Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2020-4265

2. Registrant Information.

Registrant Reference Number: 2020-US-012760

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.

19-MAY-20

5. Location of incident.

Country: UNITED STATES

Prov / State: UNKNOWN

6. Date incident was first observed.

08-MAY-20

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

• 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?

Unknown

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

Beagle

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.5

7. Weight (provide a range if necessary )

6.804

kg

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Skin
  • Symptom - Pallor

• General
  • Symptom - Lethargy

• Nervous and Muscular Systems
  • Symptom - Recumbent

• General
  • Symptom - Death

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?

Other / Autre

specify unknown

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

Dog may have been exposed to an unknown amount of the product starting approximately 5-May-2020. The dog was unvaccinated and not adequately cared for. Dog developed pallor, lethargy, and was unable to stand at an unspecified time. The dog died 8-May-2020. Dog was not evaluated by a veterinarian nor did the dog receive treatment. Necropsy was not performed. Incomplete information was provided by the reporter as they did not have their records accessible.

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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

Assessment: Off label use. Methomyl has a narrow margin of safety. Symptoms can include excessive secretions such as salivation, lacrimation, urination, diarrhea, vomiting, and bronchial secretions leading to difficulty breathing. Neurological symptoms such as tremors, weakness, and paresis as well as cardiovascular signs such as bradycardia may occur. Pallor may occur due to anemia or cardiovascular depression. Further history regarding if there was exposure to the product, route of exposure, amount of exposure, and progression of clinical signs could help determine cause of the symptoms and death. Other possible causes include infection, trauma, nutritional deficits, parasites, and congenital disorders. Product was used in an area where an animal could ingest it.