Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-3793
2. Registrant Information.
Registrant Reference Number: 2015CK236
Registrant Name (Full Legal Name no abbreviations): Bayer Inc
Address: 2920 Matheson Boulevard
City: Missisaugua
Prov / State: ON
Country: Canada
Postal Code: L4W 5R6
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
05-AUG-15
5. Location of incident.
Country: UNITED STATES
Prov / State: UNKNOWN
6. Date incident was first observed.
01-JUL-15
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. 1556-155
Product Name: Seresto Collar - small dog
- Active Ingredient(s)
- Flumethrin
- IMIDACLOPRID
- Guarantee/concentration 10 %
7. b) Type of formulation.
Other (specify)
Collar
Application Information
8. Product was applied?
Yes
9. Application Rate.
1
Other Units: collar
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 approximately 01-Feb-2014, a 17 year old, 14 pound, neutered, male, Dachshund/Papillon crossbred canine, in poor condition, with fleas and elevated liver enzymes, had 1 Seresto Small Dog (Flumethrin-Imidacloprid) collar placed around the neck by the owner.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
Subform III: Domestic Animal Incident Report
1. Source of Report
Other
2. Type of animal affected
Dog / Chien
3. Breed
cross
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
17
7. Weight (provide a range if necessary )
14
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>1 wk <=1 mo / > 1 sem < = 1 mois
10. Time between exposure and onset of symptoms
>2 mos <=6 mos / > 2 mois < = 6 mois
11. List all symptoms
System
12. How long did the symptoms last?
<=30 min / <=30 min
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 approximately 22-Feb-2014, the collar was removed.On approximately 01-Jul-2014, the dog died. A necropsy examination was not performed.The reason for the initial call to Bayer Animal Health was to discuss flea control and not to report the death of the patient.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
N - Unlikely. Death is not expected following appropriate topical product application as inconsistent with products pharmacological profile. Oral exposure to the collar is not expected to cause death either. The dog in this case was of advanced age for the breed and in poor condition with elevated liver enzymes prior to the application of the collar. Collar was removed from the dog approximately 4 months prior to the dog's death. No necropsy was performed. Considering all, it is unlikely that product have played a role in this event. The reason for the initial call to Bayer Animal Health was to discuss flea control and not to report the death of the patient. In the end, a product relation considered as unlikely.