Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5565

2. Registrant Information.

Registrant Reference Number: 100108757

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.

19-AUG-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW YORK

6. Date incident was first observed.

16-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. 2724-454

Product Name: Zodiac Fleatrol Fogger

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .09 %
  • PERMETHRIN
    • Guarantee/concentration .58 %

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PMRA Registration No.       PMRA Submission No.       EPA Registration No. 2724-404-270

Product Name: Bio Spot Flea and Tick Spray for Cats and Kittens

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .27 %
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
    • Guarantee/concentration .62 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .37 %
  • PYRETHRINS
    • Guarantee/concentration .2 %

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7. b) Type of formulation.

Liquid

Other (specify)

Aerosol

Application Information

8. Product was applied?

Unknown

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

Angora Mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

4

7. Weight (provide a range if necessary )

14

lbs

8. Route(s) of exposure

Skin

Unknown

9. What was the length of exposure?

>1 wk <=1 mo / > 1 sem < = 1 mois

10. Time between exposure and onset of symptoms

>1 wk <=1 mo / > 1 sem < = 1 mois

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Other
  • Specify - Smacking lips
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Unknown

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

Unknown

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Possible contact with treated area and treatment

17. Provide any additional details about the incident

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

On August 16, 2010 the owner noticed that the cat was symptomatic. On August 19th, the owner contacted the Animal Product Safety Service (APSS) and took the cat to the veterinarian. The APSS veterinarian stated that with exposure to both products, a taste reaction or mild gastrointestinal upset may be seen; however, due to the time frame of use, clinical signs were not expected.

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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 August 25, 2010 an APSS assistant contacted the pet owner to update the case. The pet owner informed her that the cat had died, at the veterinary clinic on August 20. The pet parent declined further consultation. The DVM suspects the cat was extremely allergic to fleas. According to the expert at APSS, the products were not related to the clinical signs.