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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-4003
2. Registrant Information.
Registrant Reference Number: Prosar 1-19595671
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.
21-AUG-095. Location of incident.
Country: UNITED STATES
Prov / State: MISSOURI
6. Date incident was first observed.
16-AUG-09Product 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.
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 %
- 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 product was applied to 2 cats on 08/16/2009.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
Female
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
6
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Agitation
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Adipsia
- Symptom - Hiding
- 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
1-19595671: A reporter (cat owner) called on 08/21/2009 to report the exposure of her 2 cats to a flea and tick dip. According to the reporter, the product was applied to both cats on 08/16/2009. Almost immediately the cats became agitated and stopped eating and drinking. The reporter was unable to locate the cats on 08/17/2009. On 08/19/2009, the reporter found Cat #1 (1st Subform III) dead in a box. Cat #2 (2nd Subform III) was finally located on 08/20/2009. Cat #2 had been eating and drinking since she was located, but she seemed lethargic at the time of the report. The reporter was advised that the signs described are not expected with routine use of the product. A recommendation was made to bathe Cat #2 and have it evaluated by a veterinarian. On follow up, the reporter stated that Cat #2 was evaluated by a veterinarian and received fluids, antibiotics, and anti-inflammatory medications. The veterinarian indicated that Cat #2 should fully recover. 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
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
Female
6. Age (provide a range if necessary )
6
7. Weight (provide a range if necessary )
6
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Agitation
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Adipsia
- Symptom - Hiding
- Symptom - Lethargy
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Yes
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
1-19595671: A reporter (cat owner) called on 08/21/2009 to report the exposure of her 2 cats to a flea and tick dip. According to the reporter, the product was applied to both cats on 08/16/2009. Almost immediately the cats became agitated and stopped eating and drinking. The reporter was unable to locate the cats on 08/17/2009. On 08/19/2009, the reporter found Cat #1 (1st Subform III) dead in a box. Cat #2 (2nd Subform III) was finally located on 08/20/2009. Cat #2 had been eating and drinking since she was located, but she seemed lethargic at the time of the report. The reporter was advised that the signs described are not expected with routine use of the product. A recommendation was made to bathe Cat #2 and have it evaluated by a veterinarian. On follow up, the reporter stated that Cat #2 was evaluated by a veterinarian and received fluids, antibiotics, and anti-inflammatory medications. The veterinarian indicated that Cat #2 should fully recover. No further information was obtained.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
