Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2014-6136
2. Registrant Information.
Registrant Reference Number: 140133325
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.
20-OCT-14
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
18-OCT-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. 25738
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Premise 1000 Flea Spray
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
7. b) Type of formulation.
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 October 18, 2014 the owner sprayed the product on her bed and couch and then she didn't wait an hour before allowing the dog access.
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
Dog / Chien
3. Breed
Yorkshire Terrier
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5.5
7. Weight (provide a range if necessary )
7.0
lbs
8. Route(s) of exposure
Skin
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
- General
- Symptom - Abnormal behaviour
- Specify - Behavior Change
- Symptom - Licking
- Specify - Licking Lips
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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 October 18, 2014 the dog was symptomatic. On October 20, 2014 the owner contacted the Animal Product Safety Service (APSS) to ask whether or not she could use a Zodiac flea and tick shampoo if the dog was scheduled to have a topical spot on applied in 2 days. The APSS veterinarian assistant recommended monitoring for GI signs, monitoring for dermatological signs (if there was a dermal exposure, the risk is for paresthesia), monitoring mucous membrane color, providing a taste treat (feed small amount of canned dog food to get rid of the bad taste), and calling back with questions.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
Signs were expected to be mild and self-limiting.