Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2016-3171
2. Registrant Information.
Registrant Reference Number: ProPharma Group case#: 1-44226983
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.
24-MAY-16
5. Location of incident.
Country: UNITED STATES
Prov / State: KENTUCKY
6. Date incident was first observed.
22-MAY-16
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. 2596-63
Product Name: HARTZ IN CONTROL 5 MONTH FLEA & TICK COLLAR FOR CATS & KITTENS
- Active Ingredient(s)
- TETRACHLORVINPHOS
- Guarantee/concentration 14.55 %
7. b) Type of formulation.
Other (specify)
Collar
Application Information
8. Product was applied?
No
9. Application Rate.
10. Site pesticide was applied to (select all that apply).
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
Male
6. Age (provide a range if necessary )
0.13
7. Weight (provide a range if necessary )
1.1
lbs
8. Route(s) of exposure
Unknown
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- Symptom - Vomiting
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Yes
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?
Other / Autre
specify Unknown
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-44226983 - The reporter, a pet owner, indicated her kitten was exposed to an insecticidal product containing the active ingredients tetrachlorvinphos. Three days before initial contact with the registrant, the reporter placed the product on her adult cat. Two days before initial contact, the reporter indicated her 7-week-old, 1.1 pound, male kitten of unknown breed became lethargic, anorexic, and started vomiting. The reporter stated the kitten may have had contact with the treated adult cat. The reporter was advised to seek immediate medical attention for the kitten as this is not an expected reaction to exposure to the product. On follow-up call two days after initial contact, the reporter indicated the kitten was taken to a veterinarian where treatment was initiated, but he died later that day at home. Condolences were offered. No additional 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