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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2018-6896
2. Registrant Information.
Registrant Reference Number: 2018TH114
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.
22-MAY-185. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
15-MAY-18Product 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. Unknown
Product Name: K9advantixII pipette size unknown
- Active Ingredient(s)
- IMIDACLOPRID
- PERMETHRIN
- PYRIPROXYFEN
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 15-May-2018, a 11 year old, 86 pound, neutered, male, Retriever Labrador (No Description) canine, in unknown condition, with no known concomitant medical conditions, was administered 1 tube of k9AdvantixII topically by the owner.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
Labrador Retriever
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
11
7. Weight (provide a range if necessary )
39.009
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
>30 min <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Insomnia
- Skin
- Symptom - Pruritus
- General
- Symptom - Abnormal behaviour
- Gastrointestinal System
- Symptom - Diarrhea
12. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
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
Fully Recovered / Complètement rétabli
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
Approximately 2 hours post application, the dog had insomnia, pruritus and was jumping on an off the bed for no apparent reason. On 19 May 2018, the dog had diarrhea. The dog was not examined by a veterinarian and the clinical signs continued. The dog was bathed in dawn dish detergent and 1 hour post bath the dog was recovered. No more information is expected. This case is closed.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
O - Unclassifiable/unassessable Pruritus is not expected to be generalised but rather be linked to the application site. Insomnia and jumping on an off the bed are an unspecific signs. However, they may be a consequence of the uncomfortable feeling caused by the applied product. Further reported diarrhoea is an unspecific sign. However, it is not expected after long time. Other causes should be considered. Dog showed signs when product was used before, however no further details available. Though time to onset is short for initial signs, considering long time to onset for further reported sign (4 days), a product connection is unassessable.
