Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2017-0174
2. Registrant Information.
Registrant Reference Number: 150161799
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.
23-NOV-15
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
06-OCT-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. 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 October 4, 2015 the owner sprayed the product onto the dog to treat for fleas.
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
Dog / Chien
3. Breed
English Bulldog
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.67
7. Weight (provide a range if necessary )
45.0
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
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 October 5, 2015 the owner bathed the dog (with warm water). On October 6, 2015 the dog became symptomatic so the owner took the dog to the veterinarian where supportive care (ointment) was provided. On October 20, 2015 the owner took the dog back to the veterinarian, where hypersensitivity testing was performed and the dog was given an antihistamine and a bath. On November 23, 2015 the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated signs could be consistent with hypersensitivity reaction, flea dermatitis or secondary skin infection. The APSS technician recommended having the veterinarian call for information and symptomatic and supportive care.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
The APSS veterinarian stated that the substance was considered to have an unknown likelihood of causing the clinical situation. A follow up was not performed, because multiple possibilities for etiologies of dermatitis, unlikely that follow up would provide helpful data.