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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2010-6292

2. Registrant Information.

Registrant Reference Number: PROSAR CB # 1-24724278

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-NOV-10

5. Location of incident.

Country: CANADA

Prov / State: QUEBEC

6. Date incident was first observed.

14-NOV-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. 2596-83

Product Name: UltraGuard Flea Tick Collar for Cats

  • Active Ingredient(s)
    • TETRACHLORVINPHOS

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).

The product, a flea and tick collar was applied to the housemate not the affected animal.

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic longhair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

0.2

7. Weight (provide a range if necessary )

2.5

lbs

8. Route(s) of exposure

Unknown

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

Unknown / Inconnu

11. List all symptoms

System

  • Eye
    • Symptom - Nystagmus
  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Muscle weakness
    • Symptom - Confusion
  • Respiratory System
    • Symptom - Mouth breathing
    • Specify - "open mouth breathing"
  • Eye
    • Symptom - Blindness (temporary)
  • General
    • Symptom - Fever
  • Cardiovascular System
    • Symptom - Tachycardia
  • Nervous and Muscular Systems
    • Symptom - Unresponsive
    • Specify - 'lack of response'

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

Euthanised / Euthanasie

16. How was the animal exposed?

Accidental ingestion/Ingestion accident.

17. Provide any additional details about the incident

(eg. description of the frequency and severity of the symptoms

1-24724278- The reporter, a veterinarian, indicates exposure of a patient to an insecticide containing the active ingredient tetrachlorvinphos. The caller indicates a pet owner had applied the product to an adult cat in the home two days prior tot the initial contact with the registrant. The pet owner indicated a ten week two and one half pound male domestic shorthair cat (Subform III, #1) that co-habited with the animal to which the product had been applied may have been exposed to the product. The pet owner indicated the younger cat may have licked the collar while it was applied to the older animal. No observed exposure was described. The evening of application to the older animal the kitten began to demonstrate the signs of seizures, tachycardia, fever, weakness, nystagmus, confusion, and lack of response. The veterinarian indicated the animal was not be visual but did not indicate how this was evaluated. The animal had been placed on intravenous fluids supplemented with dextrose, antibiotics and a non-steroidal anti-inflammatory. The veterinarian was advised by this avenue toxicity would be unexpected. The caller was advised of typical signs seen in an overdosage setting, treatments, and prognosis. The caller was advised to pursue differential diagnoses while supporting the animal. On routine call back the veterinarian indicated the animal was euthanized. The owner lacked resources to work up and treat the animal. 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