Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-5317
2. Registrant Information.
Registrant Reference Number: 145249
Registrant Name (Full Legal Name no abbreviations): Hartz Canada, Inc.
Address: 1125 Talbot Street
City: St. Thomas
Prov / State: Ontario
Country: Canada
Postal Code: N5P 3W7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
16-JAN-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
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: HARTZ 2 IN 1 FLEA TICK PUMP FOR CATS II
7. b) Type of formulation.
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).
unknown.
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
N/A
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
16
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
- Skin
- Symptom - Hair loss
- Symptom - Irritated skin
- Specify - body is raw
- General
- Symptom - Licking
- Specify - licked so much tongue is bleeding
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?
No
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
Has 3 cats. Sprayed all of them, one had reaction. After 24 hours reaction in 1 cat. Cat losing hair. Gave 2 baths in oatmeal. 3/4 of cats body raw. Cat licking that her tongue is bleeding. Consumer recommended to bath cat in dish soap, and rinse well. Apply vitamin E. Take cat to vet. Consumer wanted to know of vet compensation, since she cannot afford.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Has 3 cats. Sprayed all of them, one had reaction. After 24 hours reaction in 1 cat. Cat losing hair. Gave 2 baths in oatmeal. 3/4 of cats body raw. Cat licking that her tongue is bleeding. Consumer recommended to bath cat in dish soap, and rinse well. Apply vitamin E. Take cat to vet. Consumer wanted to know of vet compensation, since she cannot afford.