Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2017-7024

2. Registrant Information.

Registrant Reference Number: 170119374

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-JUL-17

5. Location of incident.

Country: CANADA

Prov / State: ALBERTA

6. Date incident was first observed.

13-JUL-17

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. 31473      PMRA Submission No.       EPA Registration No.

Product Name: Zodiac Power Band Plus II Dual Action Flea And Tick Collar

• Active Ingredient(s)
  • (S)-METHOPRENE
  • TETRACHLORVINPHOS

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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 the night of July 12, 2017 the owner applied the collar to the dog as prevention.

To be determined by Registrant

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

Yes

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Dog / Chien

3. Breed

Labrador Retriever

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

4.0

7. Weight (provide a range if necessary )

50.0

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

• Gastrointestinal System
  • Symptom - Vomiting

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 the night of July 13, 2017 the dog became symptomatic. Shortly after, the owner removed the collar. In the early morning hours of July 14, 2017, the owner contacted the Animal Product Safety Service (APSS). The APSS veterinarian stated that dermal hypersensitivity from the collar itself may be seen and that the active ingredient has a wide margin of safety. The APSS veterinarian also stated that typically vomiting would not be expected unless the scent or taste (if chewing on housemate's collar occurred) bothered the dog. The APSS assistant recommended the owner monitor for gastrointestinal (GI) signs (vomiting, diarrhea, inappetance, hypersalivation), manage vomiting (nothing by mouth (NPO) for 1 hour. Return water slowly over 30 min. If no emesis return to normal schedule), call back with questions (if signs are more than mild, persistent, or new signs not discussed present), and to have the veterinarian call for information.

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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

Signs were expected to be mild and self-limiting.