Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-1793
2. Registrant Information.
Registrant Reference Number: 1-31129409
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.
06-AUG-12
5. Location of incident.
Country: UNITED STATES
Prov / State: MAINE
6. Date incident was first observed.
15-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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 2724-504-2596
Product Name: UltraGuard Pro Flea and Tick Drops for Cats 5 Lbs 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).
Product was applied to cats on July 13, 2012.
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
7. Weight (provide a range if necessary )
14
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Eye
- Symptom - Pupil dilation
- Specify - Mydriasis
- Symptom - Nystagmus
- General
- Symptom - Lethargy
- Symptom - Death
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
Product was applied to cat around July 13, 2012. Cat became symptomatic a few days later and continued to show symptoms until her death on August 5, 2012. Veterinarian was not consulted to help determine cause of symptoms.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
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
7. Weight (provide a range if necessary )
8
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
- General
- Symptom - Pale mucous membrane colour
- Specify - white gums
- General
- Symptom - Lethargy
- Symptom - Death
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
Product was applied to cat around July 13, 2012. Cat became symptomatic a few days later and continued to show symptoms until her death on August 5, 2012. Veterinarian was called and he told her to bathe cat with Dawn dish soap and bring in for exam. Caller has been out of work for 2 years and could not afford to take them in. Caller had been treating her home with a product called Ectokyl and had been vacuuming and cleaning the carpets to get rid of fleas in the house. Caller said her local vets will not help her and neither will the local humane society because she has no money. Caller was instructed by our specialist to continue caring for Spooky by bathing her in Dawn dish soap and rinsing well with water and to continue to treat home for fleas as best as she can as home seemed to be heavily infested with fleas. Suggested contacting a cat rescue group to help with cats and treatment. She was also cautioned that due to this cats symptoms if no vet care is found for her she may pass away as she may be anemic due to the amount of flea bites she is getting due to infestation.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Cat died on August 7th. Caller was grateful for information provided to help her sick cats and that our specialist helped her more than any other organization she contacted for help. Staff veterinarian determined symptoms were doubtfully related to product use.