Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2009-5022

2. Registrant Information.

Registrant Reference Number: 090107523

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.

24-SEP-09

5. Location of incident.

Country: UNITED STATES

Prov / State: KANSAS

6. Date incident was first observed.

24-SEP-09

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. 2724-352

Product Name: Zoecon Precor IGR Concentrate

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 1.2 %

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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: Res. - In Home / Rés. - à l'int. maison

11. Provide any additional information regarding application (how it was applied, amount applied, the size of the area treated etc).

On September 23, 2009 the owner had a company treat the house with the product, along with another product spray for a flea infestation.

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Siamese Mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

8

7. Weight (provide a range if necessary )

20

lbs

8. Route(s) of exposure

Unknown

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

• Respiratory System
  • Symptom - Mouth breathing

• Eye
  • Symptom - Pupil dilation
  • Specify - Mydriasis

• Nervous and Muscular Systems
  • Symptom - Ataxia

• General
  • Symptom - Hypothermia
  • 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?

Yes

14. b) How long was the animal hospitalized?

1

Hour(s) / Heure(s)

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 September 23, 2009 the owners left the house with the cat in the carrier, returning to the house 4 hours after the products were applied. Shortly after the signs were noticed, the owners took the cat into a regular veterinarian, who called the Animal Product Safety Service (APSS). The APSS veterinarian stated that since the cat was not in the house right after the application, inhalation wouldn't be a significant route of exposure. The APSS veterinarian recommended a diagnostic evaluation and symptomatic and supportive care.

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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 stated that the substance was considered to have a doubtful likelihood of causing the clinical situation. The clinic reported that the cat died shortly after the APSS consultation on September 24, 2009.