Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3181
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16137776
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.
13-MAY-08
5. Location of incident.
Country: UNITED STATES
Prov / State: UNKNOWN
6. Date incident was first observed.
12-MAY-08
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. 2596-124
Product Name: Advanced Care 2 in 1 Rid Flea Cat Shampoo
- Active Ingredient(s)
- D-CIS, TRANS ALLETHRIN
- Guarantee/concentration .109 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .151 %
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).
The reporter bathed her cat with the product on 5/12/08.
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 )
1
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 / <=30 min
11. List all symptoms
System
- Respiratory System
- Symptom - Difficulty Breathing
- Symptom - Mouth breathing
- Specify - Open mouth breathing
12. How long did the symptoms last?
Persisted until death
13. Was medical treatment provided? Provide details in question 17.
Unknown
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?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16137776: The reporter called on 5/13/08 to report her 1 year old female cat had died after she had bathed it the previous evening with a flea and tick shampoo containing the active ingredients Allethrin and N-Octyl Bicycloheptene Dicarboximide. According to the reporter, when the cat had dried off after the bath she had begun open mouth breathing with a slow respiratory rate. Her pupils had also dilated. The reporter brought the cat to a veterinarian, who told her there was nothing that could be done to save the cat. A company-sponsored necropsy program was discussed with the reporter.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here