Incident Report
Subform I: General Information
1. Report Type.
New incident report
Incident Report Number: 2012-5618
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.
13-OCT-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. 25655
PMRA Submission No.
EPA Registration No.
Product Name: HARTZ ULTRAGUARD FLEA AND TICK SPRAY FOR CATS
PMRA Registration No.
PMRA Submission No.
EPA Registration No.
Product Name: HARTZ FLEA AND TICK TOPICAL LIQUID
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).
Entire tube of topical liquid pu on back of neck on skin. Entire body then sprayed with flea and tick spray. Owner assumes that the spray was licked off during grooming. Cat treated with spot-on treatment and spray (aerosol). Cat then licked aerosol spray residue off of hair while grooming.
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 - calico
4. Number of animals affected
1
5. Sex
Unknown
6. Age (provide a range if necessary )
Unknown
7. Weight (provide a range if necessary )
Unknown
8. Route(s) of exposure
Skin
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
- Specify - around face and head
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?
12
Hour(s) / Heure(s)
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
Treated with products 2 to 3 days, before symptoms were noticed. As soon as symptoms were noticed patient was brought into clinic (oct.12,2012). Fine tremors noted around face and head primarily. Patient was administered IV PLA at 2x maintenance does and initially 4mls methocarbamol given slowly IV. Tremoring didn't completely stop, so 4mls methocarbamol given again slow IV. Second dose stopped tremors. Stayed for monitoring overnight. No more tremors noted, 700 mls fluids given over 24 hour period.
To be determined by Registrant
18. Severity classification (if there is more than 1 possible classification
Not Applicable
19. Provide supplemental information here