Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-0245

2. Registrant Information.

Registrant Reference Number: 120106274

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.

31-JUL-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

31-JUL-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)

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PMRA Registration No. 15176      PMRA Submission No.       EPA Registration No.

Product Name: Agricultural Starbar Premium Fly Bait With Muscamone

• Active Ingredient(s)
  • (Z)-9-TRICOSENE
  • METHOMYL

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

10. Site pesticide was applied to (select all that apply).

Site: Res. - Out Home / Rés - à l'ext.maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

The owner's neighbor put some of the fly bait outside, and the jar fell into her yard. The owner caught her dog with her head in the jar on July 31, 2012. It is unknown how much, if any, of the product the dog may have ingested.

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

Yorkshire Terrier

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 )

7.5

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• General
  • Symptom - Polydipsia

12. How long did the symptoms last?

>30 min <=2 hrs / >30 min <=2 h

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

On July 31, 2012, shortly after discovering the dog with her head in the jar containing the product, the owner noticed that the dog was symptomatic. A short time later that day, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that methomyl is a hot carbamate insecticide with a narrow margin of safety. The APSS veterinarian also stated that the onset of clinical signs is generally rapid. The APSS veterinarian recommended that the owner take the dog to the veterinarian and have the veterinarian call for information.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Minor

19. Provide supplemental information here

On the afternoon of July 31, 2012, shortly after the APSS spoke with the owner, the owner's regular veterinarian contacted the APSS to discuss the case. The APSS veterinarian recommended that the owner's regular veterinarian give the dog a physical examination, monitor the dog's heart rate, give the dog 0.1 to 0.2 milligrams per kilogram (mg/kg) of atropine intramuscularly or subcutaneously, give the dog diazepam, give the dog one dose of activated charcoal, provide fluid therapy for cardiovascular support, provide supportive care, and call back with questions. On August 2, 2012 an APSS assistant called the owner's regular veterinarian. The owner's regular veterinarian stated that the dog was no longer adipsic or otherwise symptomatic when she arrived at the clinic on the afternoon of July 31, 2012. The owner's regular veterinarian stated that she did a physical examination, but no cares were given because the dog had fully recovered. Label states in large bold highlighted text: is not to be used inside or around homes, or any other place where children or pets are likely to be present.