Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4966
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-31668198
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.
01-OCT-12
5. Location of incident.
Country: CANADA
Prov / State: NEW BRUNSWICK
6. Date incident was first observed.
27-SEP-12
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. 25655
PMRA Submission No.
EPA Registration No.
Product Name: UltraGuard Flea/Tick Spray for Cats (Canada)
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?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
4
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>30 min <=2 hrs / >30 min <=2 h
11. List all symptoms
System
- Respiratory System
- Symptom - Rapid breathing
- General
- Symptom - Hemorrhage
- Symptom - Death
- Ear
- Symptom - Other
- Specify - blood in cats ears
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
1-31668198 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal spray containing the active ingredient Tetrachlorvinphos. The pet owner reported applying the spray to his 4-month-old, female cat four days prior to initial contact with the registrant. Approximately two hours after applying the spray the reporter indicated that his cat did not want to move and was breathing fast. That evening the reporter brought the cat to the veterinarian who noticed blood in the cats ears and nose. Per the pet owner no known testing was performed and no known treatment was administered and the cat was sent home that evening. The cat passed away on its own at home the following day. The reporter was advised that bleeding from the nose and ears is not consistent with product exposure and a necropsy was recommended to determine a cause of death but the reporter indicated that the cat was already buried. 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