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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2011-5602

2. Registrant Information.

Registrant Reference Number: PROSAR Case # 1-27617623

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.

05-OCT-11

5. Location of incident.

Country: UNITED STATES

Prov / State: NEW JERSEY

6. Date incident was first observed.

05-OCT-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.       PMRA Submission No.       EPA Registration No. 2596-147

Product Name: UltraGuard One Spot Flea Egg Larvae Treatment for Cats Kittens

  • Active Ingredient(s)
    • (S)-METHOPRENE
      • Guarantee/concentration 2.9 %

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

6. Age (provide a range if necessary )

11

7. Weight (provide a range if necessary )

11

lbs

8. Route(s) of exposure

Skin

9. What was the length of exposure?

Unknown / Inconnu

10. Time between exposure and onset of symptoms

>3 days <=1 wk / >3 jours <=1 sem

11. List all symptoms

System

  • Gastrointestinal System
    • Symptom - Anorexia
  • General
    • Symptom - Lethargy
    • Symptom - Dehydration
  • Renal System
    • Symptom - Urinary incontinence
  • General
    • Symptom - Vocalizing
  • Nervous and Muscular Systems
    • Symptom - Other
    • Specify - 'Went limp'
  • General
    • Symptom - Death

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?

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

1-27617623- The reporter, a pet owner, indicated his animal had been exposed to an insecticidal product containing the active ingredient methoprene. The reporter indicated he had applied the product to his eleven year eleven pound female cat one week prior to his initial contact with the registrant. The pet owner stated the day of his initial contact he had noted the animal was lethargic and not eating. The pet was taken to the veterinarian and diagnosed with dehydration. The animal was treated with subcutaneous fluids injectable corticosteroids and released. The pet owner was advised neither the active ingredient nor the finished product would be expected to result in the signs seen but to bathe the animal with a non insecticidal shampoo to remove the product if the animal is otherwise debilitated. On follow up five days later the pet owner indicated the animal had died one day after their initial contact. She indicated the animal had seemed to be improving but that evening had been observed to urinate on itself, vocalized, went limp and died while being transported to the veterinarian. The animal had been buried without a necropsy. 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