Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2018-1969

2. Registrant Information.

Registrant Reference Number: 180040992

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.

09-MAR-18

5. Location of incident.

Country: UNITED STATES

Prov / State: FLORIDA

6. Date incident was first observed.

Unknown

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.       PMRA Submission No.       EPA Registration No. 2724-803-270

Product Name: Adams Flea And Tick Spray For Dogs And Cats

• Active Ingredient(s)
  • (S)-METHOPRENE
    • Guarantee/concentration .1 %
  • ETOFENPROX
    • Guarantee/concentration .25 %
  • PIPERONYL BUTOXIDE
    • Guarantee/concentration .75 %

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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 either March 2, 2018 or March 4, 2018, the owner applied the spray to the cat per label instructions.

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

Russian Blue

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 )

9.0

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 - Anorexia

• Nervous and Muscular Systems
  • Symptom - Ataxia

• Respiratory System
  • Symptom - Mouth breathing

• General
  • Symptom - Hypothermia

• Cardiovascular System
  • Symptom - Bradycardia

• Nervous and Muscular Systems
  • Symptom - Recumbent

• General
  • Symptom - Death

12. How long did the symptoms last?

Persisted until death

13. Was medical treatment provided? Provide details in question 17.

Yes

14. a) Was the animal hospitalized?

Yes

14. b) How long was the animal hospitalized?

.5

Hour(s) / Heure(s)

15. Outcome of the incident

Died

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

Between March 2, 2018 and March 4, 2018, after the application of the spray, the cat developed anorexia. On March 4, 2018, the cat developed ataxia. On March 5, 2018, the cat developed mouth breathing. Soon after, the owner called their regular veterinarian who recommended the owner bathe the cat and set up an appointment. The owner bathed the cat (with soap and water) and an hour later, the owner took the cat to their regular veterinarian who did a physical examination and noted hypothermia (unknown temperature), bradycardia (unknown heart rate), and recumbency and advised the owner to take the cat to an emergency veterinarian. The owner then took the cat to the emergency veterinarian who provided fluid therapy, symptomatic care (unknown medications administered), and oxygen. Shortly after, the cat died. On March 9, 2018 the owner contacted the Animal Product Safety Service (APSS) to report the death. The owner declined speaking with an APSS veterinarian and declined a necropsy.

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To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Death

19. Provide supplemental information here

The APSS veterinarian stated that the substance was considered to have a doubtful likelihood of causing the clinical situation.