Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5559

2. Registrant Information.

Registrant Reference Number: 100105314

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.

12-AUG-10

5. Location of incident.

Country: UNITED STATES

Prov / State: MAINE

6. Date incident was first observed.

07-AUG-10

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. 11715-254-2724

Product Name: Zodiac Flea and Tick Powder for Dogs Puppies Cats and Kittens

• Active Ingredient(s)
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration 1 %
  • PYRETHRINS
    • Guarantee/concentration .1 %

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7. b) Type of formulation.

Dust

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

Cat / Chat

3. Breed

Domestic Shorthair Cat

4. Number of animals affected

4

5. Sex

Unknown

6. Age (provide a range if necessary )

0.0027

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• General
  • Symptom - Death

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

Died

16. How was the animal exposed?

Other / Autre

specify Relay

17. Provide any additional details about the incident

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

On August 7, 2010 four kittens were born to a mother who had the agent applied to her the day before. On August 7, 2010 the first kitten died. On August 8, 2010 the second kitten died. On August 12, 2010 the third and fourth kittens died. Also on August 12, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that cats generally tolerate low dose pyrethroids well. Grooming of the product can cause drooling, taste reaction, and possible gastrointestinal upset are possible. The APSS veterinarian recommend necropsies for the kittens, but owner has already buried them.

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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

This product was not used according to label directions: Consult a veterinarian before using on pregnant animals.