Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-4150
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-16481435
Registrant Name (Full Legal Name no abbreviations): The Hartz Mountain Company
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.
04-AUG-08
5. Location of incident.
Country: UNITED STATES
Prov / State: CONNECTICUT
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)
PMRA Registration No.
PMRA Submission No.
EPA Registration No. 2596-126
Product Name: Tetrachlorvinphos-based Flea and Tick Spray for Cats (Non-specific)
- Active Ingredient(s)
- TETRACHLORVINPHOS
- Guarantee/concentration 1.08 %
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).
Reporter had a UPC code that matched three different flea and tick products, all with the same EPA number and the same active ingredient. It is unknown exactly which product the cats were exposed to. We assume the product was applied to the cats since the reporter believed the cats had oral exposure and ingestion of the product via grooming.
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
Other
2. Type of animal affected
Cat / Chat
3. Breed
Unknown
4. Number of animals affected
4
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Death
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?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Died
16. How was the animal exposed?
Other / Autre
specify It was assumed product was applied to the cats as reporter believed the cats had oral exposure/ingestion of the product via grooming.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16481435: Reported called on 8/4/2008, to report exposure of her Mother¿s four cats to a flea and tick product the active ingredients Tetrachlorvinphos. The UPC code provided by the caller matched 3 separate flea and tick products, all with the same EPA number and the same active ingredient. It is unknown which of the three products was applied to the cats. It is assumed the product was applied to the cats since the reporter believed the cats had oral exposure and ingestion of the product via grooming. All four cats experienced lethargy then "curled up" and died. No further information was provided.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here