Déclaration d'incident

Sous-formulaire I: Renseignements généraux

1.Type de rapport.

Nouvelle déclaration d'incident

No de la demande: 2010-3871

2. Renseignements concernant le titulaire.

Numéro de référence du titulaire d'homologation: PROSAR Case # 1-23086045

Nom du titulaire (nom légal complet, aucune abbréviation): The Hartz Mountain Corporation

Adresse: 400 Plaza Drive

Ville: Secaucus

État: New Jersey

Pays: USA

Code postal /Zip: 07094-3688

3.Choisir le (les) sous-formulaire(s) correspondant à l'incident.

Incident chez un animal domestique

4. Date à laquelle le titulaire d'homologation a été informé pour la première fois de l'incident.

18-JUN-10

5. Lieu de l'incident.

Pays: UNITED STATES

État: KANSAS

6. Date de la première observation de l'incident.

14-JUN-10

Description du produit

7. a) Donner le nom de la matière active et, si disponibles, le numéro d'homologation et le nom du produit (incluant tous les mélanges). Si le produit n'est pas homologué, donner le numéro de la demande d'homologation.

Matière(s) active(s)

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ARLA No d'homologation       ARLA No de la demande d'homologation       EPA No d'homologation. 2596-147

Nom du produit: UltraGuard One Spot Flea Egg Larvae Treatment for Cats Kittens

• Matière active
  • (S)-METHOPRENE
    • Garantie/concentration 2.9 %

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7. b) Type de formulation.

Liquide

Renseignments sur l'application

8. Est-ce que le produit a été appliqué?

Oui

9. Dose d'application.

Inconnu

10. Site d'application (choisir tout ce qui s'applique).

Site: Animal / Usage sur un animal domestique

11. Donner tout renseignement additionnel concernant l'application (comment le produit a été appliqué, la quantité utilisée, la superficie de la zone traitée, etc.)

À être déterminé par le titulaire

12. Selon vous, le produit a-t-il été utilisé en conformité avec le mode d'emploi de L'étiquette?

Inconnu

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

domestic shorthair

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

7

7. Poids (fournir un ordre de grandeur si nécessaire)

10

lbs

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

>24 hrs <=3 days / >24 h <=3 jours

11. Énumérer tous les symptômes

Système

• Systèmes nerveux et musculaire
  • Symptôme - Ataxie
  • Symptôme - Réveil difficile

• General
  • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23086045- The reporter called to indicate her animals had been exposed to pesticide containing the active ingredient S-Methoprene. The reporter states she applied the product, a topical antiparasitic, to six of her animals (cats) 06/12/10. This was six days prior to her initial contact with the registrant. The first animal, a seven year domestic shorthair cat (sub-form III, #3), developed ataxia and difficulty standing within two days of application. The owner brought the animal to the veterinarian who stated the animal had been "poisoned" and "nothing could be done". The caller brought the animal home and it died suddenly. The caller reports two additional animals, two 8 month male domestic shorthair cats (sub-form III. #2) developed the same symptoms (ataxia and difficulty rising) at an indeterminate time after application and also died suddenly five days after application. These animals were not brought to the veterinarian. The caller remarked that two more cats, 8 month male domestic shorthair cats (sub-form III. #3,and #4), were at the time of the call ill demonstrating ataxia and lethargy of indeterminate onset and one last animal, a 8 month male domestic shorthair cat, had remained asymptomatic. The specialist that spoke with the caller stated she seemed confused about time lines and details. The caller was told the active ingredient has a low order of toxicity in mammals. The symptoms seen in these animals would not be expected after dermal application of the product. She was advised to bathe the remaining animals in a non-insecticidal shampoo and seek prompt veterinary care. The caller was further advised the animals likely are suffering from some other unrelated illness. The pet owner indicated on routine call back that one more animal had died (unspecified time line), and one had remained asymptomatic. She did not indicate the status of the sixth. The reporter also indicated the animals were not her own at this point, but her sons and reside at another household. The specialist that spoke to the reporter on this occasion also indicated the reporter seemed confused about details of the case. No necropsy was performed and veterinary care was not provided after the initial appointment. No further information is available.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

domestic shorthair

4. Nombre d'animaux touchés

2

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

0.66

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Systèmes nerveux et musculaire
  • Symptôme - Anxiété
  • Symptôme - Réveil difficile

• General
  • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23086045- The reporter called to indicate her animals had been exposed to pesticide containing the active ingredient S-Methoprene. The reporter states she applied the product, a topical antiparasitic, to six of her animals (cats) 06/12/10. This was six days prior to her initial contact with the registrant. The first animal, a seven year domestic shorthair cat (sub-form III, #3), developed ataxia and difficulty standing within two days of application. The owner brought the animal to the veterinarian who stated the animal had been "poisoned" and "nothing could be done". The caller brought the animal home and it died suddenly. The caller reports two additional animals, two 8 month male domestic shorthair cats (sub-form III. #2) developed the same symptoms (ataxia and difficulty rising) at an indeterminate time after application and also died suddenly five days after application. These animals were not brought to the veterinarian. The caller remarked that two more cats, 8 month male domestic shorthair cats (sub-form III. #3,and #4), were at the time of the call ill demonstrating ataxia and lethargy of indeterminate onset and one last animal, a 8 month male domestic shorthair cat, had remained asymptomatic. The specialist that spoke with the caller stated she seemed confused about time lines and details. The caller was told the active ingredient has a low order of toxicity in mammals. The symptoms seen in these animals would not be expected after dermal application of the product. She was advised to bathe the remaining animals in a non-insecticidal shampoo and seek prompt veterinary care. The caller was further advised the animals likely are suffering from some other unrelated illness. The pet owner indicated on routine call back that one more animal had died (unspecified time line), and one had remained asymptomatic. She did not indicate the status of the sixth. The reporter also indicated the animals were not her own at this point, but her sons and reside at another household. The specialist that spoke to the reporter on this occasion also indicated the reporter seemed confused about details of the case. No necropsy was performed and veterinary care was not provided after the initial appointment. No further information is available.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

domestic shorthair

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

0.6

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Systèmes nerveux et musculaire
  • Symptôme - Ataxie
  • Symptôme - Réveil difficile

