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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-1767
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-25531316
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.
07-MAR-115. Location of incident.
Country: UNITED STATES
Prov / State: FLORIDA
6. Date incident was first observed.
03-MAR-11Product 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 %
- (S)-METHOPRENE
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
Siamese
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
7
7. Weight (provide a range if necessary )
12
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Rigidity
- Symptom - Fasciculations
- General
- Symptom - Death
- Nervous and Muscular Systems
- Symptom - Other
- Specify - abnormal open and closing of the mouth
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
1-25531316- The reporter, a pet owner, indicates exposure of his animals to an insecticidal product containing the active ingredient methoprene. The pet owner indicated he applied the product, a topical flea preventative labeled for cats, to his seven year twelve pound female Siamese cat (Subform III, #1) and his five year seven pound female Siamese cat (Subform III, #2) one week prior to his initial contact with the registrant. The pet owner indicated three days after application he noted the signs of aggression, muscle rigidity fasciculations, abnormal mouth movements, and sudden death in the older animal. The cat was not brought to the veterinarian and had been buried at the point of the initial contact with the registrant. The pet owner indicated the second animal developed similar signs of fasciculations, muscle rigidity and abnormal mouth movements shortly after the first cat (time frame not specified). He indicates the animal was washed and its signs spontaneously resolved. The pet owner was advised the signs indicated were inconsistent with the toxicity profile of the active ingredient found in this product. He was advised to seek veterinary assistance in determining the diagnosis. The caller was advise of registrant supported necropsy and hair testing to assist in diagnosis. He did not pursue this avenue of diagnosis. 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
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Siamese
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
7
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>3 days <=1 wk / >3 jours <=1 sem
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Fasciculations
- Symptom - Rigidity
- Symptom - Other
- Specify - abnormal open and closing of the mouth
12. How long did the symptoms last?
Unknown / Inconnu
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
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
1-25531316- The reporter, a pet owner, indicates exposure of his animals to an insecticidal product containing the active ingredient methoprene. The pet owner indicated he applied the product, a topical flea preventative labeled for cats, to his seven year twelve pound female Siamese cat (Subform III, #1) and his five year seven pound female Siamese cat (Subform III, #2) one week prior to his initial contact with the registrant. The pet owner indicated three days after application he noted the signs of aggression, muscle rigidity fasciculations, abnormal mouth movements, and sudden death in the older animal. The cat was not brought to the veterinarian and had been buried at the point of the initial contact with the registrant. The pet owner indicated the second animal developed similar signs of fasciculations, muscle rigidity and abnormal mouth movements shortly after the first cat (time frame not specified). He indicates the animal was washed and its signs spontaneously resolved. The pet owner was advised the signs indicated were inconsistent with the toxicity profile of the active ingredient found in this product. He was advised to seek veterinary assistance in determining the diagnosis. The caller was advise of registrant supported necropsy and hair testing to assist in diagnosis. He did not pursue this avenue of diagnosis. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
