Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2009-5311
2. Registrant Information.
Registrant Reference Number: 127189
Registrant Name (Full Legal Name no abbreviations): Hartz Canada, Inc.
Address: 1125 Talbot Street
City: St. Thomas
Prov / State: Ontario
Country: Canada
Postal Code: N5P 3W7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
02-SEP-08
5. Location of incident.
Country: CANADA
Prov / State: QUEBEC
6. Date incident was first observed.
Unknown
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. 2596-126
Product Name: HARTZ 2 IN 1 FLEA TICK PUMP FOR CATS I
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).
unknown.
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
N/A
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
5
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>8 hrs <= 24 hrs / >8 h <= 24 h
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Gastrointestinal System
- Symptom - Salivating excessively
- Specify - salivating
- Symptom - Anorexia
- Specify - loss of appetite for 2 days,
- General
- Symptom - Weakness
- Specify - weak
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
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
Product applied to cat and after 3 hours cat shaking and salivating. Consumer bathed cat in the tub as recommended by vet. Consumer takes cat to vet. Vet reports cat unstable, suspected from weakness, and 2 days of inappitence. CNS symptoms are atypical in healthy cat, and OP toxicity unlikely if following labeled use. Cats that groom themselves may experience minor GI upset and /or salivation or drooling. Hartz provides cholinesterase testing. Faxed testing instructions for submission of samples.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Product applied to cat and after 3 hours cat shaking and salivating. Consumer bathed cat in the tub as recommended by vet. Consumer takes cat to vet. Vet reports cat unstable, suspected from weakness, and 2 days of inappitence. CNS symptoms are atypical in healthy cat, and OP toxicity unlikely if following labeled use. Cats that groom themselves may experience minor GI upset and /or salivation or drooling. Hartz provides cholinesterase testing. Faxed testing instructions for submission of samples.