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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-4591
2. Registrant Information.
Registrant Reference Number: PROSAR Case # 1-27114095
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.
11-AUG-115. Location of incident.
Country: UNITED STATES
Prov / State: MINNESOTA
6. Date incident was first observed.
11-AUG-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. 2596-22
Product Name: UltraGuard Rid Flea Dog Shampoo Refreshing Fresh Citrus
- Active Ingredient(s)
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
- Guarantee/concentration .149 %
- PIPERONYL BUTOXIDE
- Guarantee/concentration .089 %
- PYRETHRINS
- Guarantee/concentration .045 %
- N-OCTYL BICYCLOHEPTENE DICARBOXIMIDE
PMRA Registration No. PMRA Submission No. EPA Registration No. 2596-153
Product Name: UltraGuard Rid Flea Tick Shampoo with Oatmeal for Dogs
- Active Ingredient(s)
- D-PHENOTHRIN
- Guarantee/concentration .27 %
- D-PHENOTHRIN
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?
No
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 )
11
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
<=30 min / <=30 min
11. List all symptoms
System
- General
- Symptom - Vocalizing
- Symptom - Malaise
- Symptom - Death
- Gastrointestinal System
- Symptom - Foaming at mouth
- General
- Symptom - Hiding
- Symptom - Hesitancy to move
- Specify - Reluctant to move
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
1-27114095-The reporter, a pet owner, indicates his animals have been exposed to two insecticidal products containing the active ingredients phenothrin and pyrethrins, n-octyl bicycloheptene dicarboximide and piperonyl butoxide. The pet owner indicated he had used one or the other product (flea and tick shampoos labeled for use on dogs) on his three cats within 2.5 hours of his initial contact with the registrant. The pet owner was unable to tell which shampoo was used on which cat. He reports his eleven year female (Subform III, #1) cat had been vocalizing, foaming at the mouth, was reluctant to move and was hiding within one hour of the application. The reporter called his veterinarian and he was advised to wash the animal with a noninsecticidal shampoo. While he was washing the animal it died. The reporter indicated a second eleven year female cat (Subform III, #2) was having muscle tremors at the point of the call. The third animal was not documented here because it demonstrated no symptoms at the point of the call. The reporter was advised canine pyrethrin/pyrethroid products can result in significant problems if inappropriately used on cats. The pet owner was advised to seek immediate veterinary care for the remaining animals. The pet owner did not respond to follow up attempts. 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 )
11
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
- Nervous and Muscular Systems
- Symptom - Muscle tremors
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
1-27114095-The reporter, a pet owner, indicates his animals have been exposed to two insecticidal products containing the active ingredients phenothrin and pyrethrins, n-octyl bicycloheptene dicarboximide and piperonyl butoxide. The pet owner indicated he had used one or the other product (flea and tick shampoos labeled for use on dogs) on his three cats within 2.5 hours of his initial contact with the registrant. The pet owner was unable to tell which shampoo was used on which cat. He reports his eleven year female (Subform III, #1) cat had been vocalizing, foaming at the mouth, was reluctant to move and was hiding within one hour of the application. The reporter called his veterinarian and he was advised to wash the animal with a noninsecticidal shampoo. While he was washing the animal it died. The reporter indicated a second eleven year female cat (Subform III, #2) was having muscle tremors at the point of the call. The third animal was not documented here because it demonstrated no symptoms at the point of the call. The reporter was advised canine pyrethrin/pyrethroid products can result in significant problems if inappropriately used on cats. The pet owner was advised to seek immediate veterinary care for the remaining animals. The pet owner did not respond to follow up attempts. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
