Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2020-6020
2. Registrant Information.
Registrant Reference Number: 35151
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.
12-DEC-20
5. Location of incident.
Country: CANADA
Prov / State: UNKNOWN
6. Date incident was first observed.
19-OCT-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)
PMRA Registration No. 29777
PMRA Submission No.
EPA Registration No.
Product Name: k9 advantix II small dog
- Active Ingredient(s)
- IMIDACLOPRID
- Guarantee/concentration 8.8 %
- PERMETHRIN
- Guarantee/concentration 44 %
- PYRIPROXYFEN
- Guarantee/concentration .44 %
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 19-Oct-2020, a 0.4 year old, 2.7 kg, female Crossbred (Dog) in good condition with no concomitant medical conditions was administered one K 9 ADVANTIX II 4 X 0.4 ML SM DOG, KP0DRS2 KP0DN8X (-), by Animal owner. The product was used according to label (No). Product was applied in one spot on the Dorsal midline.
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
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Crossbred dog
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.4
7. Weight (provide a range if necessary )
2.7
kg
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Skin
- Symptom - Red skin
- Symptom - Itchy skin
- Symptom - Hair loss
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
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
Immediately after application, owner notice redness and itchiness at application site. Dog was bathed with dish soap approximately 2 hours prior to application. There was alopecia at application site noticed and itchiness continues. Owner bathed dog 2 weeks after application with dog shampoo. Hair growing back seems thin. Dog still itches at the application site as of 09-Dec-2020.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here