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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-3410
2. Registrant Information.
Registrant Reference Number: 140080724
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.
30-JUN-145. Location of incident.
Country: UNITED STATES
Prov / State: UNKNOWN
6. Date incident was first observed.
30-JUN-14Product 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. 2724-274
Product Name: Starbar Golden Malrin Fly Bait 1% Methomyl
- Active Ingredient(s)
- (Z)-9-TRICOSENE
- Guarantee/concentration .049 %
- METHOMYL
- Guarantee/concentration 1 %
- (Z)-9-TRICOSENE
7. b) Type of formulation.
Bait
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).
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
Dog / Chien
3. Breed
American Pit Bull Terrier Mix
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.30
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Retching
- Symptom - Vomiting
- 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?
Accidental ingestion/Ingestion accident.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
On June 30, 2014 the dog ingested an unknown amount of the bait outside. Immediately after the puppy began retching and shortly after began vomiting. Later that night, the owner contacted the Animal Product Safety Service (APSS). The APSS assistant recommended taking the puppy right into the veterinary clinic and having the veterinarian call for information. The APSS veterinarian stated methomyl is a carbamate that is rapidly absorbed after ingestion, but does not accumulate in the tissues and it does not "age" on the receptors like OP's (organophosphate) do, so signs are often short-lived. The APSS veterinarian also stated signs occur very soon after ingestion, and include SLUDDE (lacrimation, urination, defecation, dyspnea, emesis) signs, bradycardia, ataxia, weakness, tremors, seizures, and possibly death. The APSS veterinarian further stated if signs resolve on their own or are successfully treated, prognosis is good. The APSS veterinarian finally stated potential complications could be aspiration, from the excessive salivation that may occur.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
On July 7, 2014 an APSS technician called the owner, who stated the puppy had started seizuring in the car and had died once they got to the veterinary clinic. A necropsy was not available.
