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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3124
2. Registrant Information.
Registrant Reference Number: PROSAR Case 1-26504966
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.
Human
Domestic Animal
4. Date registrant was first informed of the incident.
15-JUN-115. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
09-JUN-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. 26491 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard One Spot Treatment for Cats Kittens
- Active Ingredient(s)
- (S)-METHOPRENE
PMRA Registration No. PMRA Submission No. EPA Registration No. 2596-151
Product Name: UltraGuard Flea Tick Drops for Dogs Puppies 16-30 lbs
- Active Ingredient(s)
- D-PHENOTHRIN
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 II: Human Incident Report (A separate form for each person affected)
1. Source of Report.
Data Subject
2. Demographic information of data subject
Sex: Female
Age: >19 <=64 yrs / >19 <=64 ans
3. List all symptoms, using the selections below.
System
- Gastrointestinal System
- Symptom - Nausea
4. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
5. Was medical treatment provided? Provide details in question 13.
No
6. a) Was the person hospitalized?
No
6. b) For how long?
7. Exposure scenario
Non-occupational
8. How did exposure occur? (Select all that apply)
Application
9. If the exposure occured during application or re-entry, what protective clothing was worn? (select all that apply)
Unknown
10. Route(s) of exposure.
Skin
11. What was the length of exposure?
Unknown / Inconnu
12. Time between exposure and onset of symptoms.
>2 hrs <=8 hrs / > 2 h < = 8 h
13. Provide any additional details about the incident (eg. description of the frequency and severity of the symptoms, type of medical treatment, results from medical tests, outcome of the incident, amount of pesticide exposed to, etc.)
1 26504966 The reporter, a pet owner, indicates exposure of herself to and insecticidal product containing the active ingredient methoprene and her animals to both that product and another containing phenothrin. The pet owner states she applied the methoprene product to her five year twenty eight pound domestic shorthair cat (Subform 3, 1) six days prior to her initial contact with the registrant. She reports she (Subform 2, 1) experienced nausea through the night that only resolved three days later. She described she rubbed the product with her hand after application. The caller was advised of the potential irritant effect of the product. Nausea would not be expected following dermal exposure. The reporter indicated the cat to which the product was applied demonstrated signs immediately following application that included anorexia lethargy and constipation. She further reported the animals 'paws curled up' following application. She reported the signs persisted and she phoned her veterinarian the day after application and three subsequent times. The veterinarian had recommended she wash the product off of the animal. She reports she had bathed the animal three times since the initial contact with her veterinarian. The caller was advised the signs seen were inconsistent with the toxicity profile of the active ingredient and the animal should be brought to the veterinarian to determine what may be affecting its health and the proper treatment. The pet owner then stated she applied the phenothrin containing product to her one year seven and one half pound female miniature pinscher (Subform 3, 2) six days prior to her initial contact with the registrant. Within nine hours of application the animal demonstrated vomiting fasciculations skittish behavior and salivation. The pet owner had indicated the product used was labeled for dogs 16 30 pounds, but that she had applied a partial vial of the product to the animal. She reported the animal was bathed and given an oral dose of the OTC medication Pepto Bismol. The animal¿s SXS spontaneously resolved within 24 hours. The reporter was encouraged to follow label instructions and dosing recommendations. Signs of this nature would not be expected if label instructions were followed. The reporter did not respond to follow up attempts regarding her cat. No further information is available
