Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2406

2. Registrant Information.

Registrant Reference Number: 2011US02171

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

Address: 16750 Transcanada Highway

City: Kirkland

Prov / State: QC

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.

11-APR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: OKLAHOMA

6. Date incident was first observed.

05-APR-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)

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PMRA Registration No. 25488      PMRA Submission No.       EPA Registration No.

Product Name: UltaBoss

• Active Ingredient(s)
  • PERMETHRIN
    • Guarantee/concentration 5 %

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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 11 Apr 2011, a producer reported that approximately 377 calves were vaccinated with Vision 7 Somnus, Pyramid 5 + Presponse, 1.5ml Ivomec and 5-10 ml Ultra Boss between 5 Apr 2011 and 8 Apr 2011. Also, some of the bull calves were castrated. In the first group of 87 head vaccinated on 5 Apr 2011, 1 calf died. In the second group of 77 head vaccinated on 6 Apr 2011, 1 calf died and in the third group vaccinated of 213 calves on 8 Apr 201, 3 calves died. All were found flat on their side, very stiff and foamy froth coming out of their mouth and noses. No necropsies were done. No further follow up expected.

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

Cow / Vache

3. Breed

Maine-Anjou

4. Number of animals affected

5

5. Sex

Unknown

6. Age (provide a range if necessary )

0.25

7. Weight (provide a range if necessary )

150

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• General
  • Symptom - Death

• Nervous and Muscular Systems
  • Symptom - Rigidity

• Respiratory System
  • Symptom - Other
  • Specify - Foam in nose

• Gastrointestinal System
  • Symptom - Foaming at mouth
  • Specify - foam in mouth

12. How long did the symptoms last?

Persisted until death

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?

Treatment / Traitement

17. Provide any additional details about the incident

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

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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