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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3771
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23125854
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.
21-JUN-105. Location of incident.
Country: UNITED STATES
Prov / State: VIRGINIA
6. Date incident was first observed.
11-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. PMRA Submission No. EPA Registration No. 2596-147
Product Name: UltraGuard One Spot Flea Egg Larvae Treatment for Cats Kittens
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration 2.9 %
- (S)-METHOPRENE
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).
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
Persian
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
2
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Lethargy
- Symptom - Vocalizing
- Symptom - Death
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
1-23125854-The reporter called to indicate her animal had been exposed to a pesticide containing the active ingredient S-Methoprene. The reporter states she applied the product eleven days prior to the initial contact with the registrant. Within 24 hours the animal demonstrated the signs of lethargy and vocalization. Within another 24 hours the signs were commented to be yet worse at which point she attempted to wash the product off of the animal with a wet washcloth and a hand dishwashing liquid. The cat was reported to have died three days after application and had been buried. No veterinary assistance had been sought and no necropsy was performed. The caller was told the active ingredient has a low order of toxicity in mammals. The symptoms seen would not be expected after dermal application of the product. The caller was further advised the animal likely suffered from some other unrelated illness.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
