Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-3252
2. Registrant Information.
Registrant Reference Number: 29855
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.
25-JUN-19
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
21-JUN-19
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. 27585
PMRA Submission No.
EPA Registration No.
Product Name: advantage II small cat
- Active Ingredient(s)
- IMIDACLOPRID
- PYRIPROXYFEN
7. b) Type of formulation.
Application Information
8. Product was applied?
Yes
9. Application Rate.
.4
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).
On 21-Jun-2019 at 8am, a 12.3 year old, 3.17 kg, female spayed Domestic Longhair in good condition with no concomitant medical conditions was administered one ADVANTAGE II 6 X 0.4 ML SMALL CAT, KPOD7O3 KPOD5F6 (-), by Animal owner. The product was used according to label (No)Applied between the shoulder blades.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
12.3
7. Weight (provide a range if necessary )
3.17
kg
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>3 days <=1 wk / >3 jours <=1 sem
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Shaking
- Symptom - Seizure
- Symptom - Muscle twitching
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?
Yes
14. b) How long was the animal hospitalized?
1
Day(s) / Jour(s)
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 21-Jun-2019, 12 hours a after application, cat began to shake. On 21-Jun-2019, 16 hours after application cat had a seizure. On 22-Jun-2019 cat was seen by the veterinarian and cat was still twitching and shaking. The cat was treated with an injection of Methacarbamol, was administered IV fluids for the day and had a blood panel done(results unknown) Outcome is unknown.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here