Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-3423
2. Registrant Information.
Registrant Reference Number: 1-28579591
Registrant Name (Full Legal Name no abbreviations): WELLMARK INTERNATIONAL
Address: 100 STONE ROAD WEST, SUITE 111
City: GUELPH
Prov / State: ON
Country: CANADA
Postal Code: N1G 5L3
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
07-JAN-12
5. Location of incident.
Country: UNITED STATES
Prov / State: DELAWARE
6. Date incident was first observed.
06-JAN-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. 2724-401-2596
Product Name: Hartz Ultraguard Plus Flea Tick Home Spray 16 fl oz
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .01 %
- PERMETHRIN
- Guarantee/concentration .28 %
7. b) Type of formulation.
Liquid
Other (specify)
Spray
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).
Caller inappropriately applied home spray to her geriatric cat on January 6, 2012.
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
Cat / Chat
3. Breed
Domestic Long Hair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
20
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- 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
Cat became symptomatic on January 6, 2012 later in the evening after product was inappropriately applied to her geriatric cat in the afternoon. Caller did not bathe the cat but used cleansing cloths to help remove residue. This cat was born with a cerebellum disease and all kittens she was born with died. After suggestion from our specialist to take cat to the vet, caller then left message with her vet but did not receive a call back. She later called a local vet who told her that it would most likely be euthanized if she brought her in. Cat did not receive veterinary care.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Symptoms described are not typical of the amount sprayed on the cat. Given the cat's age and her pre-existing medical condition this low percentage of product is considered unlikely to have caused her symptoms. This product is labeled for use as a home spray and label clearly states not to spray on pets or humans. Cat died in the morning on January 8, 2012.