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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-0071
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-28191511
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.
27-NOV-115. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
27-NOV-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. 29283 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard Pro Flea Tick Drops for Dogs Puppies Under 30 lbs
- Active Ingredient(s)
- (S)-METHOPRENE
- PERMETHRIN
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 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 )
0.41
7. Weight (provide a range if necessary )
5
lbs
8. Route(s) of exposure
Oral
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
- Symptom - Fasciculations
- Symptom - Seizure
- Symptom - Ataxia
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.
Yes
14. a) Was the animal hospitalized?
Yes
14. b) How long was the animal hospitalized?
1
Day(s) / Jour(s)
15. Outcome of the incident
Fully Recovered / Complètement rétabli
16. How was the animal exposed?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-28191511- The reporter, a pet owner, indicated her animals were exposed to an insecticidal product containing the active ingredients methoprene and permethrin. The pet owner indicated she had applied the product to her four year male boxer dog (Subform III, #3) earlier the day prior to her report. She later observed her five month five pound female kitten (Subform III, #1) licking the product from the dog. The kitten had at the point of the call demonstrated the signs tremor, fasciculation, seizure, and ataxia. It was advised the pet owner seek immediate veterinary care for the affected cat. The product was not meant to be taken internally and cats as a species are sensitive to ingredients seen in concentrated canine topical flea and tick preparations. On follow up four days later the pet owner indicated the affected kitten had been taken to the veterinarian, treated and released. It was, at the point of follow up, asymptomatic. The pet owner, then, indicated the dog to which the product had originally been applied had developed tremors and had spontaneously resolved. She also indicated her seventeen year female cat (Subform III, #2) had developed fasciculations and spontaneously resolved. She did not observe exposure in the latter animal mentioned in the report. 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
Unknown
4. Number of animals affected
1
5. Sex
Female
6. Age (provide a range if necessary )
17
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Oral
9. What was the length of exposure?
Unknown / Inconnu
10. Time between exposure and onset of symptoms
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Muscle tremors
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?
Contact treat.area/Contact surf. traitée
17. Provide any additional details about the incident
(eg. description of the frequency and severity of the symptoms
1-28191511- The reporter, a pet owner, indicated her animals were exposed to an insecticidal product containing the active ingredients methoprene and permethrin. The pet owner indicated she had applied the product to her four year male boxer dog (Subform III, #3) earlier the day prior to her report. She later observed her five month five pound female kitten (Subform III, #1) licking the product from the dog. The kitten had at the point of the call demonstrated the signs tremor, fasciculation, seizure, and ataxia. It was advised the pet owner seek immediate veterinary care for the affected cat. The product was not meant to be taken internally and cats as a species are sensitive to ingredients seen in concentrated canine topical flea and tick preparations. On follow up four days later the pet owner indicated the affected kitten had been taken to the veterinarian, treated and released. It was, at the point of follow up, asymptomatic. The pet owner, then, indicated the dog to which the product had originally been applied had developed tremors and had spontaneously resolved. She also indicated her seventeen year female cat (Subform III, #2) had developed fasciculations and spontaneously resolved. She did not observe exposure in the latter animal mentioned in the report. 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
Dog / Chien
3. Breed
Boxer
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
4
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
>24 hrs <=3 days / >24 h <=3 jours
11. List all symptoms
System
- Nervous and Muscular Systems
- Symptom - Fasciculations
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
1-28191511- The reporter, a pet owner, indicated her animals were exposed to an insecticidal product containing the active ingredients methoprene and permethrin. The pet owner indicated she had applied the product to her four year male boxer dog (Subform III, #3) earlier the day prior to her report. She later observed her five month five pound female kitten (Subform III, #1) licking the product from the dog. The kitten had at the point of the call demonstrated the signs tremor, fasciculation, seizure, and ataxia. It was advised the pet owner seek immediate veterinary care for the affected cat. The product was not meant to be taken internally and cats as a species are sensitive to ingredients seen in concentrated canine topical flea and tick preparations. On follow up four days later the pet owner indicated the affected kitten had been taken to the veterinarian, treated and released. It was, at the point of follow up, asymptomatic. The pet owner, then, indicated the dog to which the product had originally been applied had developed tremors and had spontaneously resolved. She also indicated her seventeen year female cat (Subform III, #2) had developed fasciculations and spontaneously resolved. She did not observe exposure in the latter animal mentioned in the report. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
