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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2010-6294
2. Registrant Information.
Registrant Reference Number: PROSAR CB # 1-24704213
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.
13-NOV-105. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
13-NOV-10Product 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. 26491 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard One Spot Treatment for Cats Kittens
- Active Ingredient(s)
- (S)-METHOPRENE
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).
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 Longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
0.5
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
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Bizarre behaviour
- Eye
- Symptom - Contraction of the pupil
- Respiratory System
- Symptom - Rapid breathing
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
1-24704213- The reporter, a pet owner, indicates his animals had been exposed to a pesticide containing the active ingredient methoprene. The pet owner indicated he had applied the product to his six month five pound female domestic longhair (Subform III, #1) and his eighteen month twenty pound male domestic long hair (Subform III, #2) cat three hours prior to the initial contact with the registrant. The pet owner indicated the younger animal demonstrated the signs of bizarre behavior including hissing, miosis, and rapid breathing shortly following application. The older animal was described as acting strange as well. The pet owner was advised no harm would be expected to follow use of the product per the label instructions. The pet owner was advised some feline patients resent the application of topical products regardless of the active ingredient. The pet owner was advised they may remove the product via a bath with a non-insecticidal shampoo, but the pet would likely become accustom to the application in the near term. The pet owner did not respond to follow up attempts. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic Long hair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
1.5
7. Weight (provide a range if necessary )
20
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- General
- Symptom - Abnormal behaviour
12. How long did the symptoms last?
Unknown / Inconnu
13. Was medical treatment provided? Provide details in question 17.
Unknown
14. a) Was the animal hospitalized?
Unknown
14. b) How long was the animal hospitalized?
15. Outcome of the incident
Unknown/Inconnu
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
1-24704213- The reporter, a pet owner, indicates his animals had been exposed to a pesticide containing the active ingredient methoprene. The pet owner indicated he had applied the product to his six month five pound female domestic longhair (Subform III, #1) and his eighteen month twenty pound male domestic long hair (Subform III, #2) cat three hours prior to the initial contact with the registrant. The pet owner indicated the younger animal demonstrated the signs of bizarre behavior including hissing, miosis, and rapid breathing shortly following application. The older animal was described as acting strange as well. The pet owner was advised no harm would be expected to follow use of the product per the label instructions. The pet owner was advised some feline patients resent the application of topical products regardless of the active ingredient. The pet owner was advised they may remove the product via a bath with a non-insecticidal shampoo, but the pet would likely become accustom to the application in the near term. The pet owner did not respond to follow up attempts. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
