Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2024-2286

2. Registrant Information.

Registrant Reference Number: CAN-ZZELANCO-CA2024_000725

Registrant Name (Full Legal Name no abbreviations): Elanco

Address: 1919 Minnesota Court, Suite 401

City: Mississauga

Prov / State: ON

Country: Canada

Postal Code: L5N 0C9

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

20-MAR-24

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

04-JUN-23

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. 29777      PMRA Submission No.       EPA Registration No.

Product Name: K9 Advantix II Small Dog

• Active Ingredient(s)
  • IMIDACLOPRID
  • PERMETHRIN
  • PYRIPROXYFEN

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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 20 Mar 2024, a veterinary technician contacted Elanco to report a potential adverse reaction involving Advantage Multi 10 (Imidacloprid, Moxidectin) and K9 advantix II Small Dog (Permethrin, Imidacloprid, Pyriproxyfen) in a dog. On 03 Jun 2023, the owner applied a tube of Advantage Multi 10 (Imidacloprid, Moxidectin) to the dog. On 04 June 2023 the owner applied a tube of K9 advantix II Small Dog (Permethrin, Imidacloprid, Pyriproxyfen) to the dog. The dog was on no concomitant medications.

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

Crossbred Yorkshire Terrier/ Maltese

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

5

7. Weight (provide a range if necessary )

3

kg

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Sleepiness
  • Symptom - Difficulty walking

• General
  • Symptom - Lethargy

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Diarrhea

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

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

On 04 June 2023, the 5 year old, 3kg, female neutered, crossbred Yorkshire Terrier/ Maltese Dog, developed sleepiness. On 05 Jun 2023 the dog was lethargic, was having difficulty walking, and developed vomiting and diarrhea. On an unknown date, the dog recovered at home without treatment.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here