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Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-4982
2. Registrant Information.
Registrant Reference Number: PROSAR Case#: 1-31843583
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.
19-OCT-125. Location of incident.
Country: UNITED STATES
Prov / State: PENNSYLVANIA
6. Date incident was first observed.
19-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. PMRA Submission No. EPA Registration No. 2596-140
Product Name: UltraGuard Plus Flea/Tick Spray for cats
- Active Ingredient(s)
- (S)-METHOPRENE
- Guarantee/concentration .07 %
- TETRACHLORVINPHOS
- Guarantee/concentration 1.08 %
- (S)-METHOPRENE
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
Mixed breed
4. Number of animals affected
3
5. Sex
Unknown
6. Age (provide a range if necessary )
0.08
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
- General
- Symptom - Death
12. How long did the symptoms last?
Persisted until death
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
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
1-31843583 - The reporter, a pet owner, indicated that his kittens were exposed to an insecticidal product containing the active ingredients methoprene and tetrachlorvinphos. The pet owner reported that he applied the product to his five mixed breed four week old kittens in the evening, one day prior to initial contact with the registrant. The reporter then left his home and returned the following afternoon and found 3 of the kittens (Subform III #1) had died and the other 2 kittens (Subform III #2) were cold to the touch. The reporter was advised that per the package label the product should not be applied to kittens less than 12 weeks of age. Bathing with a hand dish washing was recommended for the two kittens that were cold to the touch. On follow-up call, three days later, the pet owner indicated that the two kittens were bathed as recommended and within two hours they were much better and within a few hours they were acting normal. 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
Subform III: Domestic Animal Incident Report
1. Source of Report
Animal's Owner
2. Type of animal affected
Cat / Chat
3. Breed
Mixed breed
4. Number of animals affected
2
5. Sex
Male
6. Age (provide a range if necessary )
0.08
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
- General
- Symptom - Hypothermia
12. How long did the symptoms last?
>30 min <=2 hrs / >30 min <=2 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
1-31843583 - The reporter, a pet owner, indicated that his kittens were exposed to an insecticidal product containing the active ingredients methoprene and tetrachlorvinphos. The pet owner reported that he applied the product to his five mixed breed four week old kittens in the evening, one day prior to initial contact with the registrant. The reporter then left his home and returned the following afternoon and found 3 of the kittens (Subform III #1) had died and the other 2 kittens (Subform III #2) were cold to the touch. The reporter was advised that per the package label the product should not be applied to kittens less than 12 weeks of age. Bathing with a hand dish washing was recommended for the two kittens that were cold to the touch. On follow-up call, three days later, the pet owner indicated that the two kittens were bathed as recommended and within two hours they were much better and within a few hours they were acting normal. No further information is available.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Minor
