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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-2654
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-26243045
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.
23-MAY-115. Location of incident.
Country: UNITED STATES
Prov / State: NEBRASKA
6. Date incident was first observed.
22-MAY-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
domestic shorthair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
Unknown
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- General
- Symptom - Death
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
1-26243045- The caller, a pet owner, indicates her animals have been exposed to an insecticidal product containing the active ingredient methoprene. The pet owner indicated she applied the product to seven cats the day prior to her initial contact with the registrant. The pet owner indicates she had found two five pound female domestic shorthair cats (Subform III, #1) dead prior to her initial contact. She notes that one five pound female one and one half year domestic shorthair cat (Subform III, #2) had a seizure just prior to her contact, and four other cats (Subform III, #3) of unknown signalment are lethargic an refusing to eat. The pet owner was advised the signs seen were inconsistent with the toxicity profile of the active ingredient; she was advised to seek immediate veterinary care for the ill animals and of registrant supported necropsy that may help determine the cause of death of the animals that had died. On routine follow up the pet owner stated she did not bring her animals to the veterinarian. The animal that had been reported to have a seizure had died (unspecified time frame). The remaining animals had spontaneously recovered within a day. The caller indicated she would not pursue necropsy. 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
unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1.5
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
>8 hrs <=24 hrs / > 8 h < = 24 h
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Seizure
- General
- Symptom - Death
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
1-26243045- The caller, a pet owner, indicates her animals have been exposed to an insecticidal product containing the active ingredient methoprene. The pet owner indicated she applied the product to seven cats the day prior to her initial contact with the registrant. The pet owner indicates she had found two five pound female domestic shorthair cats (Subform III, #1) dead prior to her initial contact. She notes that one five pound female one and one half year domestic shorthair cat (Subform III, #2) had a seizure just prior to her contact, and four other cats (Subform III, #3) of unknown signalment are lethargic an refusing to eat. The pet owner was advised the signs seen were inconsistent with the toxicity profile of the active ingredient; she was advised to seek immediate veterinary care for the ill animals and of registrant supported necropsy that may help determine the cause of death of the animals that had died. On routine follow up the pet owner stated she did not bring her animals to the veterinarian. The animal that had been reported to have a seizure had died (unspecified time frame). The remaining animals had spontaneously recovered within a day. The caller indicated she would not pursue necropsy. 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
unknown
4. Number of animals affected
4
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
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
- General
- Symptom - Lethargy
- Gastrointestinal System
- Symptom - Anorexia
12. How long did the symptoms last?
>8 hrs <=24 hrs / > 8 h < = 24 h
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
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
1-26243045- The caller, a pet owner, indicates her animals have been exposed to an insecticidal product containing the active ingredient methoprene. The pet owner indicated she applied the product to seven cats the day prior to her initial contact with the registrant. The pet owner indicates she had found two five pound female domestic shorthair cats (Subform III, #1) dead prior to her initial contact. She notes that one five pound female one and one half year domestic shorthair cat (Subform III, #2) had a seizure just prior to her contact, and four other cats (Subform III, #3) of unknown signalment are lethargic an refusing to eat. The pet owner was advised the signs seen were inconsistent with the toxicity profile of the active ingredient; she was advised to seek immediate veterinary care for the ill animals and of registrant supported necropsy that may help determine the cause of death of the animals that had died. On routine follow up the pet owner stated she did not bring her animals to the veterinarian. The animal that had been reported to have a seizure had died (unspecified time frame). The remaining animals had spontaneously recovered within a day. The caller indicated she would not pursue necropsy. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
