Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3428
2. Registrant Information.
Registrant Reference Number: 2011TH031
Registrant Name (Full Legal Name no abbreviations): Bayer Inc
Address: 77 Belfield Road
City: Toronto
Prov / State: ON
Country: Canada
Postal Code: M9W 1G6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
14-JUN-11
5. Location of incident.
Country: CANADA
Prov / State: SASKATCHEWAN
6. Date incident was first observed.
18-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. 27659
PMRA Submission No.
EPA Registration No.
Product Name: K9 Advantix 100
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
4
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).
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
Labrador Retriever cross
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
3.25
7. Weight (provide a range if necessary )
27.9
kg
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Licking
- Symptom - Abnormal behaviour
- Specify - chewed her rawhide bone
- Symptom - Abnormal behaviour
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
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
Owners applied product on May 18 and felt the dog exhibited changes in behaviour immediately. The dog was reported to be lethargic, licked at her paws, chewed her rawhide bone vigourously and tried to scratch her back. The owners noted that she liked to have her back scratched when normally she prefers to have her belly rubbed. The owner also thinks the dog had bad dreams. No skin lesions were noted and the dog was not examined by a veterinarian. The owners bathed the dogs on the third day after treatment and it returned to normal.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here