Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-0132

2. Registrant Information.

Registrant Reference Number: 120129118

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.

14-SEP-12

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

14-SEP-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. 21744      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Flea and Tick Spray For Dogs and Cats

• Active Ingredient(s)
  • (S)-METHOPRENE
  • N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
  • PIPERONYL BUTOXIDE
  • PYRETHRINS

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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

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

On September 14, 2012 the owner sprayed the cat with the product to treat for fleas, the owner may have over-applied the product. The owner saw the cat lick some of the product after it had been applied.

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

Female

6. Age (provide a range if necessary )

9.0

7. Weight (provide a range if necessary )

10.0

lbs

8. Route(s) of exposure

Skin

Oral

9. What was the length of exposure?

>15 min <=2 hrs / >15 min <=2 h

10. Time between exposure and onset of symptoms

>30 min <=2 hrs / >30 min <=2 h

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting
  • Symptom - Other
  • Specify - Increased Swallowing

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 September 14, 2012 the owner observed that the cat began vomiting and was swallowing more than usual after she licked some of the product off of herself. Several minutes later the owner gave the cat 10 milliliters (mL) of milk to dilute the product. A minute later, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that ingestion of the product can cause a taste reaction or mild vomiting. During the consultation, the cat was bathed with regular cat shampoo and the owner noticed that the cat was no longer swallowing more than usual. The APSS technician recommended that the owner monitor the cat at home for vomiting and increased swallowing, monitor the cat for gastrointestinal (GI) signs of vomiting and diarrhea, manage any vomiting by giving nothing by mouth for 1 hour and then gradually introducing water and food, re-bathe the cat with liquid dish washing detergent (LDWD) and lukewarm water if needed and then towel dry the cat and keep her warm, monitor the cat's appetite, call back with questions or if the cat's appetite decreased, and take the cat to the veterinarian if the cat's signs recurred or if the cat's appetite decreased.

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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

Signs expected to be mild and self limiting.