Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-2002
2. Registrant Information.
Registrant Reference Number: 120017877
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.
13-FEB-12
5. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
6. Date incident was first observed.
13-FEB-12
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. 2724-404-270
Product Name: Bio Spot Flea And Tick Spray For Dogs And Puppies
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .27 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .62 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .37 %
- PYRETHRINS
- Guarantee/concentration .2 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
Unknown
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 February 13, 2012 the owner sprayed the dog with the flea and tick spray product to treat for fleas.
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Boxer
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
8.5
7. Weight (provide a range if necessary )
55.0
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
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
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
On February 13, 2012, shortly after the owner sprayed the dog with the flea and tick spray, the owner noticed that the dog had a seizure. The owner immediately rinsed the dog's coat and skin with water. The owner observed that the dog died a few minutes later. A short time later that day, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian recommended that the owner have her veterinarian call for information regarding a necropsy.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
A necropsy was performed and final results revealed the cause of death was likely related to a hear worm infestation which led to cardiac insufficiency and death.