Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-2693
2. Registrant Information.
Registrant Reference Number: Prosar 1-18530933
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.
Human
4. Date registrant was first informed of the incident.
20-MAY-09
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
18-MAY-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. 26491
PMRA Submission No.
EPA Registration No.
Product Name: Control Pet Care System One Spot Topical Treatment for Cats/Kittens
7. b) Type of formulation.
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 being applied to a cat when the cat owner dropped the applicator on her foot on 05/18/2009.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
Unknown
Subform II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Data Subject
2. Demographic information of data subject
Sex: Female
Age: >64 yrs / > 64 ans
3. List all symptoms, using the selections below.
System
- Skin
- Symptom - Blister
- Symptom - Erythema
- Symptom - Dry skin
4. How long did the symptoms last?
>3 days <=1 wk / >3 jours <=1 sem
5. Was medical treatment provided? Provide details in question 13.
No
6. a) Was the person hospitalized?
No
6. b) For how long?
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
Application
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
11. What was the length of exposure?
<=15 min / <=15 min
12. Time between exposure and onset of symptoms.
>2 hrs <=8 hrs / > 2 h < = 8 h
13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)
1-18530933: A reporter called on 05/20/2009 to report her exposure to a feline flea egg and larvae product containing the active ingredient Methoprene. According to the reporter, she was applying the product to her cat on 05/18/2009 when she dropped the used applicator on the top of her foot. Within 3 hours, she developed a red blister. At the time of the report, the caller had soaked her foot in epsom salts and applied Benadryl cream and polysporin ointment to the area. The reporter was advised that the product may irritate the skin but would not be expected to cause blisters. A recommendation was made to continue soaking the foot and using the topical products. The reporter was advised to contact her physician if her signs persist or worsen. On follow up, the reporter stated that she continued to soak her foot and applied calamine lotion. The blister resolved within 1 week, but at the time of the follow up she had some dry skin. No further information was obtained.
To be determined by Registrant
14. Severity classification.
Minor
15. Provide supplemental information here.