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Consumer Product Safety

Incident Report

Subform I: General Information

1. Report Type.

New incident report

Incident Report Number: 2012-0112

2. Registrant Information.

Registrant Reference Number: x

Registrant Name (Full Legal Name no abbreviations): x

Address: x

City: x

Prov / State: x

Country: x

Postal Code: X

3. Select the appropriate subform(s) for the incident.

Domestic Animal

4. Date registrant was first informed of the incident.

5. Location of incident.

Country: CANADA

Prov / State: ONTARIO

6. Date incident was first observed.

12-DEC-12

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. 26489      PMRA Submission No.       EPA Registration No.

Product Name: Hartz Ultraguard Plus Flea & Tick Drops for Dogs and Puppies

  • Active Ingredient(s)
    • (S)-METHOPRENE
    • PERMETHRIN

7. b) Type of formulation.

Application Information

8. Product was applied?

Yes

9. Application Rate.

1

Units: mL

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).

Gave 1 tube - 1ml of spot-on treatment directly on skin all the way down the cat's back. The owner doesn't believe that she licked any of the contents off. Cat was treated with dog flea medication spot-on treatment. Used 1ml tube which stayed on skin and absorbed into skin until washed off. 24 hours after applied.

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

Medical Professional

2. Type of animal affected

Cat / Chat

3. Breed

Domestic Shorthair

4. Number of animals affected

1

5. Sex

Female

6. Age (provide a range if necessary )

Unknown

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

  • Nervous and Muscular Systems
    • Symptom - Shaking
    • Specify - shaking violently
  • General
    • Symptom - Hiding
  • Nervous and Muscular Systems
    • Symptom - Seizure
  • General
    • Symptom - Abnormal behaviour
    • Specify - acting funny
  • Nervous and Muscular Systems
    • Symptom - Muscle tremors

12. How long did the symptoms last?

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

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?

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

Pesticide applied Dec.12th. Dec 13th AM the cat was hiding and acting 'funny'. By 5:45pm Dec.13th she was shaking violently. Owner bathed her with dish soap and brought her to the vet clinic immediately. Upon giving 2.55CC methocarbomol intravenous tremors. stopped immediately. Began tremoring again 1 hour later gave 1CC methocarbamol IV and began IV fluids Plasmalyte. Blood drawn and electrolytes evaluated calcium low (1.93 - range 2.05 - 2.7) (PK High (2030 - range 56 -529), all likely to prolonged seizures. Tremors started again Dec.15th AM - gave 3.5CC methocarbamol IV again and tremors stopped and didn't begin again. Got 1.5 L of fluids before being discharged.


To be determined by Registrant

18. Severity classification (if there is more than 1 possible classification

Not Applicable

19. Provide supplemental information here