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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2407

2. Registrant Information.

Registrant Reference Number: 2011US03086

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.

19-MAY-11

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

16-MAY-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. 25488      PMRA Submission No.       EPA Registration No.

Product Name: UltaBoss

  • Active Ingredient(s)
    • PERMETHRIN
      • Guarantee/concentration 5 %

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

50

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).

On 19 May 2011, a veterinarian reported that a dairy poured 160 Holstein heifers with Ultra Boss on 16 May 2011 with 40-50 cc Ultra Boss. This is off label use of the Ultra Boss as the maximum dose is 30 cc/ head. In the morning of 19 May 2011, 5 heifers were found dead and one was down. A total of 5 were under treatment. The attending vet later reported that he felt the dead heifers were due to blackleg and not the overdose of Ultra Boss. One heifer necropsies looked like blackleg and one had a 107 degree temperature with a swollen leg. The dairy had not given a blackleg vaccine to these heifers as scheduled and possible crowding during the Ultra Boss treatment could have contributed to stress in the heifers and brought on symptoms. No further follow up expected.

To be determined by Registrant

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

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cow / Vache

3. Breed

Holstein

4. Number of animals affected

5

5. Sex

Female

6. Age (provide a range if necessary )

1

7. Weight (provide a range if necessary )

800

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

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

11. List all symptoms

System

  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Ataxia

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


To be determined by Registrant

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

Death

19. Provide supplemental information here