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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-1771

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-25611901

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-MAR-11

5. Location of incident.

Country: UNITED STATES

Prov / State: KENTUCKY

6. Date incident was first observed.

11-MAR-11

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. 2596-139

Product Name: UltraGuard Plus Flea Tick Collar for Cats Kittens

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 1.02 %
    • TETRACHLORVINPHOS
      • Guarantee/concentration 14.55 %

7. b) Type of formulation.

Other (specify)

collar

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 long hair

4. Number of animals affected

1

5. Sex

Male

6. Age (provide a range if necessary )

2

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

>8 hrs <=24 hrs / > 8 h < = 24 h

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Vomiting
  • General
    • Symptom - Lethargy
  • Gastrointestinal System
    • Symptom - Anorexia
    • Symptom - Salivating excessively
  • Nervous and Muscular Systems
    • Symptom - Seizure
    • Symptom - Aggressive behaviour
    • Symptom - Muscle tremors
  • General
    • Symptom - Death
    • Symptom - Hyperthermia

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?

Yes

14. b) How long was the animal hospitalized?

Unknown

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

1-25611901- The caller, a pet owner, indicated exposure of her animal to an insecticidal product containing the active ingredient tetrachlorvinphos. The pet owner stated she had placed the product, a flea and tick collar labeled for use on cats, on her two year seven pound male domestic long hair cat six days prior to her initial contact with the registrant. The day following application the caller had indicated the animal vomited in the morning and then several additional times through the day. Five days after application the pet owner noted salivation, and lethargy. The collar was removed and the animal brought to the veterinarian the next day due to loss of appetite and continued lethargy. The caller reports the animal had a seizure while at the veterinarian¿s office and its temperature was elevated (unspecified). The caller returned home with the animal and bathed it. The animal had another seizure at that point. The caller indicated an intention to return the animal to the veterinarians¿ office. The caller was advised of the unexpectedness of the signs seen and referred to the veterinarian for further care and assistance with diagnosis. The caller was advised of registrant supported cholinesterase screening. The same day the veterinarian had called to obtain information regarding cholinesterase screening. It was advised they thoroughly wash the animal and support it. On routine follow up two days later the pet owner advised the registrant that the animal had received atropine and improved. It was then sent home where it resumed seizures and salivating. The pet owner also reported muscle tremors and abnormal behavior. The animal was brought back to the veterinarian where intravenous medications were administered (unspecified) and the animal was hospitalized. Follow up was obtained from the owner five days after her initial contact. She indicated her animal had died the day prior and had been buried. Cholinesterase testing obtained from the Illinois Department of Agriculture Bureau of Animal Disease Laboratory indicated no cholinesterase depression in samples taken from this 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