Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2014-6237

2. Registrant Information.

Registrant Reference Number: 130162852

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.

25-NOV-13

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

18-NOV-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. 28382      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Dual Action Flea And Tick Spray For Cats And Kittens

• 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 November 17, 2013 the owner sprayed an unknown amount of the product on the cat to treat for fleas.

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

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 )

1.5

7. Weight (provide a range if necessary )

10.5

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>24 hrs <=3 days / >24 h <=3 jours

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Diarrhea
  • Symptom - Other
  • Specify - Borborygmus

12. How long did the symptoms last?

>1 wk <=1 mo / > 1 sem < = 1 mois

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

Fully Recovered / Complètement rétabli

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 17, 2013 owner applied Flea and Tick spary to treat for fleas. On November 18, 2013 the owner applied a topical flea and tick product on the cat. Later that evening the owner noticed that the cat was having liquid diarrhea, 5 or 6 times a day, and that the cat also had borborygmus (her stomach was rumbling and gurgling whenever she would lie down). On November 25, 2013 the owner contacted the Animal Product Safety Service (APSS) to obtain help. The APSS veterinarian stated that with both the spray product and the topical product that vomiting could be seen if an oral ingestion occurred. The APSS technician recommended that the owner take the cat to the veterinarian to have a fecal sample examined for parasites, have the veterinarian call for information if necessary, give the cat a bland diet of boiled hamburger or boiled white chicken and cooked white rice twice daily for 2 to 3 days to help with the diarrhea, 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

On November 27, 2013 an APSS technician called the owner to update the case. The owner stated that at an unspecified time she started giving the cat a modified bland diet, feeding the cat rice with her regular food; the owner did not take the cat to the veterinarian. The owner stated that the cat had fully recovered on November 27, 2013.