Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-6153
2. Registrant Information.
Registrant Reference Number: 2015KP269
Registrant Name (Full Legal Name no abbreviations): Bayer Inc
Address: 2920 Matheson Blvd. East
City: Mississauga
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.
19-OCT-15
5. Location of incident.
Country: UNITED STATES
Prov / State: UNKNOWN
6. Date incident was first observed.
15-AUG-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. 11556-130
Product Name: Advantage II Extra Large dog
- Active Ingredient(s)
- IMIDACLOPRID
- Guarantee/concentration 9.1 %
- PYRIPROXYFEN
- Guarantee/concentration .46 %
7. b) Type of formulation.
Liquid
Application Information
8. Product was applied?
Yes
9. Application Rate.
4
Units: mL
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 14Aug2015, a 13 year old, 70 pound, intact, male, Australian Shepherd crossbred canine, in good condition, with no known concomitant medical conditions, was administered 1 tube of Advantage II Extra Large Dog (Imidacloprid-Pyriproxyfen) topically by the owner.
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
Other
2. Type of animal affected
Dog / Chien
3. Breed
Australian Shepherd Crossbreed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
13
7. Weight (provide a range if necessary )
70
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Death
- Symptom - Lethargy
- Gastrointestinal System
- Symptom - Anorexia
- Symptom - Salivating excessively
- Symptom - Vomiting
- Symptom - Diarrhea
- Nervous and Muscular Systems
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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 15Aug2015, the dog exhibited lethargy, inappetance, drooling, vomiting, ataxia, and diarrhea. On 17Aug2015, the dog was found deceased. The dog was not examined by a veterinarian and no necropsy was performed. No more information is expected and the case is closed.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Hypersalivation may occur after ingestion of product. Sign is consistent with distaste reaction. Vomiting and diarrhoea are not anticipated with appropriate topical product use. As hypersalivation occurred oral exposure of the product can not be ruled out completely. Lethargy and inappetence may be consequence of vomiting and diarrhoea. Reported ataxia is not typically observed with appropriate topical product administration, however are possible with oral product exposure. Time to onset is short though. Death is inconsistent with pharmaco-toxicological product profile and experience. Product has wide margin of safety. Oral LD50 in rat 642 mg/kg BW. 20-fold overdosage tolerated by dogs without showing any side effect. No necropsy was performed. Finally, a product relation was considered unassessable.