Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2013-7169

2. Registrant Information.

Registrant Reference Number: 120155533

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.

07-NOV-12

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

01-NOV-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. 19211      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Integral Buckle Flea and Tick Collar For Dogs

• Active Ingredient(s)
  • PROPOXUR

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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 November 1, 2012 the owner placed the collar on the geriatric dog to treat for fleas.

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

Dog / Chien

3. Breed

Airedale Terrier Mix

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

15.0

7. Weight (provide a range if necessary )

100.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

<=30 min / <=30 min

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Anorexia
  • Symptom - Vomiting

• Nervous and Muscular Systems
  • Symptom - Sleepiness

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

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 November 1, 2012, immediately after the owner placed the collar on the dog, the owner noticed that the dog was symptomatic. On November 3, 2012 the owner removed the dog's collar. On November 7, 2012 the owner took the dog to the veterinarian. A short time later that day, the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS technician stated that the risk would typically be for dermal hypersensitivity, although mild gastrointestinal (GI) upset would be possible because the product contains a carbamate. The APSS technician also stated that without an oral exposure, signs were not expected to be as significant as those the dog was experiencing. The APSS technician recommended that the owner have her 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

Minor

19. Provide supplemental information here

Unknown if owner contacted veterinarian before using on geriatric dog.