To be determined by Registrant
14. Severity classification.
Minor
15. 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
domestic shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
5
7. Weight (provide a range if necessary )
28
lbs
8. Route(s) of exposure
Skin
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
<=30 min / <=30 min
11. List all symptoms
System
- Gastrointestinal System
- Symptom - Anorexia
- General
- Symptom - Lethargy
- Gastrointestinal System
- Symptom - Constipation
- General
- Symptom - Abnormal behaviour
- Specify - paws curled up
12. How long did the symptoms last?
>24 hrs <=3 days / >24 h <=3 jours
13. Was medical treatment provided? Provide details in question 17.
Unknown
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 26504966 The reporter, a pet owner, indicates exposure of herself to and insecticidal product containing the active ingredient methoprene and her animals to both that product and another containing phenothrin. The pet owner states she applied the methoprene product to her five year twenty eight pound domestic shorthair cat (Subform 3, 1) six days prior to her initial contact with the registrant. She reports she (Subform 2, 1) experienced nausea through the night that only resolved three days later. She described she rubbed the product with her hand after application. The caller was advised of the potential irritant effect of the product. Nausea would not be expected following dermal exposure. The reporter indicated the cat to which the product was applied demonstrated signs immediately following application that included anorexia lethargy and constipation. She further reported the animals 'paws curled up' following application. She reported the signs persisted and she phoned her veterinarian the day after application and three subsequent times. The veterinarian had recommended she wash the product off of the animal. She reports she had bathed the animal three times since the initial contact with her veterinarian. The caller was advised the signs seen were inconsistent with the toxicity profile of the active ingredient and the animal should be brought to the veterinarian to determine what may be affecting its health and the proper treatment. The pet owner then stated she applied the phenothrin containing product to her one year seven and one half pound female miniature pinscher (Subform III, 2) six days prior to her initial contact with the registrant. Within nine hours of application the animal demonstrated vomiting fasciculations skittish behavior and salivation. The pet owner had indicated the product used was labeled for dogs 16 30 pounds, but that she had applied a partial vial of the product to the animal. She reported the animal was bathed and given an oral dose of the OTC medication Pepto Bismol. The animal¿s SXS spontaneously resolved within 24 hours. The reporter was encouraged to follow label instructions and dosing recommendations. Signs of this nature would not be expected if label instructions were followed. The reporter did not respond to follow up attempts regarding her cat. No further information is available
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
19. Provide supplemental information here
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Dog / Chien
3. Breed
Miniature pinscher
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
1
7. Weight (provide a range if necessary )
7.5
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
- Gastrointestinal System
- Symptom - Vomiting
- Nervous and Muscular Systems
- Symptom - Fasciculations
- Symptom - Skittish
- Specify - skittish behavior
- Gastrointestinal System
- Symptom - Salivating excessively
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 26504966 The reporter, a pet owner, indicates exposure of herself to and insecticidal product containing the active ingredient methoprene and her animals to both that product and another containing phenothrin. The pet owner states she applied the methoprene product to her five year twenty eight pound domestic shorthair cat (Subform 3, 1) six days prior to her initial contact with the registrant. She reports she (Subform 2, 1) experienced nausea through the night that only resolved three days later. She described she rubbed the product with her hand after application. The caller was advised of the potential irritant effect of the product. Nausea would not be expected following dermal exposure. The reporter indicated the cat to which the product was applied demonstrated signs immediately following application that included anorexia lethargy and constipation. She further reported the animals 'paws curled up' following application. She reported the signs persisted and she phoned her veterinarian the day after application and three subsequent times. The veterinarian had recommended she wash the product off of the animal. She reports she had bathed the animal three times since the initial contact with her veterinarian. The caller was advised the signs seen were inconsistent with the toxicity profile of the active ingredient and the animal should be brought to the veterinarian to determine what may be affecting its health and the proper treatment. The pet owner then stated she applied the phenothrin containing product to her one year seven and one half pound female miniature pinscher (Subform 3, 2) six days prior to her initial contact with the registrant. Within nine hours of application the animal demonstrated vomiting fasciculations skittish behavior and salivation. The pet owner had indicated the product used was labeled for dogs 16 30 pounds, but that she had applied a partial vial of the product to the animal. She reported the animal was bathed and given an oral dose of the OTC medication Pepto Bismol. The animal¿s SXS spontaneously resolved within 24 hours. The reporter was encouraged to follow label instructions and dosing recommendations. Signs of this nature would not be expected if label instructions were followed. The reporter did not respond to follow up attempts regarding her cat. No further information is available
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
