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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3768
2. Registrant Information.
Registrant Reference Number: PROSAR Case #: 1-23026701
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-JUN-105. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
14-JUN-10Product 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. 26490 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard Plus Flea Tick Drops for Dogs Puppies Over 30 lbs
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
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).
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 long hair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
20
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle tremors
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?
Unknown
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
1-23026701- The caller reports his animal was exposed to a pesticide containing the active ingredients Permethrin and methoprene. The caller indicated he applied the product to his two year 20 pound male domestic longhair cat one day prior to the initial contact with the applicant. The caller indicated he had not known the product was labeled only for use in dogs (label instructions not read). He reported within 6 hours of application he noted muscle tremors in his animal. He had at the time of the initial contact washed his animal with a non-insecticidal shampoo twice. The animal¿s signs persist. The caller was informed that the symptoms were consistent with inappropriate use of canine products with this active ingredient on feline patients. The caller was advised decontamination as done was appropriate and may be repeated. The caller was, further, advised of symptomatic and supportive care that could be administered. On routine call back it was revealed the animal had been at the veterinarian for two days. The party spoken with was unable to elucidate the treatments given or the animal¿s status. The reporter did not respond to further follow up attempts. No further information is known.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
