Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2013-3506
2. Registrant Information.
Registrant Reference Number: 2013-US-05276
Registrant Name (Full Legal Name no abbreviations): Merck Animal Health (Intervet Canada Corp)
Address: 16750 Transcanada Highway
City: Kirkland
Prov / State: Quebec
Country: Canada
Postal Code: H9H 4M7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
26-JUN-13
5. Location of incident.
Country: UNITED STATES
Prov / State: LOUISIANA
6. Date incident was first observed.
15-MAY-13
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. 773-95
Product Name: ACTIVYL TICK PLUS
- Active Ingredient(s)
- INDOXACARB TECHNICAL
- PERMETHRIN
- Guarantee/concentration 42.5 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
1
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).
Suspected lack of expected efficacy On 26 Jun 2013 a veterinary technician reported two dogs had ticks while treated with Activyl Tick Plus for Dogs and Puppies (over 11 lb and up to 22) administered on 01 May 2013. The product was purchased from the vet clinic. One of the dogs, a dachshund, was presented to the vet clinic on 11 May 2013 with live, attached and engorged ticks. The ticks were removed. Though the tech did not know these dogs' specific lifestyles and home environment. The tech suspected the dogs were allowed to roam free in woods and untreated fields. Adverse reaction: The technician reported the second dog, a Maltese, in the household was found outside dead on about 15 May 2013. The dog had no other signs and a necropsy was not preformed. No more information expected.
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
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Maltese
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4.0
7. Weight (provide a range if necessary )
16.00
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
<=15 min / <=15 min
10. Time between exposure and onset of symptoms
>1 wk <=1 mo / > 1 sem < = 1 mois
11. List all symptoms
System
12. How long did the symptoms last?
Unknown / Inconnu
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
Suspected lack of expected efficacy On 26 Jun 2013 a veterinary technician reported two dogs had ticks while treated with Activyl Tick Plus for Dogs and Puppies (over 11 lb and up to 22) administered on 01 May 2013. The product was purchased from the vet clinic. One of the dogs, a dachshund, was presented to the vet clinic on 11 May 2013 with live, attached and engorged ticks. The ticks were removed. Though the tech did not know these dogs' specific lifestyles and home environment. The tech suspected the dogs were allowed to roam free in woods and untreated fields. Adverse reaction: The technician reported the second dog, a Maltese, in the household was found outside dead on about 15 May 2013. The dog had no other signs and a necropsy was not preformed. No more information expected.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here