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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-0772
2. Registrant Information.
Registrant Reference Number: 1-35300369
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.
22-OCT-135. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
6. Date incident was first observed.
11-OCT-13Product 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: Hartz UltraGuard Plus Drops for Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 3.6 %
- ETOFENPROX
- Guarantee/concentration 40 %
- (S)-METHOPRENE
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 October 8th, 2013 product was applied to 7 cats of unknown weights.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
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
.27
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
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
- Symptom - Seizure
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Difficulty getting up
- Specify - Unable to rise
- General
- 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
On October 8 2013 the caller applied product to 7 cats. Caller confirmed that the cats were not separated after application and ingestion via grooming may have occurred. On October 11, 2013 the cats became symptomatic. Caller bathed the cats in Dawn dish soap. Caller spoke to 2 vets, was given different suggestions. Veterinary attention was not sought. The cat died on October 19, 2013.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller adopted stray cats. Staff Veterinarian determined product use not consistent with death of cat.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1.5
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Difficulty getting up
- Specify - Unable to rise
- Symptom - Ataxia
- Gastrointestinal System
- Symptom - Anorexia
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- 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
On October 8 2013 the caller applied product to 7 cats. Caller confirmed that the cats were not separated after application and ingestion via grooming may have occurred. On October 11, 2013 the cats became symptomatic. Caller bathed the cats in Dawn dish soap. Caller spoke to 2 vets, was given different suggestions. Veterinary attention was not sought. The cat died at an unknown time approximately 1.5 weeks before call on October 22, 2013.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller adopted stray cats. Staff Veterinarian determined product use not consistent with death of cat.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Difficulty getting up
- Specify - Unable to rise
- Symptom - Ataxia
- Gastrointestinal System
- Symptom - Anorexia
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- 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
On October 8 2013 the caller applied product to 7 cats. Caller confirmed that the cats were not separated after application and ingestion via grooming may have occurred. On October 11, 2013 the cats became symptomatic. Caller bathed the cats in Dawn dish soap. Caller spoke to 2 vets, was given different suggestions. Veterinary attention was not sought. The cat died at an unknown time approximately 1.5 weeks before call on October 22, 2013.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller adopted stray cats. Staff Veterinarian determined product use not consistent with death of cat.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Persian
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Difficulty getting up
- Specify - Unable to rise
- Symptom - Ataxia
- Gastrointestinal System
- Symptom - Anorexia
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- 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
On October 8 2013 the caller applied product to 7 cats. Caller confirmed that the cats were not separated after application and ingestion via grooming may have occurred. On October 11, 2013 the cats became symptomatic. Caller bathed the cats in Dawn dish soap. Caller spoke to 2 vets, was given different suggestions. Veterinary attention was not sought. The cat died on October 20, 2013.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller adopted stray cats. Staff Veterinarian determined product use not consistent with death of cat.
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Manx
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Adipsia
- Nervous and Muscular Systems
- Symptom - Difficulty getting up
- Specify - Unable to rise
- Symptom - Ataxia
- Gastrointestinal System
- Symptom - Anorexia
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- 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
On October 8 2013 the caller applied product to 7 cats. Caller confirmed that the cats were not separated after application and ingestion via grooming may have occurred. On October 11, 2013 the cats became symptomatic. Caller bathed the cats in Dawn dish soap. Caller spoke to 2 vets, was given different suggestions. Veterinary attention was not sought. The cat died on October 21, 2013.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Caller adopted stray cats. Staff Veterinarian determined product use not consistent with death of cat.
