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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-3216
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16221081
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.
02-JUN-085. Location of incident.
Country: UNITED STATES
Prov / State: TENNESSEE
6. Date incident was first observed.
Unknown
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. 2596-86
Product Name: UltraGuard Flea and Tick Dip for Dogs and Cats Concentrate 12 fl. oz
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration 1.11 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .67 %
- PYRETHRINS
- Guarantee/concentration .33 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
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 used the product on her cat the weekend prior to the call.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 Longhair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
10
7. Weight (provide a range if necessary )
8
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
Unknown / Inconnu
11. List all symptoms
System
- General
- Symptom - Lethargy
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Trembling
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Vocalizing
- Gastrointestinal System
- Symptom - Weight loss
- Nervous and Muscular Systems
- Symptom - Other
- Specify - "permanent nerve damage"
- General
- Symptom - Death
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?
Yes
14. b) How long was the animal hospitalized?
Unknown
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
1-16221081: The reporter called on 6/2/08 to report she had used a flea and tick dip on her 10 year old cat sometime the previous weekend (5/30-5/31). The product contained the active ingredients Pyrethrins, Piperonyl Butoxide, and N-Octyl Bicycloheptane Dicarboximide. According to the reporter, the cat had become lethargic, ataxic, anorexic, and had developed tremors. She had taken the cat to a veterinarian the morning of 6/2/08. The cat was still at the veterinary clinic at the time of the call. The reporter stated the cat had lost 5 lbs. since the weekend and per the veterinarian may have permanent nerve damage. The company sponsored testing program was discussed. A follow-up call was placed on 6/6. When the reporter called back that same day, she revealed the cat had passed away earlier in the day while at the veterinary clinic. Note: It is unknown if the dip had been diluted prior to use.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
