Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-6962

2. Registrant Information.

Registrant Reference Number: 170063840

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.

21-APR-17

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

21-APR-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)

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2724-274

Product Name: Starbar Golden Malrin Fly Bait 1% Methomyl

• Active Ingredient(s)
  • (Z)-9-TRICOSENE
    • Guarantee/concentration .049 %
  • METHOMYL
    • Guarantee/concentration 1 %

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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

Mountain Cur

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2.0

7. Weight (provide a range if necessary )

71.0

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Seizure

• Gastrointestinal System
  • Symptom - Salivating excessively

• Respiratory System
  • Symptom - Other
  • Specify - Aspiration Pneumonia

• Cardiovascular System
  • Symptom - Cardiac arrest

• Renal System
  • Symptom - Frequent urination

• Gastrointestinal System
  • Symptom - Diarrhea

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

About thirty minutes after the ingestion of the product on April 21, 2017 the owner found the dog seizing. The owner then took the dog to the regular veterinarian who performed an endotracheal intubation, administered anesthesia, and gave the dog atropine and epinephrine. The regular veterinarian contacted an Animal Product Safety Service (APSS). Veterinarian who stated that methomyl is a carbamate that is rapidly absorbed after ingestion, but does not accumulate in the tissues or age on the receptors like organophosphates (OPs) do, so signs are often short-lived. The APSS veterinarian also stated that signs occur very soon after ingestion and that if signs resolve on their own or are successfully treated, that prognosis is good. The APSS veterinarian also stated that potential complications could be aspiration from the excessive salivation and recommended to the regular veterinarian to continue treatment with maropitant (to prevent vomiting and possibly help with the hypersalivation), give methocarbamol (55-220 milligrams per kilogram (mg/kg) slow intravenous (IV), increase and repeat to effect as necessary (PRN)), monitor heart rate, monitor for respiratory difficulty, and treat the aspiration pneumonia. The APSS veterinarian also recommended the regular veterinarian give 0.1-0.2 mg/kg of atropine (give 1/4 IV and the rest intramuscular (IM) if the dog becomes bradycardic again or dyspneic, but do not over-atropiniz and to call back with questions.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

On April 23, 2017 an APSS assistant called the clinic for a follow up and learned that the dog had passed away on April 21, 2017. At the time of this report, a necropsy is not pending, as it was refused. This product was not used according to label direction because it should have been stored away from the reach of children and animals.