Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2007-5997

2. Registrant Information.

Registrant Reference Number: 070045514

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.

09-MAY-07

5. Location of incident.

Country: UNITED STATES

Prov / State: MISSOURI

6. Date incident was first observed.

09-MAY-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. 2724501

Product Name: Zodiac Triple Action Flea &Tick Shampoo

• Active Ingredient(s)
  • DI-N-PROPYL ISOCINCHOMERONATE
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration 1 %
  • PYRETHRINS
    • Guarantee/concentration .15 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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).

Around 4:00 pm CDT on May 9, 2007, the owner appropriately bathed both of her cats with the Zodiac Triple Action Flea and Tick Shampoo for Dogs Puppies Cats and Kittens to treat and prevent fleas.

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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

7. Weight (provide a range if necessary )

8

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• 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

Not recovered / Non 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

The APSS DVM stated that a bad taste reaction would be the only reaction expected with this exposure. The owner stated that her cat was acting normal post exposure. On May 9, 2007 at 5:15 pm CDT, she discovered the cat was dead. The owner stated that the cat that died had gone blind over the past seven months, but had not been examined by a DVM.

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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

The APSS DVM stated that this exposure would not cause death. The APSS DVM strongly suspects that the cat had cardiomyopathy, especially in view of the recent onset of blindness. A necropsy was recommended to ascertain the cause of death. The APSS staff was unsuccessful with attempts to follow-up with the owner in regard to going forward with a necropsy. Therefore, additional information was not determined.