Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-5465
2. Registrant Information.
Registrant Reference Number: 120124804
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.
05-SEP-12
5. Location of incident.
Country: UNITED STATES
Prov / State: WISCONSIN
6. Date incident was first observed.
01-SEP-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. 2724-462-270
Product Name: Adams Flea And Tick Mist For Cats With Precor
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .1 %
- 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 August 30, 2012 the owner sprayed 2 cats with the product. On September 4, 2012 the owner sprayed a small amount of the product on the domestic shorthair cat.
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
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 )
16.0
lbs
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
>3 days <=1 wk / >3 jours <=1 sem
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 September 4, 2012, after spraying the cat with the product, the owner noticed that the cat was able to lick some of the product and began drooling. Later that evening, the owner noticed that the cat was lethargic. On the morning of September 5, 2012, the owner observed that the cat had a seizure and died a short time later. Later that morning, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that dermal and taste reactions were possible. The APSS veterinarian recommended that the owner have a necropsy done to determine the cat's cause of death and that the owner have her regular 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
Owner does rescue work for cats and indicated heavy flea infestation. On September 6, 2012 an APSS technician contacted the owner to see if she wanted a necropsy for the cat. The owner stated that she did not want a necropsy and that the cat had been buried.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Bengal
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
8.0
7. Weight (provide a range if necessary )
18.0
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
Unknown / Inconnu
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 an unknown date after the cat was exposed to the product, the owner noticed that the cat was lethargic. On September 1, 2012 the owner observed that the cat had a seizure and died a short time later. On September 5, 2012 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that dermal and taste reactions were possible. A necropsy was not available because the cat had been dead for several days already.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Owner does rescue work for cats and indicated heavy flea infestation