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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-5674
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23889621
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.
23-AUG-105. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
22-AUG-10Product 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. 2596-151
Product Name: UltraGuard Flea Tick Drops for Dogs Puppies
- Active Ingredient(s)
- D-PHENOTHRIN
PMRA Registration No. 17959 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard Flea Tick Powder for Cats
- Active Ingredient(s)
- TETRACHLORVINPHOS
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).
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
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
Male
6. Age (provide a range if necessary )
6
7. Weight (provide a range if necessary )
12
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>2 hrs <=8 hrs / >2 h <=8 h
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle tremors
- Symptom - Muscle twitching
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
No
14. a) Was the animal hospitalized?
No
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Recvrd resid.effects/Rétabli séquelles
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
1-23889621- The reporter, a pet owner, indicates his animal was exposed to two insecticides, one containing the active ingredient tetrachlorvinphos, the other containing the active ingredient phenothrin. The reporter indicates he applied the two products (one was a topical flea and tick preparation labeled only for use on dogs) to his six month twelve pound male domestic shorthair cat one day prior to the initial contact with the registrant. The animal had within four hours of application developed muscle tremors and twitching. The caller had attempted to wash the animal but the signs had not resolved at the point of the initial contact with the registrant. The caller was advised concentrated canine pyrethrin/pyrethroid spot-on type products can result in serious problems if inappropriately used on cats. He was advised of proper topical decontamination and to seek prompt veterinary assistance. On routine follow up the reporter indicated the animal was washed and its signs had resolved ¿¿¿90%?. He had not sought the veterinarian. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
