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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-5676

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-23897261

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.

24-AUG-10

5. Location of incident.

Country: UNITED STATES

Prov / State: ALABAMA

6. Date incident was first observed.

24-AUG-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. 2596-140

Product Name: UltraGuard Plus Flea Tick Spray for Cats

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration .07 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 1.08 %

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 )

0.6

7. Weight (provide a range if necessary )

5

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

  • General
    • Symptom - Lethargy
    • Symptom - Vocalizing
  • Renal System
    • Symptom - Lack of control of urination
  • General
    • Symptom - Hiding
    • Symptom - Listless
    • Symptom - Pain
  • Gastrointestinal System
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Ataxia
    • Symptom - Muscle weakness
    • Symptom - Fasciculations
  • Eye
    • Symptom - Pupil dilation
  • 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

1-23897261- The reporter, a pet owner, indicates exposure of her animal to an insecticide containing the active ingredient tetrachlorvinphos and methoprene. The caller reported she applied the product (a topical flea and tick spray for cats) to her eight month five pound male domestic shorthair cat every one to two weeks and most recently the night prior to the initial contact with the registrant. The caller indicated at the time of the call the animal was vocalizing ┐┐┐like it was in pain?, seemed lethargic, seemed unable to use the liter box, and had urinated on himself. The caller was advised the signs seen were not expected following routine use of the product according to the label. The caller was advised to wash the animal in a noninsecticidal shampoo and seek veterinary assistance. The caller was further advised the animals signs were consistent with a very common urinary disorder in young male cats that could be potentially life threatening. The reporter spontaneously called back two hours later to indicate the animal had now developed incoordination, weakness, drooling, muscle fasciculations, dilated pupils, and difficulty walking. The animal had not yet seen the veterinarian. The caller was advised to bring the animal to the veterinarian. On routine follow-up one day later the reporter informed he registrant the animal had died. The animal had presented to the veterinarian ┐┐┐too late? to offer effective treatment. The caller added the signs seen in the animal of hiding and limp listless behavior prior to its death. The caller was advised of registrant supported necropsy, but had buried the animal. The registrant was advised a family member would exhume the animal, but no further contact was initiated by the reporter regarding the details of the program. 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