Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5661

2. Registrant Information.

Registrant Reference Number: 110111425

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.

29-AUG-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

29-AUG-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. 28199      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Powerband Plus Dual Action Flea and Tick Collar for Cats

• Active Ingredient(s)
  • (S)-METHOPRENE
  • PROPOXUR

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PMRA Registration No. 25695      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Premise 2000 Flea Spray

• Active Ingredient(s)
  • (S)-METHOPRENE
  • PERMETHRIN

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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

Préciser le type: Animal and Residential - Inside Home

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

On July 15, 2011 the owner placed the flea and tick collar on his cat. The owner noticed that the cat chewed on the flea and tick collar from time to time. On July 15, the owner also sprayed his house with the spray product and continued to spray the house until the morning of August 7, 2011. The owner also removed the cat's flea and tick collar on the evening of August 7, 2011. Unknown if cat was exposed to Premise collar.

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

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Mediumhair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

16.0

7. Weight (provide a range if necessary )

10.0

lbs

8. Route(s) of exposure

Skin

Oral

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

• General
  • Symptom - Hiding

• Gastrointestinal System
  • Symptom - Anorexia

• General
  • Symptom - Adipsia

• Renal System
  • Symptom - Inappropriate urination
  • Symptom - Other
  • Specify - Urinary Tract Infection

• Blood
  • Symptom - Anemia

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Euthanised / Euthanasie

16. How was the animal exposed?

Other / Autre

specify Treatment and contact with treated area

17. Provide any additional details about the incident

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

On July 29, 2011 the owner noticed the cat was symptomatic. On August 7, 2011 the owner removed the cat's flea and tick collar. On August 8, 2011 the owner took the cat to the veterinarian, where the cat was diagnosed with a urinary tract infection (UTI) and anemia. The owner's regular veterinarian also told the owner that the cat had a weak immune system. About an hour later, the cat was euthanized. On August 29, 2011 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that generally, the use of a flea collar will have minimal effect, but that a behavior change may be seen if the pet does not like or is not used to wearing a collar. The APSS veterinarian stated that any signs should develop within 2 to 24 hours. The APSS veterinarian also stated that if the spray product is used per label, it should be dry by the time a pet has access, and no signs would be anticipated. The APSS veterinarian further stated that if some of the still-wet product were licked up, a bad taste reaction (drooling) within minutes might be anticipated. The APSS assistant recommended that the owner have his regular veterinarian call the APSS to get details and discuss the potential causes for this situation.

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To be determined by Registrant

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

Moderate

19. Provide supplemental information here