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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-3919
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-26716162
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.
04-JUL-115. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
04-JUL-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
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?
Unknown
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Domestic longhair
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
3
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
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Respiratory System
- Symptom - Panting
- General
- Symptom - Vocalizing
- Nervous and Muscular Systems
- Symptom - Agitation
- Symptom - Loss of coordination
- Specify - running and tripped herself on stairs
12. How long did the symptoms last?
Unknown / Inconnu
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
1-26716162- The reporter, a pet owner, indicated her animals were exposed to an insecticide containing the active ingredient methoprene. The reporter indicated she applied the product to her three year female domestic long hair cat (Subform III, #1) and her six year male ragdoll cat (Subform III, #2)within four hours of her initial contact with the registrant. The pet owner indicated she noted in the female cat panting, vocalization, agitation, and running and tripping on herself while on the stairs. The reporter commented she noted in the male cat panting and it was tense curled up in a ball. The pet owner was advised no harm would be expected following topical application of the product as labeled. She was advised cats some times resent the application of topical products and can respond behaviorally to what they may perceive as an unpleasant sensation. The pet owner was advised if signs worsened or persisted she should wash the animals with a non insecticidal shampoo and seek veterinary assistance. No further information is available.
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
Ragdoll
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
6
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
>2 hrs <=8 hrs / > 2 h < = 8 h
11. List all symptoms
System
- Respiratory System
- Symptom - Panting
- Nervous and Muscular Systems
- Symptom - Recumbent
- Specify - tense and curled up in a ball
12. How long did the symptoms last?
Unknown / Inconnu
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
1-26716162- The reporter, a pet owner, indicated her animals were exposed to an insecticide containing the active ingredient methoprene. The reporter indicated she applied the product to her three year female domestic long hair cat (Subform III, #1) and her six year male ragdoll cat (Subform III, #2)within four hours of her initial contact with the registrant. The pet owner indicated she noted in the female cat panting, vocalization, agitation, and running and tripping on herself while on the stairs. The reporter commented she noted in the male cat panting and it was tense curled up in a ball. The pet owner was advised no harm would be expected following topical application of the product as labeled. She was advised cats some times resent the application of topical products and can respond behaviorally to what they may perceive as an unpleasant sensation. The pet owner was advised if signs worsened or persisted she should wash the animals with a non insecticidal shampoo and seek veterinary assistance. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
