Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-0821
2. Registrant Information.
Registrant Reference Number: 140138832
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.
01-NOV-14
5. Location of incident.
Country: UNITED STATES
Prov / State: PENNSYLVANIA
6. Date incident was first observed.
31-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.
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).
The owner bathed the cat and the following day, October 31, 2014, the owner sprayed the cat with the product. The cat licked herself once. The owner noted a runny nose and sneezing prior to flea treatments.
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
Domestic Longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2.5
7. Weight (provide a range if necessary )
4.0
lbs
8. Route(s) of exposure
Skin
Oral
9. What was the length of exposure?
>15 min <=2 hrs / >15 min <=2 h
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Collapse
- Renal System
- Symptom - Urinary incontinence
- General
- Symptom - Adipsia
- 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 31, 2014 the cat began to vocalize, became ataxic, collapsed, so the owner moved the cat to fresh air, then bathed the cat (with cat shampoo), and provided thermoregulation. On November 1, 2014 the cat developed urinary incontinence, anorexia, and adipsia. The owner left the house and a few hours later he found the cat dead. Later that afternoon, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated inhalation, in a rare individual, may cause a respiratory reaction similar to asthma. The APSS veterinarian recommended a necropsy, having a veterinarian call for information, and calling 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 considered to have a doubtful likelihood of causing the clinical situation.