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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-3781
2. Registrant Information.
Registrant Reference Number: PROSAR Case #: 1-23412581
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.
12-JUL-105. Location of incident.
Country: UNITED STATES
Prov / State: NORTH CAROLINA
6. Date incident was first observed.
09-JUL-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
Domestic shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.25
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Ataxia
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Vocalizing
- Symptom - Lethargy
- 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
1-23412581- The reporter, a pet owner, calls to indicate her animal had been exposed to the insecticide s-methoprene. The caller indicated she applied the product, a topical flea drop, to her twelve week female domestic shorthair cat (Subform III #1) five days prior to the initial contact with the registrant. The caller states she also applied the product at the same time to a male kitten of the same age that remained asymptomatic. The caller reports the female kitten began vocalizing and staggering two days after application of the product. Following the development of these signs the pet owner bathed the animal with a non-insecticidal shampoo. The next day the animal became lethargic and was brought to the veterinarian. While at the veterinary office the animal died before the vet could provide an antemortem examination. The animal was brought home and buried in the pet owner¿s back yard. No necropsy was performed. The pet owner was informed neither the signs seen nor outcome would be expected following the use of this product. The active ingredient carries a very low order of mammalian toxicity. The animal was likely suffering from some other unrelated undiagnosed illness. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
