Health Canada
www.hc-sc.gc.ca
Common menu bar links
Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-4987
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-23818157
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.
16-AUG-105. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
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. 2596-151
Product Name: UltraGuard Flea Tick Drops for Dogs Puppies
- Active Ingredient(s)
- D-PHENOTHRIN
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).
canine product applied to catTo 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
Medical Professional
2. Type of animal affected
Cat / Chat
3. Breed
Domestic shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
8
7. Weight (provide a range if necessary )
10.3
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
>24 hrs <=3 days / >24 h <=3 jours
10. Time between exposure and onset of symptoms
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle tremors
- Symptom - Seizure
12. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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?
1
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
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
1-23818157- The reporter, a veterinarian, indicates a patient had been exposed to an insecticide containing the active ingredient phenothrin. The caller indicates the pet owner applied the product, a topical flea and tick drop labeled only for use on dogs, to their eight year ten pound male domestic shorthair cat two or three days preceding presentation and initial contact with the registrant. One day prior to presentation and initial contact with the registrant the owner noted tremors and seizures. Upon presentation the veterinarian washed the animal and placed it on intravenous fluids. . The caller was advised the use of concentrated canine pyrethrin/pyrethroid spot-on type products can result in significant problems if inappropriately used on cats. The caller was advised of signs seen after such exposures, standard treatment protocols, and prognosis. On routine call back the veterinarian informed the registrant the animal was discharged from her service within 24 hours. The extent of treatments provided were described as bathing, IV fluids, and methocarbamol. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
