. The owner and the dog were not in the home when the product was applied, and they returned home approximately 2-3 hours after the PCO sprayed the product in 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

Other

2. Type of animal affected

Dog / Chien

3. Breed

Canine Domestic Unspecified

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

19.0

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Regurgitation
  • 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?

4

Day(s) / Jour(s)

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 January 5, 2010, the owner and the dog returned home 2-3 hours after the PCO sprayed the house with the product. The owner left the dog inside the house for 1 hour. When the owner returned, the dog was regurgitating. The owner took the dog to the veterinarian, where the dog was admitted into the hospital for treatment. After spending 4 days in the hospital, the dog died on January 10, 2011. The PCO contacted the Animal Product Safety Service (APSS) on January 11, 2011. The APSS veterinarian stated that once the agent is dry, there shouldn't be a problem. The APSS veterinarian further stated that inhalation should not be a significant route of exposure once the agent is dry. The APSS veterinarian also stated with oral exposures death is not expected. The APSS veterinarian recommended that the PCO call back with any additional questions.


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. Multiple attempts to update the case with the owner contact information were unsuccessful; therefore, a necropsy could not be offered.