Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-0022
2. Registrant Information.
Registrant Reference Number: 110105458
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.
15-AUG-11
5. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
10-AUG-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. 26493
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Powerspot Flea And Tick Control For Dogs Over 14 kg
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
2
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 August 6, 2011 the owner applied the product down the dog's back to treat a pre-existing flea infestation.
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Siberian Husky Mix
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
9.0
7. Weight (provide a range if necessary )
105.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- Skin
- Symptom - Pruritus
- Symptom - Hives
- Symptom - Erythema
- Symptom - Hair loss
12. How long did the symptoms last?
>1 wk <=1 mo / > 1 sem < = 1 mois
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
On August 10, 2011 the owner noticed the dog was symptomatic. On August 14, 2011 the owner bathed the dog with an oatmeal shampoo per her regular veterinarian's instructions. On August 15, 2011 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS assistant recommended that the owner bathe the dog with liquid dish washing detergent (LDWD) and take the dog to the veterinarian for further evaluation.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
On August 18, 2011 the owner called back and updated the case. The owner stated that she had bathed the dog a couple of times and that the dog had fully recovered. The urticaria and erythema had ended on August 15, 2011, shortly after the call to APSS, and the pruritus and alopecia had ended by August 18, 2011.