Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-4709
2. Registrant Information.
Registrant Reference Number: Prosar 1-20212019
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.
25-SEP-09
5. Location of incident.
Country: UNITED STATES
Prov / State: GEORGIA
6. Date incident was first observed.
13-SEP-09
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. 2596-140
Product Name: UltraGuard Plus Flea/Tick Spray for Cats 8 fl oz
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .07 %
- 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).
The product was applied to a cat on 09/12/2009.
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 Longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
14
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
- Gastrointestinal System
- Symptom - Loss of appetite
- General
- Symptom - Adipsia
- 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?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-20212019: A reporter (cat owner) called on 09/25/2009 to report the exposure of his cat to a flea and tick spray containing the active ingredients Tetrachlorvinphos and Methoprene. According to the reporter, the product was applied to the cat on 09/12/2009 to treat an active flea infestation. Within 24 hours following product application, the cat became lethargic and was eating and drinking very little. The reporter did bathe the cat with a noninsecticidal shampoo once signs were noted, but the signs persisted. The reporter was advised that the signs described are not expected with routine product use. A recommendation was made to seek prompt veterinary evaluation given the length of time the signs had been present. On follow up on 09/28/2009, the reporter stated that the cat was evaluated by a veterinarian on 09/26/2009. It is unknown if treatment was provided. The cat died on 09/27/2009. A recommendation was made to consider necropsy to determine the cause of death. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here