Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-1766
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-25511375
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.
04-MAR-11
5. Location of incident.
Country: UNITED STATES
Prov / State: WASHINGTON
6. Date incident was first observed.
04-MAR-11
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: UltraGuard Flea Tick Cat Spray
- 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).
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 )
0.9
7. Weight (provide a range if necessary )
5
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Gastrointestinal System
- Symptom - Salivating excessively
- Symptom - Anorexia
- Respiratory System
- Symptom - Difficulty Breathing
- General
- Symptom - Death
- Symptom - Abnormal behaviour
- Specify - circling
12. How long did the symptoms last?
Persisted until death
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
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
1-25511375- The caller, a pet owner, indicated her animal was exposed to an insecticide containing the active ingredient tetrachlorvinphos. The pet owner indicated her eleven month five pound female domestic shorthair cat had the product (a topical flea and tick spray) applied one day prior to her initial contact with the registrant. One day later the animal had developed signs of ataxia, excessive salivation, and loss of appetite. The animal was bathed with a non insecticidal shampoo prior to the call but the signs had not abated. The pet owner was advised the signs seen would not be expected following use of the product according to the label. She was advised to wash her animal with a noninsecticidal shampoo again and seek prompt veterinary care. On routine follow-up the pet owner indicated the animal had additionally developed breathing problems, circling and had died within thirty minutes of her initial contact with the registrant. She did not seek veterinary care. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here