Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2008-4189
2. Registrant Information.
Registrant Reference Number: Prosar case 1-16381647
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.
10-JUL-08
5. Location of incident.
Country: UNITED STATES
Prov / State: OHIO
6. Date incident was first observed.
06-JUL-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. 2596-79
Product Name: UltraGuard Flea and Tick Powder for Dogs
- Active Ingredient(s)
- TETRACHLORVINPHOS
- Guarantee/concentration 3.3 %
7. b) Type of formulation.
Dust
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 applied the product to her dog the week prior to the call. The reporter's cat usually kept in close contact with the dog. The reporter suspected dermal exposure to the cat from close contact with the dog.
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
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
2
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
- Nervous and Muscular Systems
- Symptom - Depression
- Symptom - Recumbent
- General
- Symptom -
- Specify - Lack of normal grooming behavior/rough coat
- Symptom - Vocalizing
- Respiratory System
- Symptom - Rapid breathing
- Gastrointestinal System
- Symptom - Salivating excessively
- General
- Symptom - Other
- Specify - rought coat
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?
Other / Autre
specify Product had been applied to the reporter's dog. Reporter suspected dermal exposure to the cat from close contact with the dog.
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-16381647: The reporter called on 7/10/08 to report the possible exposure of her 2 year old male cat to a canine topical flea and tick product (powder) containing the active ingredient Tetrachlorvinphos. According to the reporter, she had applied the product to her dog the week prior to the call. The reporter's cat had kept in close contact with the dog and she suspected dermal exposure to the cat from close contact with the dog. Per the reporter, the cat had been ill for the previous 4 days. Initial symptoms had included a lack of normal grooming behavior and depression. By the evening of 7/9, the cat had become anorexic and could not get up. About 30 minutes prior to the call, the cat had begun to vocalize, to breathe rapidly, and to salivate. The safety profile of the product was discussed, including the fact that the timing of exposure and progression of symptoms would be inconsistent with the product. A recommendation was made to take the cat to a veterinarian immediately. A follow-up call on 7/11 revealed that the cat had passed away a few minutes after the initial call, just as the owners were getting ready to take him to see an emergency veterinarian.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here