Health Canada
Symbol of the Government of Canada
Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-2945

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-26572715

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.

21-JUN-11

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

21-JUN-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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: UltraGuard Plus Flea TIck Drops for Dogs Puppies

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • PERMETHRIN

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?

No

Subform III: Domestic Animal Incident Report

1. Source of Report

Animal's Owner

2. Type of animal affected

Cat / Chat

3. Breed

mixed breed

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

1

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

  • Eye
    • Symptom - Pupil dilation
  • Nervous and Muscular Systems
    • Symptom - Fasciculations
    • Symptom - Muscle cramps
    • Specify - "legs curled up
  • Renal System
    • Symptom - Urinary incontinence
  • Nervous and Muscular Systems
    • Symptom - Stiffness
    • Specify - stiff tail
  • Ear
    • Symptom - Other
    • Specify - ears twitching

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

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

1-26572715- The reporter, a pet owner, indicates her animals had been exposed to an insecticide containing the active ingredients permethrin and methoprene. The pet owner indicates she applied the product to her one year female mixed breed cat (Subform III, #1) and her male mixed breed cat (Subform III, #2) one day prior to her initial contact with the registrant. The pet owner acknowledge at the outset of her call to the registrant that she had not followed the labeling for the product and had applied the dog product to cats. She had noted just prior to her initial contact that the female cat had developed the signs of pupils completely dilated in the light, stiff tail, shaking, twitching ears, legs curled up, and incontinence. The male cat had developed twitching ears, hyperactivity. The pet owner was advised of proper decontamination, treatment and prognosis. It was advised she seek immediate veterinary care. On follow up the pet owner stated she had taken the animals to the veterinarian the night of her initial contact. They were bathed and are improving. She did not provide further detail.


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

Mixed breed

4. Number of animals affected

1

5. Sex

Male

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

  • Ear
    • Symptom - Other
    • Specify - ear twitching

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

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

1-26572715- The reporter, a pet owner, indicates her animals had been exposed to an insecticide containing the active ingredients permethrin and methoprene. The pet owner indicates she applied the product to her one year female mixed breed cat (Subform III, #1) and her male mixed breed cat (Subform III, #2) one day prior to her initial contact with the registrant. The pet owner acknowledge at the outset of her call to the registrant that she had not followed the labeling for the product and had applied the dog product to cats. She had noted just prior to her initial contact that the female cat had developed the signs of pupils completely dilated in the light, stiff tail, shaking, twitching ears, legs curled up, and incontinence. The male cat had developed twitching ears, hyperactivity. The pet owner was advised of proper decontamination, treatment and prognosis. It was advised she seek immediate veterinary care. On follow up the pet owner stated she had taken the animals to the veterinarian the night of her initial contact. They were bathed and are improving. She did not provide further detail.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Moderate

19. Provide supplemental information here