Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-1957
2. Registrant Information.
Registrant Reference Number: Prosar 1-18061705
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.
09-APR-09
5. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
06-APR-09
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/Tick Dip for Dogs/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 %
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 product was used on a 14 year old cat on 04/05/2009.
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 )
14
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Subdued
- Specify - Unresponsive
- Respiratory System
- Symptom - Laboured breathing
- Specify - "Not breathing well"
- General
- Symptom - Abnormal behaviour
- Symptom - Death
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?
Treatment / Traitement
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-18061705: A reporter called on 04/09/2009 to report the exposure of a cat to a flea and tick dip containing the active ingredients Pyrethrins, Piperonyl Butoxide, and NOBD. According to the reporter, the product was applied to the cat on 04/05/2009. She used one capful of product in an unknown amount of water. On 04/06/2009, the cat may have being acting abnormally but reporter could not be certain. On 04/07/2009, the cat was tried, unresponsive, not eating, and seemed to have trouble breathing. The reporter called her veterinarian who said that there was nothing to be done for the cat at that point. The cat died at home on 04/09/2009. The reporter was advised that the signs described are not expected with product use. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here