Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-0143

2. Registrant Information.

Registrant Reference Number: 150172125

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.

14-DEC-15

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

13-DEC-15

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. 26493      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Powerspot Flea And Tick Control For Dogs Over 14 kg (30 lbs)

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration 2.9 %
  • PERMETHRIN
    • Guarantee/concentration 45 %

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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: 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 December 13, 2015 the owner's husband accidentally applied the dog spot on onto the cat.

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

Cat / Chat

3. Breed

Feline Domestic Unspecified

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

11.0

7. Weight (provide a range if necessary )

9.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

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

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 - Ataxia
  • Symptom - Trembling
  • Symptom - Fasciculations

• General
  • Symptom - Lethargy

12. How long did the symptoms last?

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

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 December 13, 2015 the cat developed hypersalivation. That afternoon the owner bathed the cat (Dawn) and gave the cat activated charcoal (owner gave 2 520 milligrams (mg) tabs). Later that day the cat developed ataxia. That evening the cat started trembling. On December 14, 2015 the cat developed fasciculation (eyes are twitching from time to time) and then the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated the risk is for muscle tremors and seizures. The APSS veterinarian also stated can see renal injury secondary to myoglobinuria, and disseminated intravascular coagulation (DIC) secondary to severe hyperthermia. During the consultation the cat developed lethargy. The APSS assistant recommended taking the cat to the veterinarian (depending on the evaluation we may or may not recommend hospitalization), having the veterinarian call for information, 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

On December 16, 2015 an APSS technician called the owner to follow up on the case. The owner stated that they did not take the cat to the veterinarian for treatment, but rather monitored the cat at home and the signs resolved on December 14, 2015 and the cat had fully recovered.