Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2019-6121
2. Registrant Information.
Registrant Reference Number: 190161595
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.
12-SEP-19
5. Location of incident.
Country: UNITED STATES
Prov / State: ARIZONA
6. Date incident was first observed.
12-SEP-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. 2724-803-270
Product Name: Adams Flea And Tick Spray For Dogs And Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .1 %
- ETOFENPROX
- Guarantee/concentration .25 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .75 %
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 September 11, 2019, the owner lightly misted the three kittens with this product to treat a condition.
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
3
5. Sex
Male
Female
6. Age (provide a range if necessary )
0.46
7. Weight (provide a range if necessary )
7
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
12. How long did the symptoms last?
Unknown / Inconnu
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 the morning of September 12, 2019, three kittens passed away. That afternoon, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that in most cases death would not be expected. The APSS veterinarian also stated that etofenprox is in the pyrethroid family, although it is structurally different than other pyrethroids and that this insecticide is safe to use on cats as a topical agent to treat fleas.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
A necropsy was unavailable as the kittens had already been buried.