Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-1059

2. Registrant Information.

Registrant Reference Number: 110127863

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.

05-OCT-11

5. Location of incident.

Country: CANADA

Prov / State: NOVA SCOTIA

6. Date incident was first observed.

03-OCT-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. 26493      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Powerspot Flea And Tick Control For Dogs Over 14 kg

• 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.

2

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 October 2, 2011 the owner applied the product to the dog to treat for fleas.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Boxer

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2.5

7. Weight (provide a range if necessary )

85.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

• Skin
  • Symptom - Hair loss
  • Symptom - Pruritus

• Nervous and Muscular Systems
  • Symptom - Seizure
  • Specify - Facial Seizures
  • Symptom - Head bobbing
  • Symptom - Muscle tremors

• General
  • Symptom - Abnormal behaviour
  • Specify - Smacking Lips

12. How long did the symptoms last?

Unknown / Inconnu

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

Unknown/Inconnu

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

Between October 2 and October 4, 2011 the owner noticed the dog had symptoms. On October 5, 2011 the owner noticed the dog was having facial seizures, bobbing his head, having tremors, and smacking his lips. Later that morning, one of the owners contacted the Animal Product Safety Service (APSS) to obtain help, while the other owner took the dog to the veterinarian. The APSS veterinarian stated that permethrins and pyrethroids could cause a tingling sensation to the skin.The APSS veterinarian also stated that some animals are more sensitive to the product than others. The APSS veterinarian said that these signs often resolved after bathing and with topical applications of vitamin E and cool compresses, but it could take up to 24 to 72 hours. The APSS veterinarian also said she would not expect the signs the dog was showing from the use of the product. The APSS veterinarian recommended that the owner have the veterinarian call for information.

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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

The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation.