Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-0867
2. Registrant Information.
Registrant Reference Number: Prosar 1-21195288
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.
30-DEC-09
5. Location of incident.
Country: UNITED STATES
Prov / State: WISCONSIN
6. Date incident was first observed.
28-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.
PMRA Submission No.
EPA Registration No. 2596-124
Product Name: UltraGuard Flea/Tick Conditioning Shampoo for Cats 12 fl oz
- Active Ingredient(s)
- D-CIS, TRANS ALLETHRIN
- Guarantee/concentration .109 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .151 %
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 cat on 12/28/2009.
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
Male
6. Age (provide a range if necessary )
0.83
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
<=30 min / <=30 min
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Ataxia
- Symptom - Abnormal posture
- Specify - "Unable to hold head up"
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
1-21195288: A reporter (cat owner) called on 12/30/2009 to report the exposure of her cat to a flea and tick shampoo containing the active ingredients Allethrin and NOBD. According to the reporter, the cat was bathed with the product on 12/28/2009. Following the bath, the cat was placed on a towel and fell over. The reporter wrapped him in a towel. Later on 12/28/2009, the cat was unable to hold his head up. By 12/29/2009, the cat appeared more responsive and was walking around. The cat was evaluated by a veterinarian. Because the cat had improved, a recommendation was made to rinse the cat with water and keep it warm with a heating blanket. The reporter took the cat home and fed it water and kitten milk with a dropper. The cat started to look ill again on 12/29/2009 and was found dead on 12/30/2009. The reporter was advised that a necropsy should be considered to determine the cause of the cat's death as the signs described are not expected with product use. 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