Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1842

2. Registrant Information.

Registrant Reference Number: US2011-00725

Registrant Name (Full Legal Name no abbreviations): Intervet Canada Corp.

Address: 16750 Transcanada Highway

City: Kirkland

Prov / State: Quebec

Country: Canada

Postal Code: H9H 4M7

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

03-FEB-11

5. Location of incident.

Country: UNITED STATES

Prov / State: ARIZONA

6. Date incident was first observed.

02-FEB-11

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)

---

PMRA Registration No.       PMRA Submission No.       EPA Registration No. 773-73

Product Name: Proticall

• Active Ingredient(s)
  • PERMETHRIN
    • Guarantee/concentration 65 %

---

7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

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 03 Feb 2011 the ASPCA Animal Product Safety Service received a report regarding a cat that experienced tremors within 30 minutes of administration of Proticall on 02 Feb 2011. Proticall has warnings not to use on cats. The owner washed the cat with water. The ASPCA recommended the owner rebathe the cat with dish washing detergent. Follow-up revealed the cat died 8 hours following administration. The cat was not examined or treated by a vet. No more information expected.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Other

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Short haired

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

7

7. Weight (provide a range if necessary )

2.27

kg

8. Route(s) of exposure

Skin

9. What was the length of exposure?

<=15 min / <=15 min

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• 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?

No

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Died

16. How was the animal exposed?

Other / Autre

specify Proticall has warnings not to use on cats.

17. Provide any additional details about the incident

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

The owner washed the cat with water. The ASPCA recommended the owner rebathe the cat with dish washing detergent.

---

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

Follow-up revealed the cat died 8 hours following administration. The cat was not examined or treated by a vet.