Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-6483

2. Registrant Information.

Registrant Reference Number: 130118298

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.

23-AUG-13

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

23-AUG-13

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. 2724-401

Product Name: Zodiac Fleatrol Carpet And Upholstery Pump Spray

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .01 %
  • PERMETHRIN
    • Guarantee/concentration .28 %

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7. b) Type of formulation.

Liquid

Application Information

8. Product was applied?

Yes

9. Application Rate.

Unknown

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 August 23, 2013 the owner's grandchildren sprayed the product in the house; details of the use of the product were unclear, but the bird was likely exposed to the fumes from the product.

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

Bird / Oiseau

3. Breed

Umbrella Cockatoo

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

5.0

7. Weight (provide a range if necessary )

Unknown

8. Route(s) of exposure

Respiratory

9. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Nervous and Muscular Systems
  • Symptom - Trembling

• Respiratory System
  • Symptom - Difficulty Breathing
  • Specify - Abnormal Breathing

• General
  • Symptom - Abnormal behaviour
  • Specify - Behavior Change
  • Symptom - Abnormal behaviour

12. How long did the symptoms last?

Persisted until death

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

Died

16. How was the animal exposed?

Contact treat.area/Contact surf. traitée

17. Provide any additional details about the incident

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

On August 23, 2013 the owner's son noticed that the bird was symptomatic. The owner's son immediately put the bird in the box and took the bird outside to get some fresh air. Several minutes later, the owner's son contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that systemic toxicosis from the Permethrin and the Methoprene would not be expected, but since birds are very sensitive to inhalant exposures, respiratory signs could develop. During the consultation the owner's son checked on the bird and observed that the bird's breathing was back to normal and the trembling was milder. The APSS technician recommended that the owner ventilate the home before the bird came back inside, prevent further exposure to the product by keeping the bird in an unexposed area until the treated area was ventilated, take the bird to the veterinarian, have the veterinarian call for information, and call back with questions.

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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

The APSS veterinarian stated that the substance was considered to have an unknown likelihood of causing the clinical situation. On August 27, 2013 an APSS technician called the owner's son to update the case. He stated that the bird had died on the evening of August 23, 2013. A necropsy was not available. Extra Label Use: Bird not removed from area from label before spraying.