Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-0117

2. Registrant Information.

Registrant Reference Number: 120094919

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.

10-JUL-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

09-JUL-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. 23853      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Endalsect Flea Egg Collar For Dogs

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

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7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Other Units: collar

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 July 7, 2012 the owner placed the flea egg collar on 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

Chinese Shar pei

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

0.21

7. Weight (provide a range if necessary )

16.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Skin
  • Symptom - Rash

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

On July 9, 2012 the owner took the dog to a regular veterinarian, and it was discovered that the dog had a rash developing on the underside of her neck. The flea egg collar was removed and the regular veterinarian recommended that the owner use a different flea prevention product. On July 10, 2012 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS assistant stated that mild dermal irritation could be seen if the animal is sensitive to the ingredients. The APSS assistant recommended that the owner bathe the dog with liquid dish washing detergent (LDWD), especially around the neck, and call back with questions. The APSS assistant also referred the owner to the product's manufacturer to get a list of inactive ingredients in the flea egg collar.

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To be determined by Registrant

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

Minor

19. Provide supplemental information here