Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2008-4424

2. Registrant Information.

Registrant Reference Number: 080071648

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-JUL-08

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

23-JUN-08

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. 2724-504

Product Name: Zodiac Spot On Plus Flea And Tick Control For Cats 5 Pounds And Over

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 3.6 %
  • ETOFENPROX
    • Guarantee/concentration 40 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

1.8

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 June 21 or 22, 2008, the owner applied the product to her cat as a form of treatment.

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

Unspecified Domestic Feline

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

11

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

>24 hrs <=3 days / >24 h <=3 jours

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom -
  • Specify - Decreased grooming

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Hyperthermia

• Blood
  • Symptom - Leukopenia
  • Specify - Lymphopenia
  • Symptom - Leukocytosis
  • Specify - Monocytosis
  • Symptom - Other
  • Specify - Hyperchloremia
  • Symptom - Other
  • Specify - Macrocytes
  • Symptom - Other
  • Specify - Elevated Serum Total Protein
  • Symptom - Other
  • Specify - Elevated Mean Corpuscular Hemoglobin Concentration
  • Symptom - Other
  • Specify - Red Cell Distribution Width

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

14. a) Was the animal hospitalized?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

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 June 23, 2008, the owner bathed the animal two or three times and took the animal to the local veterinary clinic where diagnostic evaluations took place and an antibiotic was given. On June 25, 2008, the animal died. The APSS veterinarian recommended a necropsy to determine the cause of the animal's death, but the body was not available.

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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 veterinarian doubted that this substance was related to causing the clinical situation.