Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-2009

2. Registrant Information.

Registrant Reference Number: 120011044

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.

27-JAN-12

5. Location of incident.

Country: UNITED STATES

Prov / State: TEXAS

6. Date incident was first observed.

27-JAN-12

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. 2724-274

Product Name: Starbar Golden Malrin Fly Bait 1% Methomyl

• Active Ingredient(s)
  • (Z)-9-TRICOSENE
    • Guarantee/concentration .049 %
  • METHOMYL
    • Guarantee/concentration 1 %

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7. b) Type of formulation.

Bait

Application Information

8. Product was applied?

Yes

9. Application Rate.

.25

Other Units: teaspoon

10. Site pesticide was applied to (select all that apply).

Site: Res. - In Home / Rés. - à l'int. maison

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

On January 27, 2012 the cat accidentally ingested some of the bait product that was sitting out on the counter.

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 Shorthair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3.0

7. Weight (provide a range if necessary )

10.0

lbs

8. Route(s) of exposure

Oral

9. What was the length of exposure?

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

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Drooling
  • Symptom - Inappropriate defecation

• Nervous and Muscular Systems
  • Symptom - Seizure

• Skin
  • Symptom - Cyanosis

• General
  • Symptom - Hyperthermia

• Nervous and Muscular Systems
  • Symptom - Coma

• General
  • Symptom - Hypothermia
  • 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?

Yes

14. b) How long was the animal hospitalized?

1

Day(s) / Jour(s)

15. Outcome of the incident

Died

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

On January 27, 2012, shortly after the owner saw the cat ingest some of the bait product, the owner observed that the cat was drooling and defecated inappropriately. Later that evening, the owner took the cat to the emergency veterinarian, where the cat began having seizures and had cyanosis. At that time, the emergency veterinarian gave the cat oxygen. Soon after the cat arrived at the clinic, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that the product is a hot carbamate insecticide and that (SLUDDE) signs and seizures could occur. The APSS veterinarian recommended that the emergency veterinarian give 1 milliliter (mL) of Diazepam to the cat to stop the seizures, check for atropine cholinergic toxicity, and monitor the cat for cardiovascular function and central nervous system (CNS) signs.

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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 the early morning of January 28, 2012 the emergency veterinarian contacted the APSS to update the case. The emergency veterinarian stated that on an unknown date and time the cat was given Diazepam and was checked for atropine cholinergic toxicity. The emergency veterinarian also stated that the cat's seizures ended on the evening of January 27, 2012. The emergency veterinarian further stated that on the evening of January 27, 2012 the cat was observed to be hyperthermic, with a recorded temperature greater than 110 degrees Fahrenheit, and that a short time later the cat was in a coma, possibly due to brain damage from hyperthermia. Just before the emergency veterinarian called the APSS on January 28, 2012, the cat was no longer hypothermic; rather, the cat observed to be hypothermic, with a recorded temperature of 98 degrees Fahrenheit. The emergency veterinarian stated that the cat's heart rate was recorded as 158.0 beats per minute (bpm), within the normal range. During the consultation with the APSS, the emergency veterinarian noted that the cat's cyanosis had ended. On February 1, 2012 an APSS assistant called the owner to update the case. The owner stated that the cat died at the emergency clinic on the evening of January 28, 2012. A necropsy was not available. Label states: GOLDEN MALRIN FLY BAIT IS NOT TO BE USED INSIDE OR AROUND HOMES, OR ANY OTHER PLACE WHERE CHILDREN OR PETS ARE LIKELY TO BE PRESENT.