Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2007-7739
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-15064150
Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Corporation
Address: 400 Plaza Drive
City: Secaucus
Prov / State: New Jersey
Country: USA
Postal Code: 07094-3688
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
02-JUL-07
5. Location of incident.
Country: UNITED STATES
Prov / State: ILLINOIS
6. Date incident was first observed.
29-JUN-07
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: Advanced Care 3 in 1 Flea + Tick Collar for Cats - EPA: 2596-139
- Active Ingredient(s)
- (S)-METHOPRENE
- TETRACHLORVINPHOS
7. b) Type of formulation.
Other (specify)
Collar
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).
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 )
5
7. Weight (provide a range if necessary )
10
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Respiratory System
- Symptom - Shortness of breath
- Nervous and Muscular Systems
- Symptom - Difficulty walking
- Nervous and Muscular Systems
- Symptom - Shaking
- Symptom - Agitation
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
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
Product was applied to his cat on Friday, 6/29. Became concerned immediately when he activated it and the dust went over the cat. Around 1 am Saturday morning cat started having problems, appeared to be convulsing (shaking), problems walking, and problems breathing. Also she was very agitated and crying. States that after speaking to a friend and then contacting an animal Emergency clinic he was advised to remove the collar and then bathe her. This was done and she started to improve Saturday. Sunday morning cat was not looking good again, laid down on the floor and died. Cat was not taken to a DVM at anytime. Did have fleas, denies use of any other products on cat or in home over the past 1 week. State he knows this caused the death since it could be the only possible cause. Cat is still at home in a box. Planning to take her to the DVM within the next 1 hour. CS mentioned Necropsy, is interested in this as long as he does not have to pay.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here