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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-4403

2. Registrant Information.

Registrant Reference Number: 130065596

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.

19-MAY-13

5. Location of incident.

Country: UNITED STATES

Prov / State: INDIANA

6. Date incident was first observed.

18-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. 2724-705-270

Product Name: Adams Flea And Tick Indoor Fogger

  • Active Ingredient(s)
    • ETOFENPROX
      • Guarantee/concentration .5 %
    • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
      • Guarantee/concentration .5 %
    • PYRIPROXYFEN
      • Guarantee/concentration .1 %
    • TETRAMETHRIN
      • Guarantee/concentration .4 %

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: Res. - In Home / Rés. - à l'int. maison

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

On May 17, 2013 the owner set off the fogger product and the cat was accidentally exposed to the product when she entered the room about an hour later.

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

Cat / Chat

3. Breed

Domestic Longhair Mix

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

2.0

7. Weight (provide a range if necessary )

6.0

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Lethargy
    • Symptom - Hiding
    • 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?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

On May 18, 2013 the owner noticed that the cat was mildly lethargic. On May 19, 2013 the owner noticed that the cat's lethargy had worsened and that the cat was hiding. Later that morning the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that mild respiratory signs could be seen if the scent of the product bothered her and that dermal contact or ingestion of the wet agent could cause paw shaking, facial twitching, retching, and drooling. The APSS veterinarian said that the cat's signs suggested some other cause, such as flea anemia or lily ingestion. The APSS veterinarian recommended that the owner take the cat to the veterinarian, have the veterinarian call for information, and call back with questions.


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 not considered to be related to causing the clinical situation and that flea anemia was considered to have a medium likelihood of causing the clinical situation. On May 22, 2013 an APSS assistant called the owner to update the case. The owner stated that shortly after her consultation with the APSS on May 19, 2013 she bathed the cat; she did not take the cat to the veterinarian. The owner said that on the afternoon of May 19, 2013 the cat died. A necropsy was not available. Owner allowed cat to enter treated area before labelled airing out interval completed.