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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2011-5244
2. Registrant Information.
Registrant Reference Number: Case # 1-27374041
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.
08-SEP-115. Location of incident.
Country: CANADA
Prov / State: BRITISH COLUMBIA
6. Date incident was first observed.
06-SEP-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 Shorthair
4. Number of animals affected
2
5. Sex
Unknown
6. Age (provide a range if necessary )
0.33
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
- Gastrointestinal System
- Symptom - Salivating excessively
- Nervous and Muscular Systems
- Symptom - Seizure
12. How long did the symptoms last?
Persisted until death
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
Euthanised / Euthanasie
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
1-27374041- The reporter, a pet owner, indicates her animals were exposed to an insecticide containing the active ingredient methoprene. The reporter indicated she applied the product to her two four month domestic shorthair kittens two days prior to her initial contact with the registrant. The pet owner indicated within a few hours of application one animal began foaming at the mouth and shaking. The pet was taken to the veterinarian where it was given injectable medication the pet owner could not list to control seizures. The pet owner indicated the same signs were noted in her second animal within 1.5 hours. The caller reports that animal was also brought to the veterinarian and received similar care. The reporter indicated she had received a call from her veterinarian the night prior to her initial report to convey one of the animals was not doing well and by the time she made it to the clinic the animal was dead. It was conveyed to her the second animal was, as well, struggling and she elected to euthanize it. The animals remains were not available for necropsy. Neither the listed active ingredient or the finished product would be expected to elicit the signs described or the described out come.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Death
