Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-4502
2. Registrant Information.
Registrant Reference Number: 190106445
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.
20-JUN-19
5. Location of incident.
Country: UNITED STATES
Prov / State: TEXAS
6. Date incident was first observed.
16-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.
PMRA Submission No.
EPA Registration No. 2724-485-89459
Product Name: Adams Plus Flea And Tick Foaming Shampoo And Wash For Cats And Kittens
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .1 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration 1.88 %
- PYRETHRINS
- Guarantee/concentration .15 %
7. b) Type of formulation.
Liquid
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 June 15, 2019, the owner bathed the cat with this shampoo.
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
Cat / Chat
3. Breed
Domestic Shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.92
7. Weight (provide a range if necessary )
6.5
lbs
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
- Renal System
- Symptom - Anuria
- Specify - Not Urinating
- Gastrointestinal System
- Symptom - Constipation
- Specify - Absent Bowl Movements
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?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
On June 16, 2019, the cat developed lethargy and anorexia. The cat also was not urinating and had absent bowel movements. On June 18, 2019, the owner gave the cat milk and water by mouth with a syringe. On June 19, 2019, the cats lethargy and anorexia became more severe. That evening, the cat passed away. On June 20, 2019, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that no problems are expected with appropriate use. The APSS veterinarian recommended 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. A necropsy was not available, as the cat had already been buried.