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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5498

2. Registrant Information.

Registrant Reference Number: PROSAR Case #1-24145461

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.

19-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: IOWA

6. Date incident was first observed.

17-SEP-10

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. 2596-147

Product Name: UltraGuard One Spot Flea Egg Larvae Treatment for Cats Kittens

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 2.9 %

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

Male

6. Age (provide a range if necessary )

Unknown

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

  • Skin
    • Symptom - Hair loss
  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Renal System
    • Symptom - Inappropriate urination
  • General
    • Symptom - Death
  • Nervous and Muscular Systems
    • Symptom - Difficulty walking

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

1-24145461- The reporter, a pet owner, indicates his animal has been exposed to an insecticide with the active ingredient Methoprene. The reporter indicates he applied the product, a topical flea drop, to his male domestic shorthair cat three days prior to the initial contact with the registrant. He indicated one day following the application he noted hair loss at the application site, lethargy, vomiting and urinating outside the box. The caller stated the animal was also having difficulty walking to the liter box. The caller was advised the sign seen would not be expected to follow use of the product according to the label. He was advised to wash the animal with a non insecticidal shampoo and seek prompt veterinary assistance. On routine call back the pet owner advised the registrant the animal had died one day after the initial contact with the registrant. He had not brought the animal to the veterinary and had buried the animal before necropsy could be done. 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