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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5500

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-24243887

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.

29-SEP-10

5. Location of incident.

Country: UNITED STATES

Prov / State: NORTH CAROLINA

6. Date incident was first observed.

28-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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

unknown

4. Number of animals affected

1

5. Sex

Unknown

6. Age (provide a range if necessary )

0.11

7. Weight (provide a range if necessary )

0.94

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

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 - Seizure
  • General
    • Symptom - Death

12. How long did the symptoms last?

Persisted until death

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

Yes

14. a) Was the animal hospitalized?

Unknown

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

1-24243887- The caller, a veterinarian, reports a patient of his was exposed to an insecticide containing the active ingredient methoprene. The caller reports the owners of a six week 0.94 pound kitten placed the product, a topical flea and tick drop, on the animal the day prior to his initial contact with the registrant. The animal had presented to him the day of the initial contact with the registrant with the complaint of seizures that had been noted the night prior initially. He indicates the owner had stated the animal had four discreet seizures the night prior and one the day of its initial presentation. The caller was advised the product was labeled for use in animals 12 weeks and older, but despite the misuse signs as described would not be expected. The caller was advised of the low order of toxicity and low concentration of the active ingredient in this product. He was advised of registrant supported hair testing that might be done to determine if the active ingredient involved was accurately represented. It was recommended the animal be washed in a non insecticidal, symptoms treated as they arise, and additional etiologies be ruled out. The reporter was contacted two more times to conduct follow up. The registrant was advised the animal was washed numerous times. The animal continued to have intermittent discreet seizures. The only diagnostic allowed by the owner due to cost was to determine blood glucose (which was not reported to be abnormal). The owner would not allow further diagnostics or therapeutics due to cost. The reporter called back spontaneously one week after his initial contact with the registrant to indicate the animal had died at home following a seizure. 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