Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-0140
2. Registrant Information.
Registrant Reference Number: 2017BS063
Registrant Name (Full Legal Name no abbreviations): Bayer inc
Address: 2920 Matheson Blvd
City: Mississaugua
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.
24-NOV-17
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
11-OCT-17
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. 27582
PMRA Submission No.
EPA Registration No.
Product Name: Advantage II Large Dog
- Active Ingredient(s)
- IMIDACLOPRID
- PYRIPROXYFEN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
2.5
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).
Buda a 9 year old, M/N, 24.25 kg Corgi x cocker had Advantage II large dog applied to the dorsal midline on October 10th.
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Crossbred
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
9
7. Weight (provide a range if necessary )
24.25
kg
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
- Skin
- Symptom - Irritated skin
- Symptom - Pruritus
- Symptom - Other
- Specify - Skin sore
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?
No
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
Buda a 9 year old, M/N, 24.25 kg Corgi x cocker had Advantage II large dog applied to the dorsal midline on October 10th. Within 24 hours owner noticed Buda was vocalizing, started chewing on hind quarters. Owner used mild soap and water to clean the area and applied Polysporin. On October 12th, dog was seen by vet. Buda self-traumatized the area which became irritated and produced open sores. Buda's treatment protocol involved sedation, Vanectyl P for itching, Baytril 250mg and Viaderm for wound. Reaction was moderate.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
B - Possible
A behavioural response to the product sensation or to the product smell may occur in a particularly sensitive animal. Generalized skin reactions or skin reactions on other than the application site are not anticipated with topical product administration. If any, skin reactions would be localized at the application site. Time to onset is short. Considering all aspects, product relation is possible.