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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2358

2. Registrant Information.

Registrant Reference Number: 2010-CA-00370

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

Address: 16750 Transcanada Highway

City: Kirkland

Prov / State: QC

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.

26-MAY-10

5. Location of incident.

Country: CANADA

Prov / State: MANITOBA

6. Date incident was first observed.

13-MAY-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. 22968      PMRA Submission No.       EPA Registration No.

Product Name: DEFEND TOPICAL INSECTICIDE FOR DOGS

  • Active Ingredient(s)
    • PERMETHRIN

7. b) Type of formulation.

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).

Adverse Reaction: Dog was treated with Defend as per label instructions and developed pruritus within 1 day and next day developed redness, alopecia and dermatitis perhaps self inflicted from pruritus. The dog was re-examined on 14 May 2010 and treated with topical Surolan and oral prednisone. Dog was re-examined again on 15 May 10 and place on antibiotic cephalexin orally. The dog was re-examined 18 May 2010 and the symptoms were resolved. No more information expected; case closed.

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

Maltese mixed with Poodle

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

6.7

7. Weight (provide a range if necessary )

8.7

kg

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

  • Skin
    • Symptom - Itchy skin
    • Symptom - Erythema
    • Symptom - Hair loss
    • Symptom - Inflammation of the skin

12. How long did the symptoms last?

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

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

Fully Recovered / Complètement rétabli

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

Treated with topical Surolan and oral prednisone. Dog was re-examined again on 15 May 10 and place on antibiotic cephalexin orally. The dog was re-examined 18 May 2010 and the symptoms were resolved. No more information expected; case closed.


To be determined by Registrant

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

Minor

19. Provide supplemental information here