Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4629
2. Registrant Information.
Registrant Reference Number: 120077525
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.
09-JUN-12
5. Location of incident.
Country: UNITED STATES
Prov / State: VERMONT
6. Date incident was first observed.
02-MAY-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 814
Product Name: Kirkland Signature Flea And Tick Control For Cats 5lbs and over
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 3.6 %
- ETOFENPROX
- Guarantee/concentration 40 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
1.8
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 May 1, 2012 the owner applied the product to the cat to prevent fleas.
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
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
8.0
7. Weight (provide a range if necessary )
11.0
lbs
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
>1 mo <= 6 mos / > 1 mois < = 6 mois
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
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 May 2, 2012 the owner noticed that the cat was lethargic. On May 9, 2012 the owner noticed that the cat was anorexic and had alopecia. On June 3, 2012 the owner observed that the cat had died. On June 9, 2012 the owner contacted the Animal Product Safety Service APSS to obtain help. The APSS veterinarian stated that the signs were not consistent with the use of the product and that the cat s signs were more suggestive of a chronic illness such as kidney failure, malignancy, diabetes, or liver disease. A necropsy was not available because the cat had already been cremated.
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 June 10, 2012 the owner called the APSS to discuss other possible causes of the cats death, such as lilies or a retrovirus. The APSS veterinarian recommended that the owner call back if she had any additional questions.