• General
  • Symptôme - Mort

12. Quelle a été la durée des symptômes?

Persisted until death

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Mort

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23086045- The reporter called to indicate her animals had been exposed to pesticide containing the active ingredient S-Methoprene. The reporter states she applied the product, a topical antiparasitic, to six of her animals (cats) 06/12/10. This was six days prior to her initial contact with the registrant. The first animal, a seven year domestic shorthair cat (sub-form III, #3), developed ataxia and difficulty standing within two days of application. The owner brought the animal to the veterinarian who stated the animal had been "poisoned" and "nothing could be done". The caller brought the animal home and it died suddenly. The caller reports two additional animals, two 8 month male domestic shorthair cats (sub-form III. #2) developed the same symptoms (ataxia and difficulty rising) at an indeterminate time after application and also died suddenly five days after application. These animals were not brought to the veterinarian. The caller remarked that two more cats, 8 month male domestic shorthair cats (sub-form III. #3,and #4), were at the time of the call ill demonstrating ataxia and lethargy of indeterminate onset and one last animal, a 8 month male domestic shorthair cat, had remained asymptomatic. The specialist that spoke with the caller stated she seemed confused about time lines and details. The caller was told the active ingredient has a low order of toxicity in mammals. The symptoms seen in these animals would not be expected after dermal application of the product. She was advised to bathe the remaining animals in a non-insecticidal shampoo and seek prompt veterinary care. The caller was further advised the animals likely are suffering from some other unrelated illness. The pet owner indicated on routine call back that one more animal had died (unspecified time line), and one had remained asymptomatic. She did not indicate the status of the sixth. The reporter also indicated the animals were not her own at this point, but her sons and reside at another household. The specialist that spoke to the reporter on this occasion also indicated the reporter seemed confused about details of the case. No necropsy was performed and veterinary care was not provided after the initial appointment. No further information is available.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Mort

19. Donner des renseignements additionnels ici

Sous-formulaire III : Animal domestique

1. Source de la déclaration

Propriétaire de l'animal

2.Type d'animal touché

Cat / Chat

3. Race

domestic shorthhair

4. Nombre d'animaux touchés

1

5. Sexe:

Homme

6. Âge (fournir un ordre de grandeur si nécessaire)

0.6

7. Poids (fournir un ordre de grandeur si nécessaire)

Inconnu

8. Voie(s) d'exposition:

Cutanée

9. Durée de l'exposition?

Unknown / Inconnu

10. Temps écoulé entre l'exposition et l'apparition des symptômes

Unknown / Inconnu

11. Énumérer tous les symptômes

Système

• Systèmes nerveux et musculaire
  • Symptôme - Ataxie
  • Symptôme - Réveil difficile

12. Quelle a été la durée des symptômes?

Unknown / Inconnu

13. Des soins médicaux ont-ils été prodigués? Donner les détails à la question 17.

Non

14. a) Est-ce que l'animal a-t-il été hospitalisé?

Non

14. b) Combien de temps l'animal était-il hospitalisé?

15. Issue de l'incident

Unknown/Inconnu

16. De quelle manière l'animal a-t-il été exposé?

Treatment / Traitement

17. Donnez tout détail additionnel au sujet de l'incident

(p.ex. description des symptômes tels que la fréquence et la gravité

1-23086045- The reporter called to indicate her animals had been exposed to pesticide containing the active ingredient S-Methoprene. The reporter states she applied the product, a topical antiparasitic, to six of her animals (cats) 06/12/10. This was six days prior to her initial contact with the registrant. The first animal, a seven year domestic shorthair cat (sub-form III, #3), developed ataxia and difficulty standing within two days of application. The owner brought the animal to the veterinarian who stated the animal had been "poisoned" and "nothing could be done". The caller brought the animal home and it died suddenly. The caller reports two additional animals, two 8 month male domestic shorthair cats (sub-form III. #2) developed the same symptoms (ataxia and difficulty rising) at an indeterminate time after application and also died suddenly five days after application. These animals were not brought to the veterinarian. The caller remarked that two more cats, 8 month male domestic shorthair cats (sub-form III. #3,and #4), were at the time of the call ill demonstrating ataxia and lethargy of indeterminate onset and one last animal, a 8 month male domestic shorthair cat, had remained asymptomatic. The specialist that spoke with the caller stated she seemed confused about time lines and details. The caller was told the active ingredient has a low order of toxicity in mammals. The symptoms seen in these animals would not be expected after dermal application of the product. She was advised to bathe the remaining animals in a non-insecticidal shampoo and seek prompt veterinary care. The caller was further advised the animals likely are suffering from some other unrelated illness. The pet owner indicated on routine call back that one more animal had died (unspecified time line), and one had remained asymptomatic. She did not indicate the status of the sixth. The reporter also indicated the animals were not her own at this point, but her sons and reside at another household. The specialist that spoke to the reporter on this occasion also indicated the reporter seemed confused about details of the case. No necropsy was performed and veterinary care was not provided after the initial appointment. No further information is available.

---

À être déterminé par le titulaire

Classification selon la gravité (s'il y a plus d'une catégorie possible, veuillez choisir la plus grave)

Modérée

19. Donner des renseignements additionnels ici