Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-0870
2. Registrant Information.
Registrant Reference Number: Prosar 1-21033113
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.
14-DEC-09
5. Location of incident.
Country: UNITED STATES
Prov / State: NEW YORK
6. Date incident was first observed.
13-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. 2596-22
Product Name: UltraGuard Rid Flea/Tick Shampoo for Cats
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .149 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .089 %
- PYRETHRINS
- Guarantee/concentration .045 %
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 shampoo was applied to the cat on 12/13/2009.
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
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Unknown breed
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
0.67
7. Weight (provide a range if necessary )
8
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
- Gastrointestinal System
- Symptom - Anorexia
- Symptom - Vomiting
- General
- Symptom - Lethargy
- Symptom - Hypothermia
- Nervous and Muscular Systems
12. How long did the symptoms last?
Persisted until death
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?
Unknown
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
1-21033113: A reporter (veterinary technician) called on 12/14/2009 to report the exposure of a client's cat to a flea and tick shampoo containing the active ingredients Pyrethrins, Piperonyl Butoxide, and NOBD. According to the reporter, the cat was bathed with the product on 12/13/2009. Immediately after bathing, the cat vomited, became lethargic, and stopped eating. The cat's owner rinsed the cat off, but it is unknown if the cat was thoroughly bathed. The cat was brought to the veterinary clinic on 12/14/2009 and was hypothermic on presentation. At the time of the report, the cat was on fluids and in an incubator. The reporter was advised that treatment of product overdose or individual sensitivity is symptomatic and supportive, including decontamination by bathing with hand dish soap. Because the cat's owner had discarded the product, a recommendation was made to consider hair testing to confirm that a canine product had not been used. On follow up on 12/15/2009, the attending veterinarian stated that the cat had a seizure and died on 12/15/2009. A recommendation was made to consider necropsy to determine the cause of death. 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