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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5387

2. Registrant Information.

Registrant Reference Number: 1-23991627

Registrant Name (Full Legal Name no abbreviations): Hartz Canada, Inc.

Address: 1125 Talbot Street

City: St. Thomas

Prov / State: ON

Country: Canada

Postal Code: N5P 3W7

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.


5. Location of incident.

Country: CANADA


6. Date incident was first observed.


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.


PMRA Registration No. 26491      PMRA Submission No.       EPA Registration No.


  • Active Ingredient(s)

7. b) Type of formulation.

Application Information

8. Product was applied?


9. Application Rate.


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).

Cat owner, emailed Hartz on 08/24/2010 regarding the adverse reaction . The caller says the animal has now passed away and the treating DVM would like to speak to somebody regarding this. VET stated he was contacted by the owner because the cat was having some open mouth breathing. He saw the cat in his clinic and he was in severe respiratory distress. The cat had purple gums, crackles and wheezes heard throughout the lungs. He gave the animal desoximetasone and an antihistamine per IV and provided supplemental : oxygen. No improvement was seen so the owner opted to euthanize the animal. This was 9 days ago (08/24/2010) and the cat has since been cremated. The caller was wondering if fatal pulmonary edema has ever been reported before; he also wanted to know what type of symptoms could be expected. The caller says the cat was a healthy 3-year old 16# animal and he does not believe any other products were used on the cat. The owner stated symptoms began 3 hours after applying, and the owner did bath the cat when he started to show symptoms.

To be determined by Registrant

12. In your opinion, was the product used according to the label instructions?


Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed


4. Number of animals affected


5. Sex


6. Age (provide a range if necessary )


7. Weight (provide a range if necessary )



8. Route(s) of exposure


9. What was the length of exposure?

>2 hrs <=8 hrs / >2 h <=8 h

10. Time between exposure and onset of symptoms

>2 hrs <=8 hrs / > 2 h < = 8 h

11. List all symptoms


  • Respiratory System
    • Symptom - Mouth breathing
    • Specify - open mouth breathing
  • General
    • Symptom -
    • Specify - purple mucuous membranes
  • Respiratory System
    • Symptom - Wheezing
    • Symptom - Abnormal lung sounds
    • Specify - Crackles, shortness of breath
    • Symptom - Pulmonary edema
    • Specify - pulmonary edema
    • Symptom - Respiratory distress
    • Specify - severe respiratory distress

12. How long did the symptoms last?

Unknown / Inconnu

13. Was medical treatment provided? Provide details in question 17.


14. a) Was the animal hospitalized?


14. b) How long was the animal hospitalized?

15. Outcome of the incident

Euthanised / Euthanasie

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

To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification


19. Provide supplemental information here