Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-0897
2. Registrant Information.
Registrant Reference Number: 1-25050323
Registrant Name (Full Legal Name no abbreviations): Hartz Canada, Inc.
Address: 1125 Talbot Street
City: St. Thomas
Prov / State: ON
Country: Canada
Postal Code: N5P 3W7
3. Select the appropriate subform(s) for the incident.
Domestic Animal
4. Date registrant was first informed of the incident.
27-DEC-10
5. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
26-DEC-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. 25655
PMRA Submission No.
EPA Registration No.
Product Name: UltraGuard Flea and Tick Spray for Cats
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).
Caller was a veterinary technician and she said that the product was applied by owners last night with all directions followed. Today the cat's owners noticed around 2PM that the cat was having mild twitching and tremors.
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 Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
14
7. Weight (provide a range if necessary )
9.24
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 - Muscle tremors
- Symptom - Agitation
- Skin
- Symptom - Skin sensitivity
12. How long did the symptoms last?
Unknown / Inconnu
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
Fully Recovered / Complètement rétabli
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
Caller was a veterinary technician and she said that the product was applied to cat last night by owners with all directions followed. Today the cat's owners noticed around 2PM that the cat was having mild twitching and tremors. They brought the cat to their emergency service for treatment. On the exam the cat is having mild twitches and has jerking tremors, is agitated and hypersensitive in the neck and back area. There is no any dermal irritation. The cat's body temperature is 38.7C, heart rate is 140. The cat has been bathed with dish soap and water.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
19. Provide supplemental information here
The owners of the cat have dogs and the dogs were treated 3 days ago with a topical spot on for flea and tick control. The cat does not go near the dogs and as they do not get along and the cat would not lick the dog. The cat may or may not have been exposed to the owners dogs treated with topical flea and tick drops and the tetrachlorvinphos was sprayed on the cat.