Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-0639
2. Registrant Information.
Registrant Reference Number: 194330
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.
09-DEC-09
5. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
06-DEC-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. 25923
PMRA Submission No.
EPA Registration No.
Product Name: Hartz UltraGuard FleaTick Drops for Dogs and Puppies under 14KG (30lbs
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).
Dog Product applied on cat.
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
Domestic
4. Number of animals affected
1
5. Sex
Male
Female
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
17
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
- Symptom - Head shaking
- General
- Symptom - Abnormal behaviour
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?
Yes
14. b) How long was the animal hospitalized?
3
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
Told groomer at store I had 15 lb cat. This was told 3 times. Groomer gave me this product that I guess was for a smaller dog. I did not see this till the next day. I had taken his word for this-because I thought it was ok to put on cat. Also-so on the top left corner I saw "do not use on cats", this was first time dealing with fleas. He was suffering so I used the product. Two days later, cat developed symptoms, called vet hospital and told to bring in right away. Cat having reaction to product, neurological effects. Cat admitted and on IV for 3 days/antibiotics and treated for fleas. Also cat having seizures.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Major
19. Provide supplemental information here
N/A.