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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5306

2. Registrant Information.

Registrant Reference Number: 100163820

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.

22-DEC-10

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

22-DEC-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.       PMRA Submission No.       EPA Registration No. 2724-702-270

Product Name: Adams Flea and Tick Home and Carpet Spray

  • Active Ingredient(s)
    • ETOFENPROX
      • Guarantee/concentration .5 %
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .5 %
    • PRALLETHRIN
      • Guarantee/concentration .3 %
    • PYRIPROXYFEN
      • Guarantee/concentration .02 %

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 December 21, 2010 the owner's neighbor applied the product inside 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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3

7. Weight (provide a range if necessary )

10

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

  • Nervous and Muscular Systems
    • Symptom - Seizure
  • 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?

Unknown

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 December 22, 2010 the owner's neighbor found the cat symptomatic. The owner's neighbor took the cat to the veterinarian, where atropine was given. The attending veterinarian then contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated this product contains low concentrations of etofenprox, a pyrethroid like insecticide. The APSS veterinarian also stated as the product was not reported to have been applied to cat, would anticipate low risk of signs. The APSS veterinarian recommended monitoring the cat at the veterinary facility, managing the cat's seizures with diazepam, methocarbamol, giving fluid therapy, supportive and symptomatic care, monitoring body temperature and monitor cardiovascular function. The APSS veterinarian also recommended obtain additional information on any other spot on product containing permethrin being used lately, calling back with questions, and bathing the cat with liquid dish washing detergent once the cat is stable.


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. On January 5, 2010 an APSS technician called the owner's neighbor to follow up the case. The owner's neighbor stated the cat died on December 22, 2010 after the APSS consultation. A necropsy was recommended, but the pet has been deceased too long to provide a necropsy.