Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2021-2258
2. Registrant Information.
Registrant Reference Number: 36038
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-MAY-21
5. Location of incident.
Country: CANADA
Prov / State: NOVA SCOTIA
6. Date incident was first observed.
18-MAY-21
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. 29778
PMRA Submission No.
EPA Registration No.
Product Name: k9 advantix II medium 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.
1
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 18-May-2021, a 7 year old, 9.09 kg, female spayed Cockerpoo in good condition with no concomitant medical conditions was administered one K 9 ADVANTIX II 4 X 1.0 ML MED DOG, (-), by Animal owner. The product was used according to label (Yes). The dog has received this product in the past and has had a similar reaction that was unreported.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Yes
Subform III: Domestic Animal Incident Report
1. Source of Report
Medical Professional
2. Type of animal affected
Dog / Chien
3. Breed
Cockerpoo
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
9.09
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 <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Skin
- Symptom - Itchy skin
- Symptom - Other
- Specify - Hot to the touch
- General
- Symptom - Abnormal behaviour
- Specify - Running around
- Skin
- Symptom - Pruritus
- Specify - Rubbing application site
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
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
Fully Recovered / Complètement rétabli
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
Within 1 hour of application the dog started pacing, was itchy, was hot to the touch, was running around, and rubbing her back at the application site. The pet owner applied vitamin E oil to the skin. The pet owner called the veterinary clinic which recommended administering a dose of Benadryl (diphenhydramine). Another dog in the home of similar weight was treated with the same product and had no symptoms.
On 20 May 2021 the pet owner gave the dog a bath. The dog recovered 12 hours after the bath.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here