Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-3935
2. Registrant Information.
Registrant Reference Number: Prosar 1-19150978
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-JUL-09
5. Location of incident.
Country: UNITED STATES
Prov / State: CALIFORNIA
6. Date incident was first observed.
11-JUL-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. 2596-147
Product Name: UltraGuard One Spot Flea Egg/Larvae Treatment for Cats/Kittens
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.9 %
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 applied to the 15 year old cat on 07/08/2009. NOTE: This product is not labeled for use on cats older than 10 years of age.
To be determined by Registrant
12. In your opinion, was the product used according to the label instructions?
No
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Unknown Breed
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
15
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
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- Respiratory System
- Symptom - Dyspnea
- Specify - "Gasping for air"
- General
- Symptom - Adipsia
- Symptom - Lethargy
- 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
1-19150978: A reporter (cat owner) called on 07/13/2009 to report the exposure of his cat to a flea egg and larvae product containing the active ingredient Methoprene. According to the reporter, the product was applied to the cat on 07/08/2009 along with an ear cleaner and hydrocortisone spray. The cat was asymptomatic until 07/11/2009, when she started gasping for air, would not eat or drink, and was lethargic. The cat died later that day. It was not evaluated by a veterinarian. The reporter was advised that the signs described are not expected with routine product use. The reporter was encouraged to consider necropsy to try and determine the cause of the cat's death. No further information was obtained. NOTE: This product is not labeled for use in cats older than 10 years of age.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here