Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-3408
2. Registrant Information.
Registrant Reference Number: 140079821
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.
28-JUN-14
5. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
28-JUN-14
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. 2724-803-270
Product Name: Adams Flea and Tick Spray for Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .1 %
- ETOFENPROX
- Guarantee/concentration .25 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .75 %
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: 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).
On June 28, 2014 the owner bathed the cat with hand soap, then sprayed the cat with the product to treat for fleas.
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
Persian
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
11.0
7. Weight (provide a range if necessary )
6.5
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
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 June 28, 2014 the cat ran off after he was sprayed with the product. Later that day, the owner found the cat dead. The owner then contacted the Animal Product Safety Service (APSS). The APSS veterinarian discussed a necropsy with the owner, but she wasn't comfortable having anyone but her veterinarian do the necropsy. The APSS veterinarian recommended taking the cat to the veterinarian and have the veterinarian call for information so we could further discuss necropsy.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
A necropsy is not available.