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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-6156

2. Registrant Information.

Registrant Reference Number: 180153609

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.

11-SEP-18

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

09-SEP-18

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. 89459-11

Product Name: Starbar Captivator Fly Trap Includes Fly Attractant Reusable

  • Active Ingredient(s)
    • (Z)-9-TRICOSENE
      • Guarantee/concentration 1 %
    • PUTRESCENT WHOLE EGG SOLIDS
      • Guarantee/concentration 20.5 %

7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

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

Medical Professional

2. Type of animal affected

Dog / Chien

3. Breed

Miniature Poodle

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

1.0

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Rectal hemorrhage
  • General
    • Symptom - Death

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?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Sometime on September 7 or September 8, the dog ingested an unknown amount of this product. On the evening of September 9, 2018, the dog developed symptoms. Two hours later, the dog passed away. On September 11, 2018, the regular veterinary staff contacted the Animal Product Safety Service (APSS) on behalf of the owner. The APSS veterinarian stated that the risk is for gastrointestinal (GI) upset and a possible risk for foreign body obstruction (FBO) if packaging was consumed. The APSS veterinarian also stated that internal hemorrhage would not be expected from the product. The APSS assistant recommended the regular veterinary staff and the owner call back with questions.


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 substance was not considered to be related to causing the clinical situation. At the time of this report, a necropsy was not pending. Pets should not have access to the Fly Bait.