Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-6226

2. Registrant Information.

Registrant Reference Number: 140032265

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.

18-MAR-14

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

18-MAR-14

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. 15176      PMRA Submission No.       EPA Registration No.

Product Name: Starbar Premium Fly Bait with Muscamone

• Active Ingredient(s)
  • (Z)-9-TRICOSENE
  • METHOMYL

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7. b) Type of formulation.

Application Information

8. Product was applied?

No

9. Application Rate.

10. Site pesticide was applied to (select all that apply).

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

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

Pig / Cochon

3. Breed

Vietnamese Potbelly

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

3.5

7. Weight (provide a range if necessary )

41.0

kg

8. Route(s) of exposure

Oral

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

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

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Drooling

• Nervous and Muscular Systems
  • Symptom - Seizure
  • Symptom - Muscle tremors

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?

Unknown

14. b) How long was the animal hospitalized?

15. Outcome of the incident

Unknown/Inconnu

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

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

On March 18, 2014 the pig was hypersalivating and had a seizure at home. Later that afternoon, the owner took the pig to the veterinarian and told them there was evidence of exposure to the product. The pig presented at the veterinary clinic with tremors and a normal heart rate. The attending veterinarian gave the pig activated charcoal (AC) and later that evening called the Animal Product Safety Service (APSS). The APSS veterinarian stated methomyl is a hot carbamate and muscarinic salivation, lacrimation, urination, defecation, dyspnea, emesis (SLUDDE) signs as well as nicotinic signs of tremors and seizures are possible. The APSS veterinarian also stated life threatening seizures and increased bronchial secretions may occur. The APSS veterinarian recommended monitoring the pig at the veterinary clinic for central nervous (CNS), gastrointestinal (GI), SLUDDE, and respiratory signs. The APSS veterinarian also recommended diazepam for tremors and seizures, atropine if needed for bradycardia, fluid therapy, monitoring electrolytes (sodium 4 hours post AC), and calling 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

Extra Label Use: exposure to domestic animal