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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4970
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-31705115
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.
04-OCT-125. Location of incident.
Country: CANADA
Prov / State: ONTARIO
6. Date incident was first observed.
03-OCT-12Product 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. 25923 PMRA Submission No. EPA Registration No.
Product Name: UltraGuard Flea/Tick Drops for Dogs/Puppies Under 30 lbs
- Active Ingredient(s)
- 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
Shorthair
4. Number of animals affected
1
5. Sex
Male
6. Age (provide a range if necessary )
2
7. Weight (provide a range if necessary )
8
lbs
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
- Gastrointestinal System
- Symptom - Drooling
- Respiratory System
- Symptom - Panting
- Nervous and Muscular Systems
- Symptom - Agitation
- General
- Symptom - Adipsia
- Specify - Not drinking water
- Gastrointestinal System
- Symptom - Foaming at mouth
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
1-31705115 - The reporter, a pet owner, indicated that his cat was exposed to an insecticidal product containing the active ingredient permethrin. The pet owner reported that he applied the dog spot on product to his 2-year-old, 8 pound, male cat one day prior to initial contact with the registrant. The pet owner indicated that his friend gave him the dog spot-on product and told him he could apply it to his cat and to apply the product to his cats neck and armpits. After the reporter applied the product to the armpits of his cat the cat licked the area and started foaming at the mouth, the cat then started to pant heavily, the cat also became agitated. The foaming and panting resolved but the agitation persisted until the time of initial contact and the cat was also not drinking any water at the time of initial contact. The reporter indicated that he could not take his cat to the veterinary clinic due to limited resources. The reporter was advised that as indicated on package labeling the dog spot-on product should not be applied to cats and in general cat spot-on products should not be applied to the armpits where it can be ingested via grooming. Decontamination by bathing was recommended and the caller was encouraged to seek veterinary care. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Moderate
