Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-0168
2. Registrant Information.
Registrant Reference Number: 160121511
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.
16-AUG-16
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
12-AUG-16
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. 21744
PMRA Submission No.
EPA Registration No.
Product Name: Zodiac Fleatrol Flea and Tick Spray for Dogs and Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- PIPERONYL BUTOXIDE
- PYRETHRINS
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 August 12, 2016 the owner applied the spray to all three cats to treat condition.
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 )
1.5
7. Weight (provide a range if necessary )
5.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Drooling
- Symptom - Vomiting
- Skin
- Symptom - Pale mucous membrane colour
- Specify - White Mucous Membranes
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?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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 August 12, 2016 the cat developed symtpoms. On August 15, 2016 the owner bathed the cat (Dawn). On August 16, 2016 the owner contacted the Animal Product Safety Service (APSS) and during the call mentioned that the cat had white mucous membranes. The APSS veterinarian stated if ingested, low risk for mild gastrointestinal (GI) signs. The APSS veterinarian advised the owner that white mucous membranes can be very serious and recommended taking the cat to the veterinarian and having the veterinarian call for information. The owner was unwilling to take the cat to the clinic due to finances.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
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 )
4.0
7. Weight (provide a range if necessary )
8.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Drooling
- Symptom - Vomiting
- Skin
- Symptom - Pale mucous membrane colour
- Specify - White Mucous Membranes
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?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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 August 12, 2016 the cat developed symptoms. On August 15, 2016 the owner bathed the cat (Dawn). On August 16, 2016 the owner contacted the Animal Product Safety Service (APSS) and during the call mentioned that the cat had white mucous membranes. The APSS veterinarian stated if ingested, low risk for mild gastrointestinal (GI) signs. The APSS veterinarian advised the owner that white mucous membranes can be very serious and recommended taking the cat to the veterinarian and having the veterinarian call for information. The owner was unwilling to take the cat to the clinic due to finances.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
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
Female
6. Age (provide a range if necessary )
8.0
7. Weight (provide a range if necessary )
8.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Skin
- Symptom - Pale mucous membrane colour
- Specify - White Mucous Membranes
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?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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 August 12, 2016 the cat developed symptoms. On August 15, 2016 the owner bathed the cat (Dawn). On August 16, 2016 the owner contacted the Animal Product Safety Service (APSS) and during the call mentioned that the cat had white mucous membranes. The APSS veterinarian stated if ingested, low risk for mild gastrointestinal (GI) signs. The APSS veterinarian advised the owner that white mucous membranes can be very serious and recommended taking the cat to the veterinarian and having the veterinarian call for information. The owner was unwilling to take the cat to the clinic due to finances.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here