Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-7160

2. Registrant Information.

Registrant Reference Number: 130005604

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.

13-JAN-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

12-JAN-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. 25739      PMRA Submission No.       EPA Registration No.

Product Name: Vet Kem Siphotrol 1000 Double Action Premise Treatment

• 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: 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 7, 2013 the owner sprayed her home with the product. On January 12, 2013 the cat returned home from the hospital and may have been exposed to the product after lying on the carpet where the spray had been used.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?

Unknown

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Longhair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

14.0

7. Weight (provide a range if necessary )

14.8

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Skin
  • Symptom - Lesion

12. How long did the symptoms last?

Unknown / Inconnu

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?

Unknown

15. Outcome of the incident

Unknown/Inconnu

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 January 12, 2012 the owner noticed that the cat had dermal necrosis all along one side, although the fur was unaffected. On January 13, 2013 the owner took the cat to an emergency veterinarian. Later that evening, the staff at the emergency clinic contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that dermal irritation could be seen if the pet had been exposed to the wet product, but dermal necrosis would not be expected. The APSS veterinarian also stated that dermal necrosis could be seen as a result of thermal injury, drug eruptions, caustic substances, and subcutaneous (SQ) fluids. The APSS veterinarian recommended that the emergency veterinarian perform a diagnostic evaluation, control the cat's pain, obtain a complete blood count (CBC), monitor the cat at the veterinary facility, give the cat an antibiotic, provide symptomatic and supportive care, 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

Moderate

19. Provide supplemental information here

The APSS veterinarian stated that the substance was not considered to be related to causing the clinical situation. On January 15, 2013 an APSS assistant called the staff at the emergency clinic to update the case. The vet staff member stated that on an unknown date a diagnostic evaluation was performed on the cat and a biopsy was performed; the results of the biopsy were pending. The vet staff member also said that the cat was still being treated at the clinic and seemed to be improving.