Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2015-6662
2. Registrant Information.
Registrant Reference Number: 150124531
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.
09-SEP-15
5. Location of incident.
Country: UNITED STATES
Prov / State: OKLAHOMA
6. Date incident was first observed.
06-SEP-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. 2724-797-270
Product Name: Adams Plus Flea and Tick Spray
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .27 %
- ETOFENPROX
- Guarantee/concentration .5 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration 1.75 %
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).
On September 6, 2015 the owner applied the product onto the cat to treat an existing flea infestation and pruritus.
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 Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5.0
7. Weight (provide a range if necessary )
15.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Loss of appetite
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 September 6, 2015 the cat developed lethargy. On September 8, 2015 the cat developed inappetence. On September 9, 2015 the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated no significant signs are expected from dermal exposure. The APSS veterinarian also stated ingestion may cause taste reaction or mild signs. The APSS technician recommended wiping off the cat's coat/skin (with wet washcloth and liquid dish washing detergent (LDWD)), taking the cat to the veterinarian, and having the veterinarian call for information.
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 Adams flea and tick spray was not considered to be related to causing the clinical situation. The APSS veterinarian stated that anemia (secondary to flea infestation) was considered to have a medium likelihood of causing the clinical situation. On September 11, 2015 the owner called the APSS to report that on September 10, 2015 they were taking the cat to the veterinarian, when the cat passed away on the way to the clinic. A necropsy was not available.