Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5994

2. Registrant Information.

Registrant Reference Number: 070042145

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.

01-MAY-07

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

30-APR-07

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. 2724274

Product Name: Starbar Golden Malrin Fly Bait

• Active Ingredient(s)
  • (Z)-9-TRICOSENE OR MUSCALURE
    • Guarantee/concentration .049 %
  • METHOMYL
    • Guarantee/concentration 1.1 %

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

No

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

Animal's Owner

2. Type of animal affected

Other / Autre

specify Goat / Chevre

3. Breed

Anglo Nubian Goat

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

7. Weight (provide a range if necessary )

85

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Salivating excessively
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Ataxia

• General
  • Symptom - Death

12. How long did the symptoms last?

>8 hrs <=24 hrs / > 8 h < = 24 h

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Not recovered / Non rétabli

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

On May 1, 2007 at 12:00 p.m. CDT, the goat began exhibiting signs of moderate hypersalivation, vomiting and mild ataxia. The owner gave the goat pepcid on the advice of the attending DVM. The APSS DVM recommended methocarbamol, diazepam, and atropine; however, the attending DVM believed it was too late to administer atropine. Supportive and symptomatic care were also recommended. The goat's signs resolved on May 1, 2007 at 11:00 p.m., but the animal died forty-five minutes later.

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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

On April 30, 2007 at 9:13 p.m. CDT, goat may have ingested one teaspoon of the aforementioned product. The APSS DVM stated that the risk of this exposure is very high. Label states "Product should not be placed where accessible to food producing animals", therefore product not used according to label directions.