Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-0057

2. Registrant Information.

Registrant Reference Number: 120061860

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.

12-MAY-12

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

12-MAY-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. 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.

Unknown

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

Site: Animal / Usage sur un animal domestique

Préciser le type: Relay

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

On May 11, 2012 the owner applied the product to a dog, and at an unknown time the cat was exposed to the product by relay via an unknown route, either by grooming the product off of the dog or by rubbing the product off of the dog.

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

Male

6. Age (provide a range if necessary )

12.0

7. Weight (provide a range if necessary )

15.0

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Muscle tremors

• Respiratory System
  • Symptom - Panting

• General
  • Symptom - Hiding

12. How long did the symptoms last?

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

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

Fully Recovered / Complètement rétabli

16. How was the animal exposed?

Other / Autre

specify Relay

17. Provide any additional details about the incident

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

On May 12, 2012 the owner noticed that the cat was symptomatic. At an unknown time after observing the signs, the owner bathed the cat. Later that day, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that tremors and seizures were possible. The APSS veterinarian recommended that the owner take the cat to the veterinarian and 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

On May 21, 2012 an APSS technician called the owner to update the case. The owner stated that he did not take his cat to the veterinarian, but that on the afternoon of May 12, 2012 he did administer 210 milligrams of methocarbamol to the cat, repeating the dose every 12 hours; he did not say when he stopped giving methocarbamol. The owner also stated that the cat had fully recovered on May 14, 2012. Label caution: Toxic to cats. Cats that actively groom or engage in close physical contact with recently treated dogs may be at risk of harm.