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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4977
2. Registrant Information.
Registrant Reference Number: PROSAR Case #1-23739425
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.
09-AUG-105. Location of incident.
Country: UNITED STATES
Prov / State: WISCONSIN
6. Date incident was first observed.
Unknown
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. 2596-140
Product Name: UltraGuard Plus Flea Tick Spray for Cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .07 %
- TETRACHLORVINPHOS
- Guarantee/concentration 1.08 %
- (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 longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
12
7. Weight (provide a range if necessary )
10
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
- Skin
- Symptom - Pruritus
- General
- 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
1-23739425- The reporter, a pet owner, calls to indicate exposure of her animals to an insecticide containing the active ingredients tetrachlorvinphos and methoprene. The caller indicates she applied the product, a topical flea and tick spray, to her twelve year ten pound domestic long hair cat (Sub form III, #1) and her three year ten pound female domestic long hair cat (Sub form III, #2) two weeks prior to her initial contact with the registrant. The caller reports her animals both elicited pruritis within 15 minutes of application. In response to this sign she placed the animals in the sink and washed them. The caller indicated the older animal was found dead some time (unspecified) shortly after that point. One week later the second animal was found dead. No further signs preceded death in either animal. The caller had not sought veterinary assistance and had buried the animals at the point of the initial contact with the registrant. The caller was informed use of this product according to the label would be unexpected to yield the sign or outcome seen. The caller was advised necropsy may best determine the cause of death but this would not be valuable at this point due to the lack of preservation of the remains. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
3
7. Weight (provide a range if necessary )
10
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
- Skin
- Symptom - Pruritus
- General
- 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
1-23739425- The reporter, a pet owner, calls to indicate exposure of her animals to an insecticide containing the active ingredients tetrachlorvinphos and methoprene. The caller indicates she applied the product, a topical flea and tick spray, to her twelve year ten pound domestic long hair cat (Sub form III, #1) and her three year ten pound female domestic long hair cat (Sub form III, #2) two weeks prior to her initial contact with the registrant. The caller reports her animals both elicited pruritis within 15 minutes of application. In response to this sign she placed the animals in the sink and washed them. The caller indicated the older animal was found dead some time (unspecified) shortly after that point. One week later the second animal was found dead. No further signs preceded death in either animal. The caller had not sought veterinary assistance and had buried the animals at the point of the initial contact with the registrant. The caller was informed use of this product according to the label would be unexpected to yield the sign or outcome seen. The caller was advised necropsy may best determine the cause of death but this would not be valuable at this point due to the lack of preservation of the remains. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
